Department of Community Health outlines Medicaid managed-care shift, PACE rollout and new state nurse-aide program

The Department of Community Health told the committee it is pursuing several initiatives aimed at expanding managed-care coverage, creating community-based alternatives to nursing homes and easing staffing shortages in assisted living and personal care homes.

Joe Hood, chief operating officer for the Department of Community Health, said an open procurement for care management organizations (CMOs) for Medicaid is ongoing and "under appeal," noting that an initial intent to award has been followed by an appeal process. "It may be a year or more for that to reach resolution," Hood said, adding that changes tied to new contracts will not occur until appeals and operational readiness are resolved.

Hood said the first population slated to shift from fee-for-service into managed care are people who qualify for Medicaid through Social Security (SSI). He said the department estimates that the appeal process and readiness could mean the optional shift of waiver and nursing-home populations would not occur for about three to four years. "Let's just say it took 2 years then it takes another 2 years of contract before we would be there ... I would say between 3 and 4 years," Hood said.

The department also described plans to begin contracting for PACE (Program of All-Inclusive Care for the Elderly), a capitated Medicare program that provides a community-based center offering medical and supportive services. Hood said DCH has worked with actuaries and with Myers and Stauffer to develop an RFP and rate-setting approach; he said PACE already operates in more than 30 states and that the department hopes to release an initial RFP and select providers before the end of the fiscal year. "We expect...we'll have the first of those out and in place and then that would be another alternative to nursing home care," Hood said.

Hood described initial plans for an early PACE rollout to include metropolitan Atlanta (multiple locations), Savannah, Columbus and Macon, and said the department anticipates six to seven centers in the first procurement round. He said centers typically require a sizable investment (roughly a 10,000-square-foot facility) and that operators generally need on the order of 250–300 participants to approach break-even; enrollment often grows over two years once centers open.

Hood also outlined proposed administrative changes to align licensure of behavioral-health and community-living programs with the Department of Behavioral Health and Developmental Disabilities (DBHDD). He said the transfer would shift surveyors and compliance specialists and the related budget to DBHDD to reduce duplicative oversight and to keep policy and licensure aligned with federal SAMHSA guidance.

On workforce and training, Hood described two '23 bills—House Bill 497 and Senate Bill 449—that change nurse aide reciprocity and provisional licensing for military medical personnel. He said the department is developing a state-level nurse aide and a state medication-aide program to serve assisted living and personal care homes (not nursing homes, which remain subject to federal CNA requirements). Hood said the department contracted with the University of Georgia to develop modular training curricula, training reciprocity and portable dementia training; the department is proposing that staff who pass a dementia-care competency exam would require four hours of facility-specific dementia training instead of the current 16 hours of specialized training. Hood said the new state programs would expand staffing options for state-licensed assisted living and personal care homes.

Committee members asked questions about timelines, the likely scope of population shifts into managed care, the PACE rollout and whether existing military medical training would be recognized under provisional reciprocity. Hood and staff said many details remain to be finalized in rules and RFPs; where timelines or numbers were unclear, officials described them as estimates. "I really don't have a good feel for that to be honest...I just don't know number wise," Hood said about expected numbers of military medical personnel who would enter the state training pipeline.

Witnesses and lawmakers asked that the department share more transparent outcome measures for managed-care transitions; Hood said the department uses actuarial PMPM (per-member-per-month) rate development and utilization measures to evaluate success but that rate development and some operational details may be proprietary to CMOs.