Lawmakers question state Medicaid access | Local News | times-georgian.com
Skip to main content
You have permission to edit this article.
Edit<br>Close
Log out<br>Log in<br>Register<br>Activate<br>Subscribe<br>Account Management
Home
About Us
Contact Us
Advertise
Promote Your Event
Terms of Use
Privacy Policy
Local Weather
AI Policy
News
Local News
Business
Farm and Garden
Faith and Values
Leisure
Southern Spice
Sports
Friday Night Lights
Other Pubs
Gateway-Beacon
Villa Rican
Your School
Bowdon Schools
Bremen Schools
Carrollton Schools
Central Schools
Haralson County Schools
Heard County Schools
Holy Ground Baptist Academy
Mt. Zion Schools
Oak Mountain Academy
Temple Schools
University of West Georgia
Villa Rica Schools
West Georgia Technical College
Opinion
Columnists
Editorials
Letters to the editor
Obituaries
e-Edition
Times-Georgian
Gateway-Beacon
Subscribe Today!
Classifieds
Carroll County Classifieds
Haralson County Classifieds
Georgia Press Association
To Submit
Anniversary Announcement
Birth Announcement
Engagement Announcement
Wedding Announcement
How to submit an obit
Special Sections
Videos
Newspapers.com Archives
Share This
SMS
Site search
Search
SMS
SMS
Copy article link
Save
SMS
Copy article link
Save
Georgia Medicaid recipients are likely to find outdated directories for doctors, therapists and other medical providers as the state finds thousands of them have failed to revalidate their eligibility to receive payment for services.<br>Nearly 8,000 faced suspension starting this month, according to a state report in June that noted more than 60,000 others could follow in coming months.<br>The revalidation deadlines come as some providers are threatening to voluntarily exit the networks of CareSource and Peach State Health Plan, two of Georgia's three Medicaid managed care organizations for pediatric services.
The organizations have contracts with the state that give them a fixed amount of money for each Medicaid recipient who enrolls with them. In turn, they must ensure their enrollees receive the medical care required under federal law.<br>Critics say CareSource and Peach State may be unable to follow through on their end of the bargain<br>The companies shocked pediatric therapy providers last spring by alerting them of 20% rate cuts. They said they would be cutting reimbursements to 80% of the Medicaid fee schedule. Therapists who reject CareSource's rate cut were told they would be ejected from the organization's network. That could eliminate access to care for many Georgia families, especially in rural areas that already have a dearth of providers.<br>The cost-cutting moves led to a hearing last week by a committee of the Georgia House of Representatives.<br>The Department of Community Health oversees the managed care organizations' contracts. Lynnette Rhodes, the agency's chief health policy officer, did not say at that hearing how many providers had quit CareSource's network as a result of the rate cuts, but she said the agency was getting reports from the organization about it. She also said the revalidation process would eventually clarify how many remain.<br>"It will give real clarity in terms of which providers are actually operating and where," she said. "It's been quite some time since we have completed that process in Georgia."<br>Jesse Weathington, an industry lobbyist, fielded some questions from angry lawmakers. He said the rate cuts were probably a reaction to rapidly rising demand for pediatric therapy, which he said increased by 62% from 2018 to 2025, with demand for autism care rising more like 300%.<br>Weathington speculated that the growth was driven by increasing awareness and diagnosis.<br>He said the organizations can renegotiate payment terms with the state each year.<br>"But we still have a commitment," he said. "We have to make sure that a member gets seen." Republicans and Democrats on the panel were not happy with the situation. They started getting calls about the rate cuts from constituents soon after their regular legislative session ended in early April.
"The excuse is 'well, we didn't anticipate this growth,'" said Rep. Jesse Petrea, R-Savannah, a member of the House Health Committee. "Well, that's your job to anticipate the demand and the need for services."<br>The committee met on June 23, after lawmakers returned to the Capitol for a special session.<br>Rhodes told the committee that state Medicaid contractors had authority to unilaterally cut payment rates and terminate providers and that providers knew that when they signed up to be in their networks. She said it was standard practice across the country.<br>She said it was the duty of managed care organizations to pay for necessary care, even if it meant sending patients out of their networks or paying higher rates on a case-by-case...