What's on the table as Georgia considers new Medicaid contract: 7 things to know


The state of Georgia is looking for value as it seeks to offer another Medicaid contract to a managed care company.

Here's where things stand:

1. Frank Berry, former Georgia Department of Community Health commissioner, said this summer that the state is looking for "the best bang for the buck" with a new contract, according to Kaiser Health News. The process should begin in 2022. 

2. Any new managed care organization would share the space with CareSource, Peach State Health Plan and Amerigroup.

3. Current contracted insurers average $189 million collectively each year in profits.

4. When it comes to the medical loss ratio on patients' claims and expenses, Georgia is fifth-worst in the nation. Spending rates on patient care also fell about 2 percentage points in 2020.

5. However, Georgia is looking to tighten the reins on patient spending. According to Kaiser Health News, while the state doesn't require companies to hit the typical 85 percent patient spending threshold, Peach State Health Plan did not hit 85 percent for the past three years.

6. Health officials would not comment on whether or not a spending threshold would be in place for a new contract.

7. The state is battling low COVID-19 vaccination rates for Medicaid-eligible patients and comparatively low rates when it comes to referring Medicaid-eligible children to specialty services, according to Kaiser Health News.

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