By Rebecca Grapevine
Georgia is on observe to recoup $ 500 million from state Medicaid insurers for overpayments in 2020 and 2021, based on an insurance coverage trade official representing the businesses.
The $ 500 million cost will come from two separate Medicaid recoveries, mentioned Jesse Weathington, govt director of the Georgia Affiliation for High quality Healthcare. As a result of federal function in funding Medicaid, it’s seemingly that a lot of the cash returned will go to the US authorities.
Insurers had been advised the discount was on account of many Medicaid sufferers skipping medical care through the COVID-19 pandemic, together with different changes, Weathington mentioned.
“It was superb by way of time and amount,” Weathington mentioned. He added that the three Medicaid insurers didn’t obtain detailed breakdowns of how the state actuary arrived on the figures.
Georgia Medicaid insurers (Peach State, Amerigroup, and CareSource) obtain a month-to-month payment per member to serve Medicaid members.
These insurers continued to obtain these Medicaid funds whereas there was a lower in affected person visits.
Refunds are often called recoveries – when a corporation believes it has overpaid for companies, it takes steps to get the cash again.
“The recoveries imply that folks didn’t obtain medical care,” mentioned Laura Colbert, govt director of Georgians for a Wholesome Future, a client advocacy group.
“Primarily, folks might have misplaced the companies they wanted previously 12 months. That isn’t the fault of the [Medicaid insurers] as a result of we noticed that this occurred by accessing the board no matter the kind of insurance coverage. The state nonetheless has the precise to handle that based mostly on its contract, ”Colbert added.
The Division of Group Well being, which administers Medicaid within the state, didn’t reply to GHN’s requests for remark.
The retrospective payment adjustment of $ 202 million for 2020 is now awaiting approval from the federal Facilities for Medicare and Medicaid Companies, Weathington mentioned. One other $ 300 million mid-year adjustment for 2021 is presently beneath negotiation, he added.
Medicaid, funded collectively by the federal authorities and particular person state governments, covers disabled and low-income residents. Georgia pays Medicaid insurers greater than $ four billion every year to offer look after low-income youngsters and different susceptible populations. The state covers a few third of these prices, and the feds fund the remaining.
It’s unclear how a lot of the recovered funds will go to the feds and the way a lot to Georgia’s coffers. But when divided by the traditional funding components, the state would earn greater than $ 165 million.
The projected $ 500 million restoration comes after Medicaid insurers posted large income throughout 2020, based on the Georgetown College Heart for Kids and Households.
Earlier than the pandemic, many states had measures in place to restrict the income state Medicaid insurers might make from their contracts and be sure that taxpayer cash went to affected person care. Georgia was not a kind of states, based on the Heart for Funds and Coverage Priorities.
Different states have taken or strengthened measures to get better taxpayer that went to Medicaid applications whereas sufferers stayed house through the pandemic. There are completely different ways in which states can do that.
For instance, Virginia ordered state Medicaid insurers to extend funds to medical suppliers.
Two of Georgia’s insurers, Peach State and Amerigroup, are owned by publicly traded for-profit companies, Centene and Anthem, respectively. Final 12 months, Centene acquired WellCare, one other Medicaid insurer, and closed its WellCare Medicaid operations in Could.
A 3rd Medicaid insurer, CareSource, is a non-profit firm based mostly in Indiana.