Georgia plans transition to managed care for Medicaid's Social Security population

Georgia's Medicaid System Set for Major Overhaul with New Care Management Contracts

In a significant move to enhance Medicaid services, the Georgia State Legislature discussed the ongoing procurement process for Care Management Organizations (CMOs) during a recent meeting on February 5, 2025. The current procurement is under appeal, which may delay the implementation of new contracts for up to two years. This transition aims to shift a population of Social Security SSI qualifying individuals from a fee-for-service model to managed care, marking a pivotal change in how Medicaid services are delivered in the state.

The initial phase of this transition will focus on individuals who currently receive no formal services, allowing them to benefit from managed care oversight. This change is expected to improve access to preventive healthcare, ensuring that individuals receive timely medical attention and reducing the likelihood of more severe health issues that could lead to nursing home care.

Additionally, the meeting highlighted the introduction of the PACE (Program of All-Inclusive Care for the Elderly) initiative, which aims to provide alternatives for elderly individuals to remain in their homes while receiving necessary healthcare services. The PACE program, which has been successfully implemented in over 30 states, will offer community-based care through centrally located centers, providing a range of health services tailored to the needs of seniors.

The Georgia Department of Community Health is working diligently to finalize the Request for Proposals (RFP) for the PACE program, with hopes of launching it before the end of the fiscal year. This initiative is seen as a crucial step in keeping elderly residents in their communities and out of nursing homes, aligning with the state's broader goals of enhancing care management and community support.

As the state navigates the complexities of these changes, officials are optimistic about the potential benefits for Georgia's Medicaid recipients. The next few years will be critical as the state evaluates the effectiveness of these new managed care strategies and prepares for further expansions in service delivery.