Bidding is open for the contracts that state leaders hope will ease health care coverage for more poor and middle-class Georgians.
“Georgia will lead the way in healthcare innovation,” Gov. Brian Kemp said in a statement, “focusing on lowering costs, improving access, protecting those with preexisting conditions, and increasing quality of care in every region of our state.”
Following a law passed this year, Kemp’s administration hopes to tailor federal health care coverage programs to Georgia’s needs by asking the federal government for “waivers.” The Georgia waiver programs might expand coverage through Medicaid to more poor people and attempt to lower prices for plans on the Affordable Care Act exchange.
They also might attempt to incorporate conservative facets such as work requirements.
Kemp’s office is setting a tight schedule. The consultant would provide options by Sept. 30, and Kemp’s office would make its choices and have them submitted to the federal government by the end of this year.
They’re moving quickly to hire the consultants, too. Consultants have until Friday to submit a letter of intent to apply to the state Department of Community Health and until May 20 to submit their proposals.
The procurementdocuments do not lay out perhaps the most important subject: the specific goals Kemp’s office wants the waivers to achieve and which are the biggest priorities. The main goal might be to cover more Georgians who can’t afford health care coverage now or to improve health outcomes whatever the cost. It might be to save the state money on health care or to stabilize struggling rural hospitals. Or it might be something else. The exact priorities are to be given to the consultants later.
That’s the kind of power the Legislature gave the governor to shape the program when it passed the legislation, Senate Bill 106.
The one policy decision the law made was to prevent full Medicaid expansion as designed under the Affordable Care Act to cover 300,000 to 600,000 of the state’s uninsured poor.
Six companies may apply: Accenture, Deloitte, Ernst & Young, KPMG, McKinsey, and Public Consulting Group. They are on the state’s list of approved service providers for all agencies drawn up last year, Kemp spokeswoman Candice Broce said, and the six are the only ones with experience drawing up waiver proposals.
Broce said that under rules for the approved service providers the state could have simply chosen the consultant it wanted, but it was going this route in the interests of transparency and choosing the best vendor.
A leader at another consultant, Navigant, said it was disappointed not to be allowed to apply. “I’d have welcomed the opportunity to be on this list if I’d known that it existed,” said David Mosley, a managing director for Navigant in Georgia. “We’ve done waiver work across the country,” he said, including helping shepherd successful waivers in a half-dozen states including Arizona and Kentucky. The company also recently acquired the firm that serves as the DCH’s actuary. “I have no doubt that Navigant would have qualified to be on the list,” Mosley said.
Broce said that going outside the list would have violated state rules, and she added that companies not on the list still may work on the project as subcontractors.
The state will pay consultants up to $2.6 million to develop the proposals it will pick from. The original budget was $2 million, but the state added $600,000 during the legislative session. The focus will be on identifying the companies best suited to do the work. That includes not just developing proposals that will work, but developing proposals that can pass muster under federal law with the Trump administration.
The law that set up the waiver process gave the governor broad powers to simply come to a final decision, and the work required between now and then is substantial. Before state officials make their choice, they will want to know exactly what kind of needs exist and will be aided by a given proposal.
For example, one option Kemp has mentioned is a pilot program Grady Memorial Hospital has tested to get people to stop overusing its emergency room. Grady has saved money by seeking out those patients and persuading them to accept other types of more appropriate, ongoing wellness care. That costs money, too, though. So if Georgia were to expand such a program in other parts of the state, it would want to know whether the conditions on the ground would also lead to savings in the expansion areas.
The consultants will need to do a detailed analysis of county-level demographic data on whether people have insurance and if so what kind, and the personal income, employment and health care landscape of the state.
The documents hint at a concern Kemp has voiced about whether there are enough doctors and health care providers that accept Medicaid if a new wave of insured patients comes to be. The landscape of service providers is one of the issues the documents ask the consultant to investigate.
The documents also confirm what Kemp has said in remarks, that the goal of the second waiver is to look into creating a high-risk pool for the Affordable Care Act exchange health plans. That generally means government subsidies for the private companies providing the insurance, in order that patients with the highest risks are less likely to cause premium prices to spike overall.
The consultants will submit up to three proposals for each waiver, the one about Medicaid and the one about the Affordable Care Act exchange. Kemp’s office will then choose.
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