Doctors worried clients may lose services after Medicaid management change
| Capitol Beat News Service
First look inside the new St. Joseph’s/Candler Bryan County campus
A first look inside the new St. Joseph’s/Candler Bryan County campus, which is near the Hyundai Metaplant America in Ellabell.
- Georgia’s Medicaid management contracts are under dispute after a competitive bidding process, causing concern about potential service disruptions.
- Medical providers worry about patient access to care as they must enroll with new management companies, potentially facing out-of-network doctors and specialists.
- Losing bidders have filed protests alleging conflicts of interest and irregularities in the bidding process, further delaying the implementation of new contracts.
- The protests and subsequent delays are causing uncertainty for both medical providers and Medicaid recipients, particularly in rural areas with limited provider options.
The future oversight over Georgia’s multi-billion-dollar Medicaid program is in limbo as companies battle over new management contracts after a lengthy bidding process.
The medical safety net covered 2.5 million children, pregnant women, low-income adults, seniors and people with disabilities in Georgia last year.
The program totals $17 billion, with $5 billion from the state and the rest mostly from the federal government. The total is slated to rise to nearly $18 billion next year in the budget that lawmakers sent to Gov. Brian Kemp last month.
Georgia used to manage the Medicaid program directly, but about two decades ago the state decided to contract out the work. There have been tweaks along the way, with more companies added through competitive bidding. Then, more than two years ago, the Kemp administration initiated another competitive bid, and it could result in a major overhaul.
Two of the three incumbents — Amerigroup and Peach State Health Plan — lost.
Incumbent CareSource won a new contract, along with three newcomers: Humana Employers Health Plan of Georgia, Molina Health Care of Georgia and UnitedHealthcare of Georgia.
The change is prompting concern among doctors and other medical providers, who worry about service disruptions when their patients must enroll with one of the new management companies.
They remember what happened last year when Medicaid recipients had to undergo eligibility redeterminations after the requirement was waived during the COVID-19 pandemic. Nearly 300,000 lost coverage after enrollment peaked at more than 2.8 million in 2023.
Steven Miracle, CEO of Georgia Mountains Health Services, a non-profit in Blue Ridge with a large Medicaid clientele, thinks the new contracts will have a similar effect as his patients are forced to enroll with a different company.
“If they don’t have the information or if they aren’t able to access the technology that will allow them to sign up or if somehow, some way they miss the deadline, then there will be people who believe that they have insurance coverage that in fact don’t,” Miracle said. “People don’t pay attention, so they’re not going to be aware that they have to re-enroll.”
Miracle’s organization is among three dozen represented by the Georgia Primary Care Association. Albert Grandy, Jr., the association’s president, drafted an open letter to Georgians in March on behalf of those organizations.
“This shift introduces a heightened risk of disruption to critical health-care services, particularly for those who depend on continuity of care to manage chronic conditions, access mental health services, or receive specialized treatments,” Grandy wrote, adding that colleagues across the state were finding it difficult to negotiate contracts with the new insurers, leaving thousands of patients unclear about whether they could continue with their current medical providers.
“These changes could have devastating consequences for patients. Delays in care, denied claims, and lapses in coverage are not just administrative headaches — they are life-threatening issues for many. Our most vulnerable populations — children in foster care, individuals with disabilities, pregnant women and seniors — cannot afford to fall through the cracks of an uncertain system,” wrote Grandy, CEO of Curtis V. Cooper Primary Health Care in Savannah.
In an interview this week, Grandy said the state might automatically assign existing Medicaid patients to one of the new insurers if they fail to enroll themselves.
So, they would still be insured, but they might find that their current doctors are out of network, he said, adding that labs, radiologists and other specialists might also be out of network and thus inaccessible.
Dr. Samantha D. Manderson, an obstetrician-gynecologist in Cordele, said patients in rural areas could find it particularly difficult to locate new providers.
“I’m especially concerned about expectant mothers who will be forced to change doctors mid-pregnancy,” she said through a spokeswoman. “Many of my rural patients would not have other options close by and would have to travel just to get the care they need, potentially delaying life-saving care.”
After the winning bids were selected, the Georgia Department of Administrative Services initiated what’s known as a protest period, during which the public can raise concerns about the pending contracts.
Kimberly Oviedo, an audiologist in Acworth, sent an email to the agency on March 10 that is among the hundreds of protest-related documents on file. She was concerned about the lengthy process that medical offices must go through to ensure their staff can be reimbursed for service.
UnitedHealthcare was non-responsive, she wrote.
“We were able to start credentialing with Molina Health, Humana, and CareSource. However, UHC says they have no idea of what the contract is that they won in GA,” Oviedo wrote. “We can’t get through to anyone with UHC to start the process. This is alarming as this is one of the largest bids won in GA.”
In an interview this week, nearly two months after she sent that email, Oviedo said she still hadn’t gotten through to UnitedHealthcare.
She said she had an initial email exchange with the company wherein an employee said UnitedHealthcare had no contract to manage Medicaid in Georgia. Although technically true — the contracts are on hold until the protests are resolved — she said the other three bid winners had contacted her to initiate the credentialing process, which she said can take six months.
Oviedo said she sent her correspondent at UnitedHealthcare links to articles about the company’s winning bid but said she never heard back. She said a large portion of her practice serves children in foster care, adding that UnitedHealthcare won that portion of the bid. She worries that her patients won’t have access to insurance and that it will affect her business.
“You can’t call anybody there. You have to go through their chat system. And then their chat person says, ‘Sorry, we don’t offer that contract,’ ” Oviedo said. “So that’s very frustrating.”
She said she made a lucky guess at an email address that worked, until the company stopped responding.
“You can sometimes reach somebody that way, but they don’t make it easy, where like Molina, you can call the rep — her phone number’s right on the email she sent saying, ‘Hey, we’re reaching out to credential you.’ “
As of late Friday afternoon, UnitedHealthcare had not responded to emails sent by Capitol Beat a week earlier seeking a response.
Among the protest documents are more serious allegations from the losing bidders, for instance that a state evaluator lowered her scores for one company after meeting with her boss, suggesting that the boss influenced the outcome; or that state employees and their consultant working on the procurement didn’t all fill out the required conflict of interest disclosures.
Both losing incumbents leveled what is possibly the most serious charge: a direct conflict of interest for CareSource.
They assert that the company hired away a Georgia Department of Community Health official during the bidding process, a woman they said had helped to write the state’s procurement competition, formally known as an “electronic Request for Proposals,” or eRFP.
That department is the agency responsible for the state’s Medicaid program and the management contracts.
She “undoubtedly would have been privy to confidential information about the development of the eRFP that would have been helpful to CareSource in preparing its proposal,” a lawyer for Peach State wrote in a protest document filed last month. At best, this creates an appearance of impropriety, the protest says, and at worst reflects “an improper effort by CareSource to gain an unfair competitive advantage.”
The protest says CareSource should be disqualified.
A spokeswoman for CareSource said the company had no comment “at this time per the RFP requirements.”
The protests have apparently delayed the new contracts. Peach State’s contract was set to expire June 30, which would have required the new contracts to be in place July 1.
But Grandy, the president of the Georgia Primary Care Association, said he heard the contract date was pushed back, initially to next summer and then to the start of 2027.
That’s fine by Miracle and his medical office in Blue Ridge.
“A longer lead time is better,” he said. “Because we’ve got to get providers credentialed with the new insurance companies. We’ve got to get the organizational relationships set up so that we can do billing collections. I mean there’s a lot that has to happen. You can’t just say, ‘Okay we’ve got a new company.’ Health care is much more complex than that.”
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