July 18, 2013

State plans managed care for children on Medicaid


Associated Press

ATLANTA — Health officials say they’re looking to hire a for-profit company to oversee the care of some of the state’s most vulnerable children.  

The Atlanta Journal-Constitution reported Wednesday (http://bit.ly/16K8mMo ) that youth advocates and pediatricians say so-called “managed care” of the state’s 27,000 children in foster care, adoption assistance or the juvenile justice system could help better coordinate their health care.

The move is similar to one the state plans to make next year when it transitions roughly 430,000 elderly, blind and disabled Medicaid recipients into a voluntary form of managed care.

“It was apparent that the medical continuum of care was severely lacking,” Clyde Reese, commissioner of the state Department of Community Health, told the Atlanta Journal-Constitution. The department oversees the state’s Medicaid program. “Their physicians were changing. Their records were lagging behind them.”

Foster children and others would have one primary care physician and electronic health records that doctors can use regardless of where the child lives under the managed care system, officials say. Caring for children in foster care, or children who move between multiple group homes, typically means a chance in doctors — which can lead to incomplete medical records and doctors being unaware of potential complications that could arise.

Department of Community Health officials say transitioning to a managed care system next year could save the Medicaid program $27.5 million over five years by emphasizing preventative care and trying to keep children healthier.

The state plans to hire one of three care management organizations that have collectively overseen the care of about 1.2 million children and pregnant women who are Medicaid recipients. The three companies, Peach State, WellCare and Amerigroup, earned about $2.7 billion from the state in fiscal year 2010.

Some have expressed concern that whichever company is chosen may act in the interest of profits and limit service for foster children because their care is more complicated and expensive than the rest of the general Medicaid population.

Jerry Dubberly leads the Department of Community Health’s medical assistance plans and says a quarterly oversight committee made up of officials from several agencies will regularly discuss what’s being accomplished under the managed care model.

“We’re going to do this right versus doing it fast,” Dubberly told the Atlanta Journal-Constitution.

The newspaper reports that moving foster children to a managed care model in Texas led to a 30 percent drop in the use of psychotropic medication for 60 days or more. In Maryland, 20 percent more foster children received a health risk screening after transitioning to managed care.

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Information from: The Atlanta Journal-Constitution, http://www.ajc.com