Taylor is out now clubbing Sonny like a baby seal over the Katie Beckett Program.
I received an email from Eric Johnson that attempts to shed light on the cuts. The short answer, according to the Senate President Pro Tempore, is that the state had to do it to comply with federal mandates.
His response is below the fold.
In November 2004, at the direction of the federal government, the Georgia Department of Community Health (DCH) began correctly complying with the federal regulations governing the Medicaid program known in Georgia as the Katie Beckett program. As a result, Georgians have seen some changes to the program.
After a review of existing participants in light of the existing federal regulations, approximately 2,000 children currently in the program were determined to be improperly enrolled. Acknowledging the fact that these children could not be kept in the Medicaid program without violating federal regulations, this session the General Assembly directed the Georgia Department of Human Resources (DHR) to create a foundation that could raise money to support this group of children, as well as any others that the foundation might deem eligible. The General Assembly appropriated $7.6 million in the FY2006 Amended General Budget to help these families. Of these funds, $5.2 million is scheduled to be used for families who were deemed ineligible under federal guidelines. The remaining $2.4 million is to be distributed by the foundation to assist other families with disabled children. The General Assembly did not approve any spending reductions this year and by creating a foundation, the General Assembly believes these families can be provided assistance for years to come. The foundation is scheduled to be operational by April 2007.
In addition to changes in the eligibility for the Katie Beckett Waiver program, the prior authorization process for therapy services that went into effect on September 1, 2006 applies to all children, not just Katie Beckett participants. While there are about 4,300 children currently enrolled in the Katie Beckett aid category, over 26,000 children have historically been getting therapy services through Medicaid each year. The prior authorization process is a review to determine whether the prescribed therapies are medically necessary in amount, duration, and scope. Until now, no one has reviewed whether those services are, in fact, medically necessary. It has been determined that it is more desirable to review them prospectively than to come back after the fact and recoup money for services that turned out to be unnecessary.
According to DCH, it is most important for families to know that medically necessary services can be approved. The fact that documentation is required to justify those services is not new in the health insurance industry. In fact, most health plans require prospective medical review after an evaluation visit. Medicaid will allow up to 8 units of therapy services each month without medical review. That can equate to as many as 8 visits per month, depending upon the discipline.
The actual review process for eligibility for the Katie Beckett program already includes Bachelor and Master level pediatric nurses; co-medical directors including a pediatrician and pediatric neurologist. In addition, several other pediatric specialists are available for consultation. The prior authorization process includes those noted above as well as pediatric therapy specialists who will be reviewing the requests for services above 8 units per month.
I hope this information is helpful to you in understanding the changes in Georgia’s Medicaid program for all Georgia’s children.