A Georgia Medicaid System Update

By Samantha Haun, Market Intelligence Analyst; Athena Mandros Director, Market Intelligence; Cody Brumgard RFP Database Manager, OPEN MINDS

The majority of the population in the state of Georgia is enrolled in a commercial health insurance plan (58%)—this is above the national average of 56%. About 12% of the population is enrolled in Medicaid, which is below the national average of 17% (to learn more about the state’s health care system, Elite OPEN MINDS Circle members can review Georgia Health Care System Landscape: An OPEN MINDS State Profile).

Medicaid Managed Care Overview

Georgia’s Medicaid managed care program is called Georgia Families. Under Georgia Families, four health plans, called management organizations (CMOs), deliver physical health and behavioral health benefits for children, parents and caretaker relatives. The plans are available statewide and enrollees have a choice of any plan (for more about the state’s Medicaid system, Elite OPEN MINDS Circle members can review Georgia Medicaid System: An OPEN MINDS State Profile).

Contracts for the four health plans are available for download:

Georgia also operates a voluntary managed care program called Georgia Families 360 for children in foster care, receiving adoption assistance, or involved in the juvenile justice system. Amerigroup is the sole health plan serving this population. The contract is available for download:

Georgia withholds 5% of the health plan capitation rate, which is returned to the health plan based on performance of selected quality measures. The health plans are required to share 50% of the incentive payments with provider organizations.

Behavioral Health Overview

The Department of Community Health delegates the day-to-day management of Medicaid community behavioral health rehabilitative services to the Department of Behavioral Health and Developmental Disabilities (DBHDD). Under a contract with DBHDD, the Georgia Collaborative administrative services organization (ASO), operated by Beacon Health Options, serves as the community behavioral health care ASO for the Medicaid FFS population. Beacon Health Options subcontracts with the following organizations:

  • Statewide Georgia Crisis and Access Line—provided by Behavioral Health Link
  • External Review Organization for Behavioral Health—Qlarant (formerly Delmarva Foundation)

Georgia Collaborative ASO’s functions include prior authorizations, provider credentialing, claims submission, data collection and reporting, health analytics, audits, and the 24/7 behavioral health crisis and access line.

OPEN MINDS estimates that as of January 2018, more than 99% of the SMI population was enrolled in FFS (for more information on the state’s behavioral health system, Elite OPEN MINDS Circle members can review Georgia Behavioral Health System State Profile Report).

Dual Eligible Overview

Georgia’s dual eligibles are required to enroll in Medicaid FFS to received Medicaid benefits. The state does not have any initiatives related to dual eligibles (for more information on the state’s behavioral health system, Elite OPEN MINDS Circle members can review Georgia Medicaid/Medicare Dual Eligible System: An OPEN MINDS State Profile).

Additional Resources
OPEN MINDS has also reported on these recent contract awards in the state of Georgia:

Over the past year, OPEN MINDS has reported on the following developments in the state of Georgia:

A monthly OPEN MINDS Georgia market intelligence update is available to all health and human service executives. To sign up, OPEN MINDS Circle members should set their email preferences under the My Account settings.  Not a member of the OPEN MINDS Circle?  Sign-up for a free membership today!