Georgia Medicaid:
At the Breaking Point

Georgia’s Medicaid program is in crisis. Plagued through the years by a series of payment cuts to healthcare providers, the system has reached its breaking point. Georgia Medicaid currently pays roughly 84 cents for every dollar hospitals spend in treating Medicaid patients and many Georgia physicians and dentists, unable to absorb the huge losses in caring for Medicaid recipients, have no choice but to severely limit how many Medicaid recipients they can treat. The end result? Major access problems for Medicaid recipients, weakened hospitals and physician practices, and huge cost shifts to the Georgia business community. Each problem translates to threatened healthcare access for all Georgians. The ACCESS Healthcare Coalition — a partnership of Georgia hospitals, physicians, dentists, businesses and consumers — stands together asking the state to preserve access for the state’s more than 1.7 million Medicaid recipients by providing fair and reasonable payments to Georgia’s healthcare providers.

A New Georgia Medicaid:
Strengthening Access, Protecting Caregivers

The ACCESS Healthcare Coalition is asking the state to increase its financial commitment to the Georgia Medicaid program. That includes:

• Passing the recent Department of Community Health proposal in the 2008 Georgia General Assembly to raise Medicaid payments to providers by more than $40 million. While this proposal would not alleviate the significant funding shortfalls that plague the program, it represents an important first step in improving the system.
  
• Maximizing federal matching dollars for Medicaid leaving no money on the table. For every dollar the state spends on its Medicaid program, the federal government contributes two dollars. Presently, as a result of decreased state contributions to Medicaid, millions of federal matching dollars are going to other states.
  
• Eliminating the need for Georgia healthcare providers to recoup Medicaid underpayments by cost-shifting to the Georgia business community. The end result of repeated cost-shifting is continued annual double-digit insurance premium increases for Georgia businesses forcing many companies, especially those with fewer than 50 employees, to drop health coverage altogether.
  
• Paying all Georgia healthcare providers — hospitals, physicians and dentists — reasonable costs by 2011 for providing care for Medicaid patients.

• When the state pays healthcare providers far less than it actually costs to treat a Medicaid recipient as it currently does, every Georgia business and taxpayer makes up the difference through higher health insurance premiums and out-of-pocket costs. These shortfalls often result in increased pressure on local governments to help local healthcare providers absorb these huge losses.
  
• Presently, the state pays Georgia hospitals roughly 84 cents for every dollar hospitals spend treating Medicaid recipients. To pay hospitals 100 percent of costs, the state would need to increase Medicaid payments by $168 million. The federal match of $277 million would eliminate the cost shortfall for hospitals.
  
• Georgia physicians are currently paid 30% less for treating Medicaid patients compared to what the federal government pays for the same care for Medicare patients. The current $24.2 million DCH proposal to increase Medicaid physician funding falls short of the $27.3 million needed to bring Medicaid payments on par with Medicare’s 2007 fee schedule.
  
• Nationwide, Georgia ranks 39th in Medicaid spending per enrollee spending nearly $800 per recipient less than the national average and more than $400 behind the average in the southeastern region.
  
• Only 13 states in the country spend less per enrollee than Georgia in taking care of Medicaid-enrolled children.
  
• Medicaid now pays for 60% of all babies born in Georgia. If the Medicaid payment system continues to underpay for services, an increasing number of Georgia physicians will have no choice but to quit treating Medicaid recipients threatening the health of mothers and babies.
  
• One of the many byproducts of Medicaid underfunding is a sicker, unhealthier population. Current health indicators in Georgia prove that. With #1 being best and #50 being worst, Georgia ranks:
  
  • 37th in the rate of obesity
    
  • 32nd in the rate of babies born prematurely
    
  • 42nd in the infant mortality rate
    
• Medicaid underfunding threatens the economic viability of hospitals and physicians — which is directly related to the economic vitality of communities.
  
• Medicaid underfunding is one of the primary reasons why there are only 15 designated trauma centers in Georgia. Lack of funding has threatened hospitals’ ability to continue to provide the service and has discouraged others from seeking a trauma designation.