Department of Community Health outlines Medicaid managed‑care shifts, PACE rollout and new state nurse‑aide proposal

The Department of Community Health told the House Human Relations & Aging Committee that an ongoing procurement to reassign certain Medicaid beneficiaries to care management organizations (CMOs) is under appeal and could take up to two years to resolve, delaying any operational changes until appeals and contract awards are final.

Committee members heard that the first population targeted for movement into CMOs are Social Security Administration SSI‑eligible individuals currently on fee‑for‑service Medicaid. Department officials said the initial shift is limited to that population. A later option in the request for proposals would allow the state, after two years of a new CMO contract, to consider moving elderly nursing‑home and waiver populations into managed care; officials said that option would require operational readiness and might not be exercised for several years.

Department officials also described a planned PACE (Program of All‑Inclusive Care for the Elderly) rollout. The department said it has completed actuarial work and an RFP with assistance from an experienced vendor; officials expect to seek proposals for multiple PACE centers and anticipate awarding geographic areas (zip codes) where respondents would propose center sites. The department’s initial rollout is expected to target metropolitan Atlanta (multiple sites), Savannah, Columbus and Macon and to result in roughly six or seven centers if responses and CMS approvals proceed as planned. Department staff said PACE is a Medicare program with a capitated payment model and that a center typically needs several hundred enrollees to break even; enrollment often grows over two years after opening.

On licensure and program alignment, the department said it will pursue legislation to transfer behavioral‑health and community‑living licensure responsibilities that currently sit in DCH to the Department of Behavioral Health and Developmental Disabilities (DBHDD). The stated rationale is to align federal policy oversight (for example, SAMHSA policy areas) and reduce duplicative auditing and survey activity by placing policy and licensure in the same department.

On workforce and training, DCH officials briefed members on two 2023 bills: House Bill 497 (reciprocity for nurse aide applicants who pass the competency exam) and Senate Bill 449 (provisional reciprocity for military medical personnel). Because federal rules govern nursing homes, the department said it cannot change federal CNA requirements for nursing homes but is developing a new state nurse‑aide and state medication‑aid program for assisted living and personal care homes. Under the proposal, the new state nurse‑aide and state medication‑aid would be eligible for state‑licensed assisted living and personal care settings but would not replace federally required CNAs for Medicare/Medicaid nursing homes. Officials said the state program would allow military medical personnel with matching skills to receive provisional reciprocity under the state program.

The department also proposes a dementia competency pathway: staff who pass a dementia care competency exam could be required only to complete four hours of facility‑specific dementia training instead of the current 16‑hour specialized training; those who do not pass the competency exam would still be required to complete the longer training. The department said it has worked with the University of Georgia and advocates on modular curricula and competency testing but that administrative rules and final processes are not yet complete.

Officials noted the scale of the state‑licensed assisted‑living and personal care community: the department presented a map showing more than 1,600 state‑licensed facilities that could be affected by a new state nurse‑aide program, compared with a substantially smaller number of federally certified nursing homes. Committee members asked for timelines and details on operational readiness; department officials said timelines depend on resolution of the CMO procurement appeals and completion of administrative rules and contracting steps.

Committee members asked questions about how the Social Security‑qualifying population would be transitioned, whether the new CMO population would receive primary‑care outreach and preventive care, and when waivers or nursing‑home populations might be considered for a future managed‑care move. Department officials estimated, with uncertainty, that the full process of appeals, contract implementation and potential later moves could take three to four years from the current point if all steps were exercised.

The department provided contact information for legislative outreach and offered to follow up with more detailed timelines and rule language when available. The presentation materials will be posted with supplemental documents, officials said.