Georgia seeks input on new Medicaid contracts

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Georgia is looking at five priority areas when deciding on the new contract holders: health-care quality, equity, access and outcomes, value, and coverage and services.

Credit: Vidal Balielo/Pexels stock photo

Georgia is seeking input from individuals and organizations about what it should look for when it awards new multibillion-dollar contracts for the state’s Medicaid program. 

The Georgia Department of Community Health’s request for information is the first step in the process of awarding the new health care contracts, which are expected to take effect by July 1, 2024. 

Georgia’s Medicaid program contracts with private health insurers to provide health care services to around 1.7 million Georgians, most of them low-income children and pregnant women. The contracts are worth more than $4 billion annually. 

Georgia is looking at five priority areas when deciding on the new contract holders: health care quality, equity, access and outcomes, value, and coverage and services. 

The request asks individuals, organizations, and companies to share feedback about the current program’s strengths and weaknesses and suggestions for improving outcomes, respecting linguistic and cultural needs, serving rural Georgia, and many other topics. 

Responses are due by 2 p.m. June 24. Individuals and organizations should email their responses to CMO.RFP@dch.ga.gov. 

Under the Medicaid managed care system, states pay companies a per-member, per-month rate to provide health care to members. The contracts are highly sought after by insurance providers. 

“The business of Medicaid managed care involves billions of dollars, so the stakes are very high in the competition for contracts with state Medicaid agencies,” according to a 2020 Robert Wood Johnson Foundation (RWJF) report. 

Companies that lose out on state contracts frequently sue, claiming violations of procurement rules and demanding do-overs of the process. Such protests prompted three rounds of rebidding in Kentucky and Pennsylvania. 

The contracting process presents states with a unique opportunity to implement policy changes and improve outcomes, according to the RWJF report. 

The state’s new mental health services legislation, House Bill 1013, will require Medicaid insurers to repay the state if they don’t spend at least 85% of their funds on patient care — a requirement in most other states with Medicaid managed care. 

The new mental health bill also requires DCH to evaluate whether mental and physical health are being treated equally, track complaints about suspected violations of mental health “parity,” and publish information about the findings. 

Gov. Brian Kemp has signed another bill lawmakers passed this year that will require DCH to post more financial data about Medicaid payments, spending, and numbers of primary care providers. That law takes effect July 1. 

This story comes to GPB through a reporting partnership with Capitol Beat News Service, a project of the Georgia Press Educational Foundation.