Insurance industry chief: Not opposed to Medicaid spending requirement

By Andy Miller and Rebecca Grapevine

The CEO of an insurance industry trade group said Wednesday that insurer members do not object to medical expense requirements for Medicaid managed care plans contained in a draft Mental Health Parity Act.

Among its provisions, the high-profile House Bill 1013 would establish a minimum level of medical expenses of at least 85% of the dollars that Medicaid insurers receive from the program.

Jesse Weathington, president and CEO of the Georgia Association of Health Plans, told GHN that insurers have reached 85% over the past two years through a financial reconciliation process with the government. He spoke to a reporter after testifying at a House committee hearing on the mental health bill.

News from GHN and Kaiser Health reported in september that Georgia is one of the few states that does not require a minimum level of medical expenses and quality improvements for Medicaid insurers.

Each year, Georgia pays three insurance companies — CareSource, Peach State Health Plan, and Amerigroup — a total of more than $4 billion to administer the federal state health insurance program for low-income residents. and people with disabilities.


Weathington told GHN that most states with Medicaid managed care have “medical loss ratios” of 85% or higher. He said his group had suggested additional health activities that could be included in the threshold amount.

State Rep. Todd Jones (R-Cumming), co-sponsor of the mental health bill, said Georgia is last among southeastern states in the casualty rate, with an average of 83%. (An outlier is Alabama, which has no managed care plans for Medicaid recipients.)

Georgia, he said, is “last in the SEC,” a reference to the Southeast Collegiate Athletic Conference.

Asked by a reporter if he was surprised by insurers’ lack of opposition to the financial requirement, Jones said, “It’s a pleasant surprise.

Jones and his wife, Tracey, spoke to the House Health and Human Services Committee about their eldest son’s years-long struggles with serious mental illness and addiction.

Tracey Jones, at times emotional, told lawmakers that over the past eight years, their son Justin has had multiple inpatient and outpatient stays, as well as rehab, incarceration and probation, and homelessness. shelter.

“I’m angry that it took Justin over eight years to get the necessary and proper mental health care for his diagnosis,” she said. Insurers limited her residential stays, she said. “We pay the premiums, they should provide the care.”

Tracy Jones said she hopes that as a result of the Mental Health Bill, “families and loved ones with mental illness will never have to endure and walk the difficult and frustrating path that our son and our family had to endure”.

How the system would change

Legislation requires insurers of Medicaid, the State Health Benefit Plan, and other health plans to cover mental health and addictions issues the same as physical health conditions. It aims to enforce the federal Mental Health Parity Act passed in 2008.

The provisions of the bill include:

** Establish a consumer complaint process about parity violations and oversight by the state insurance commissioner

** Define “medical necessity” in relation to behavioral health

** Provide cancellable student loans to students training in mental health and addictions fields

**Develop “co-response” teams with police and mental health professionals across the state

** Create diversion programs to help people with mental health issues stay out of the criminal justice system


Rep. Mary Margaret Oliver (D-Decatur), co-sponsor, said the bill will receive sufficient funding to pay for the changes. She said a state settlement with opioid manufacturers would net the state $600 million for drug treatment.

With the shortage of providers in these areas, Oliver said the bill would create a behavioral health workforce database. “We don’t know who provides services where,” she said.

The hope of reform

Patients, consumer advocacy and other groups have come out in support of the bill.

Johns Creek’s Mike Dvorscak testified about his development of major depression and psychosis in 2017. ‘This is a very important and long overdue bill,’ he told members of the House committee.

Lou Dekmar, LaGrange’s police chief, said, “We have criminalized mental illness. A member of a state behavioral health reform commission, Dekmar added, “The largest mental health facility in each county is the county jail.

Gabriel Carter of the Association of County Commissioners of Georgia added, “County jails have unfortunately become default housing for people in mental health crisis.”

And David Schaefer, director of the Georgia Budget and Policy Institute, described the tragedy of his brother’s suicide. He compared that 2015 death to the help another suicidal man received. “It’s about someone who hears you clearly and quickly connects you with the services you need.”

Jones cited the state’s low ranking on access to mental health services. He said he wanted Georgia to be one of the top 5 states in this category.

“It’s not a perfect bill, but it’s a good foundation to move us in the right direction,” said Abdul Henderson, executive director of Mental Health America of Georgia.

Confidentiality, rights issues

But some speakers criticized what House Bill 1013 does – and doesn’t.

Advocacy groups have called for the bill to require mental health services to be accessible to non-English speakers.

“We are asking for language access, language support and culturally, ethnically and linguistically sensitive services,” said Astrid Ross of the Georgia Mental Health Support Network.

Provisions establishing national registries of data on people (including pediatric patients) who frequently use crisis services and other mental health resources have raised concerns about the privacy of health information.

The new bill would change a standard for engaging Georgians in involuntary treatment.

Under current state law, people with mental illness must demonstrate an “imminent” risk of harm to themselves or others before they can be committed to treatment.

The bill would change that standard, requiring only a “reasonable expectation” that a crisis or material deterioration “will occur in the near future.”

“I think this definition [reasonable expectation] will be more helpful to law enforcement,” Oliver said.

“We can’t ask our police to decide whether or not ‘imminent’ means walking up and down the bridge saying I’m going to jump or whether it’s a step on the railing. That’s what we’re asking our police to do there,” Oliver said.


But some mental health consumer advocates have opposed the provision.

“Under this standard, virtually anyone with a severe psychiatric disability could be involuntarily committed,” said Devon Orland, legal and advocacy director for the Georgia Advocacy Office.

“There does not appear to be a right to counsel, appeal or other protective review of the determination that an individual meets the standard of outpatient commitment,” Orland said.

Rep. Shelly Hutchinson, a Democrat from Snellville and a licensed clinical social worker, praised the legislation’s goals but also said its new requirements could help overwhelm an already strained government bureaucracy. “The system is not fully functional right now,” she said.