Annual Report 
The Georgia Department of Community Health 
2 0 0 4 
 
 GEORGIA DEPARTMENT OF COMMUNITY HEALTH 2004 Annual Report 
Tim Burgess, Commissioner 
Overview The Georgia Department of Community Health (DCH) is involved in planning, purchasing and regulating health care in the state. Since its inception in 1999, the department's purposes have included the following:  Serving as the lead planning agency for health issues in Georgia;  Maximizing the state's health care purchasing power;  Maximizing administrative efficiency in state health care programs;  Developing a better health care infrastructure throughout Georgia which improves access and 
coverage; and  Promoting a healthy lifestyle for all Georgians. 
Mission DCH is committed to improving the health of all Georgians through health benefits, systems development and education. 
Vision DCH will be a national leader for innovative health planning, promotion, program and services to improve community health. 
Roles and Responsibilities  Insuring over 2.5 million Georgians.  Administering a budget that exceeds $8 billion.  Coordinating health planning for state agencies. 
The department must ensure quality health care services for a diverse population, including the following:  Members of the State Health Benefit Plan: 
o Public school teachers o Retirees o State employees o Public school employees o Contract Groups o Eligible dependents  Children covered under the PeachCare for Kids Program  People covered under Medicaid, including those who are: o Aged o Low income o Disabled 
The Board of Community Health is a nine-person board appointed by the Governor and confirmed by the Senate, which has policy-making authority for the department. Board meetings are held monthly. 
At the end of Fiscal Year (FY) 2004, the Board of Community Health members included:  Carol Fullerton - Albany, Chairman  Richard Holmes - Atlanta, Vice Chairman  Kent "Kip" Plowman - Augusta  Stephanie Kong, M.D. - Atlanta  Frank Rossiter, M.D. - Savannah, Secretary  Lloyd Eckberg - Thomasville  Joyce Blevins - Thomson 
1 
 
 COMPONENTS OF THE DEPARTMENT 
Division of Medical Assistance The Division of Medical Assistance administers the Medicaid program, which provides health care for people who are aged, blind, disabled or indigent. The division also administers PeachCare for Kids, the State Children's Health Insurance Program (SCHIP), as well as the Disproportionate Share Hospital (DSH) Program and Indigent Care Trust Fund (ICTF). Other Medicaid programs include: Georgia Better Health Care, home and community-based services and non-emergency transportation. In FY 2004, the division spent approximately $8 billion to provide services for 2.5 million Georgians. 
General Counsel Division The General Counsel Division provides overall legal guidance and direction for the department; drafts and reviews contracts, requests for proposal and other procurement documents; provides legal services for all aspects of the State Health Benefit Plan, Medicaid and PeachCare for Kids; develops policies and procedures for compliance with federal and state privacy and public records requirements and drafts rules, public notices, regulations and policies for consideration by the Board of Community Health. 
The division is also responsible for administering the Certificate of Need (CON) Program. Created by statute, the CON Program contains health care costs by avoiding unnecessary duplication of services, facilities or equipment. Decisions made are based on applicable rules and methodologies for expanding health care facilities and services. The Office of General Counsel provides staff support for the Health Planning Review Board, an administrative review board appointed by the Governor for CON decisions. 
In addition, the division's Health Planning Section collects and analyzes data and is responsible for the work of and for staff support to the Health Strategies Council. This 27-member council, appointed by the Governor, develops plans and regulatory criteria for health care services. 
Finally, the division is also responsible for the department's efforts to detect, prevent and investigate fraud and abuse in Medicaid, PeachCare for Kids and the State Health Benefit Plan through its Program Integrity Section. 
State Health Benefit Plan Division DCH administers the State Health Benefit Plan (SHBP), which provides health insurance coverage to state and school system employees, contract groups, retirees and eligible dependents. Within DCH, the SHBP division is responsible for the day-to-day management of the SHBP operations. At the end of FY 2004, SHBP covered 633,731 lives. 
 Operating Units - Within the division, there are seven operating units. Their responsibilities include the following: processing member eligibility transactions, assisting employer groups, processing member appeals, reviewing vendor performance and clinical standards, enforcing contract compliance among vendors, managing the annual enrollment/change period and conducting member educational programs and health benefit plan design. 
Managed Care and Quality Division The Managed Care and Quality Division is responsible for establishing and directing the managed care efforts of the department. These efforts include planning for the transition of a large proportion of the current Medicaid program into a managed care environment. 
Health Improvement Programs The department also administers four Health Improvement Programs dedicated to wellness, prevention and healthy improvement of various populations, both geographic and homogeneous. The programs are as follows: 
 The Office of Rural Health Services works to improve access to health care in rural and underserved areas to reduce health status disparities across Georgia. 
 The Office of Minority Health works to eliminate the disparity in health status between minority and 
2 
 
 non-minority populations.  The Office of Women's Health serves as a clearinghouse for women's health information.  The Georgia Commission on Men's Health recommends ways to promote the benefits of regular 
checkups, preventive screening tests and healthy lifestyle practices for men. 
Division of Financial Management The Division of Financial Management represents the department's financial interests when working with the Governor's Office, General Assembly, Board of Community Health, the Centers for Medicare and Medicaid Services and other stakeholders. The division is comprised of the Office of Planning and Fiscal Analyses, Financial and Accounting Services, Reimbursement Services and the Budget Office. 
Other DCH divisions are as follows: 
Information Technology The Project Management Office (PMO) is responsible for promoting project management standards throughout the DCH. As a centralized support function, staff serve as managers for projects with Information Technology components by assisting DCH management in the planning, development and implementation of health care initiatives. The Office of Information Technology (IT) provides technical support at both the desktop and network levels for all the divisions within DCH. 
The Medicaid Management Information Systems (MMIS) unit supports the various systems used for the processing, collecting, analyzing and reporting of information needed to support all Medicaid and PeachCare for Kids claims payment functions. The MMIS consists of all federally required subsystems as specified by the Centers for Medicare and Medicaid Services within the U.S. Federal Department of Health and Human Services. 
Legislative and External Affairs The Office of Legislative Affairs serves as the department's primary point of contact for all activities related to the Georgia General Assembly and the annual Legislative Session. During each session, the DCH legislative unit analyzes bills that affect Medicaid, State Health Benefit Plan and health care in general. The Legislative and External Affairs Unit also is responsible for ensuring the passage of the department's legislative agenda each year. 
The Office of Community Affairs (OCA) assists DCH in providing customer service for Georgia's Medicaid program. OCA interacts daily with members, providers, legislators, and others as well as helping Georgians understand the Medicaid program and the department's business functions as a whole. OCA responds to thousands of calls, emails, letters, faxes and inquiries relating to the Medicaid program. This unit also assists community-based health systems in providing access to care to Georgia's uninsured. 
Operations Divisions The Operations Division consists of the following units:  The Administrative Services Unit has three subunits which are Contract Administration, Vendor 
Management and Support Services.  The Audits Unit conducts and oversees internal and external audits.  The Communications Unit is responsible for media and public relations as well as Web site 
management.  The Human Resources Unit provides internal and external employment services for state employees 
and constituents. This unit sponsors the annual Charitable Contributions Program which is a Governor's initiative to raise funds for charities and non-profit organizations through donations from state employees.  The Vendor Operations for Affiliated Computer Services (ACS) is a group of experts who provide support with managing the agency's Medicaid fiscal agent, ACS. 
In addition, the following three administratively attached agencies are housed in DCH: 
3 
 
 Composite Board of Medical Examiners The Composite Board of Medical Examiners licenses and regulates physicians, physician's assistants, respiratory care professionals, acupuncturists, perfusionists, auricular detoxification specialists, paramedics and cardiac technicians. The Composite Board also maintains a comprehensive database that offers public access to information about licensed physicians in the state. Twelve physicians and one consumer representative serve on this board. 
Georgia Board for Physician Workforce The 15-member Georgia Board for Physician Workforce (GBPW) monitors and evaluates the supply and distribution of physicians by specialty and geographic location to identify underserved areas of the state. GBPW also develops medical educational programs through financial aid to medical schools and residency-training programs. 
State Medical Education Board The State Medical Education Board (SMEB) administers medical scholarships and loans to promote medical practices in rural areas. Initiatives include the Country Doctor Scholarship and Loan Repayment Programs, which encourage physicians to practice in the state's underserved areas. SMEB has 15 members and publishes a biennial report, submitted directly to the General Assembly. 
Auditors' Statements on Annual Reports Challenges with the implementation of the Medicaid Management Information System (MMIS) in 2003 resulted in a "disclaimer" on financial statements for FY 2003. To reflect the impact of MMIS errors, DCH conducted extensive claims management payment review to determine fiscal impact and make estimates of receivables and liabilities for the FY 2004 statement. 
As a result of those activities and the difficulties involved in reconciliation, independent auditors did not express an opinion on the department's FY 2003 financial statements. Because the balances reported as of June 30, 2003 materially affected the FY 2004 statements of activities, revenues, expenditures and changes in fund balance, the auditors did not express an opinion on those specific FY 2004 subjects. The independent auditors did express an opinion on the department's financial position as of June 30, 2004. The auditors concluded that the department's FY 2004 financial statements fairly present the department's financial position. 
The State Health Benefit Program did receive FY 2004 opinions on all financial statements. The auditors concluded that the SHBP's FY 2004 financial statements were fairly presented. 
Milestones for the Department in FY 2004  The department began exploring a managed care environment for Medicaid members.  ACS, as the contractor for the Georgia Health Partnership MMIS for processing Medicaid and 
PeachCare claims, increased the number of claims processed from over 32 million electronic claims submissions, Web, paper and capitation claims in the nine months of tabulation in FY 2003 to over 49 million in FY 2004. The MMIS became the nation's first Web-based, HIPAA-compliant, real-time claims payment system. It allowed providers to perform virtually all Medicaid program transactions through a Web portal. 
4 
 
 5 
 
 FY 2004 DCH Expenditures 
Benefits Medicaid* PeachCare for Kids* Indigent Care Trust Fund Payments to Nursing Homes State Health Benefit Plan Payments (Including HMO Premium Payments) 
 
$6,417,630,182 $261,289,775 $491,113,624 $241,946,052 
$1,848,305,329 $9,260,284,962 
 
95.20% 
 
Services Support (Contracts) Systems Support Department of Human Resources Administration Contract State Health Benefit Plan Medicaid and PeachCare for Kids Contractual Services 
 
$70,514,292 $95,542,254 $93,047,707 $128,913,616 $388,017,869 
 
3.99% 
 
Medical Education and Licensing Georgia Board for Physician Workforce State Medical Education Board Composite State Board of Medical Examiners 
 
$38,195,240 $1,341,846 $2,173,736 
$41,710,822 
 
0.43% 
 
Health Care Planning and Initiatives Health Planning Rural Health Minority Health Women's Health 
Administration State Health Benefit Plan Administration Medicaid and PeachCare Administration** 
 
$2,124,611 $8,259,683 
$444,985 $173,422 $11,002,701 
$5,328,602 $20,953,913 $26,282,515 
 
0.11% 0.27% 
 
Totals 
 
$9,727,298,869 100.00% 
 
*Based on dates of payment and includes claim and non-claim benefit payments. **Includes rent and utilities, state agency services, telecommunications, accounting and auditing, and other support services. 
 
DIVISION OF MEDICAL ASSISTANCE 
 
DCH Quality Program in Nursing Homes In FY 2004, DCH collaborated with many partners in the long-term care industry, including nursing homes, the Office of Regulatory Services, the State Ombudsman's Office in the Department of Human Resources and the American Association of Retired Persons, to develop a successful program to measure and monitor quality indicators for improvement. Georgia was able to voluntarily enroll 100 percent of all nursing homes in the state to participate, which has never been done before or since by other states. 
 
6 
 
 The program offered a range of clinical and quality indicators upon which facilities could conduct selfimprovement assessments. Each month, a scorecard was produced based on benchmarks and targets for improved care to patients. Significant improvements were made in reducing restraints and pressure sores. An outside consultant conducted family satisfaction surveys to analyze and identify areas that needed improvement. The first two years of satisfaction results indicated that 85 percent of families were satisfied with the care being delivered, and they would recommend their facilities to others. Many other states have replicated the program but none with full-facility participation. 
 
Description of Medicaid Medicaid is a joint federal/state health care assistance program for certain individuals and families with low incomes and resources. Those included in the program are individuals with low incomes, children, pregnant women and people who are elderly, blind or disabled who meet the eligibility criteria. Medicaid is the largest source of funding for medical and health-related services for Georgia's most indigent people. 
 
Medicaid reimburses health care providers for services administered to eligible individuals. People who are eligible for Medicaid receive a card, very similar to anyone else with health insurance, to use for services from participating providers. 
 
The federal government pays the largest share of Medicaid costs. In FY 2004, for every dollar of state funds, Georgia drew down $1.67 in federal-matching funding. The state's Medicaid program receives varying levels of federal reimbursement for different services and functions. For example, the federal government pays 90 percent of the cost for family planning and almost 60 percent for most other benefits. Computer costs are 75 percent federally funded and other administrative costs received 50 percent federal funding. 
 
The chart below summarizes FY 2004 Medicaid and PeachCare for Kids benefit figures: 
 
TOTALS 
 
Total Members* 
 
1,938,739 
 
Total Patients 
 
1,616,219 
 
Total Expenditures 
 
$6,678,919,957 
 
Expenditures Per Member 
 
$3,444.98 
 
Expenditures Per Patient 
 
$4,132.43 
 
Providers with Paid Claims 
 
43,942 
 
MEDICAID Total Members* Total Patients Total Expenditures Expenditures Per Member Expenditures Per Patient Providers with Paid Claims Number of Paid Claims 
 
1,724,445 1,422,773 $6,417,630,182 $3,721.56 $4,510.65 
41,512 38,397,683 
 
PEACHCARE Total Members* Total Patients Total Expenditures Expenditures Per Member Continued on Next Page 
 
276,536 230,894 $261,289,775 $944.87 
 
7 
 
 Expenditures Per Patient Providers with Paid Claims Number of Paid Claims 
 
$1,131.64 23,592 
3,089,186 
 
*Members are those who are eligible for and enrolled in the Medicaid or PeachCare for Kids Program. Patients are those members who have received any type of service under these programs. Members and Patients based on dates of service from July 2003 to June 2004, paid through September 2004. Total Expenditures are based on dates of service and include claims and non-claims benefit payments. PeachCare plus Medicaid does not necessarily add to the Totals as members may switch between PeachCare and Medicaid based on eligibility. 
 
Eligibility A person must meet the eligibility requirements within one of the following coverage groups to be eligible for Medicaid: the aged (over 65), blind, permanently or totally disabled; pregnant women; children; or parents or caregivers, when they meet income requirements and care for a Medicaid-eligible child. In all cases, the person must meet both the income and resource limits set for his respective coverage group and any established non-financial requirements. Non-financial requirements include criteria such as: age, U.S. citizenship or lawful alien status and Georgia residency. 
 
Major Coverage Groups  Supplemental Security Income (SSI) Recipients - Aged, blind or disabled individuals who receive 
SSI.  Nursing Homes - Aged, blind or disabled individuals who live in nursing homes and have low 
incomes and limited assets.  Community Care - Aged, blind or disabled individuals who need regular nursing care and personal 
services, but who can stay at home with special community care services.  Qualified Medicare Beneficiaries - Aged, blind or disabled individuals who have Medicare Part A 
(hospital) insurance and have incomes less than 100 percent of the federal poverty level and limited resources. Medicaid will pay the Medicare premiums (A & B), coinsurance and deductibles only.  Hospice  Terminally-ill individuals who are not expected to live more than six months may be eligible for coverage. Recipients must agree to receive hospice services through a Medicaid participating hospice care provider.  Low-Income Medicaid - Adults and children who meet the income standards of the Temporary Assistance for Needy Families (TANF) Program.  Right from the Start Medicaid for Pregnant Women (RSM Adults) - Pregnant women with family incomes at or below 200 percent of the federal poverty level.  Right from the Start Medicaid (RSM Children)  Children from under 1 to 19 years whose family incomes are at or below the appropriate percentage of the federal poverty levels for their age and family size.  Medically Needy - Pregnant women, children, aged, blind and disabled individuals whose family incomes exceed the established income limit may be eligible under the Medically Needy Program (MNP). The MNP allows a person to use incurred/unpaid medical bills to "spend down" the difference between his/her income and the income limit to become eligible.  Breast and Cervical Cancer Program  Uninsured and underinsured women under age 65 who have been screened by the public health department and then diagnosed with either breast or cervical cancer may be eligible for treatment of their condition under Medicaid.  Emergency Medical Assistance - Immigrants, including undocumented immigrants, who would have been eligible for Medicaid except for their immigrant status, were potentially eligible for Emergency Medical Assistance (EMA). This included persons who were aged, blind, disabled, pregnant women, children or parents of dependent children who met eligibility criteria. Services rendered to EMA recipients were limited to emergency care only as described in the Federal Regulations. (1903 (v) of the Social Security Act and the Code of Federal Regulation 42 CFR 440.255). 
 
8 
 
 Covered Services  Ambulance Services  Ambulatory Surgical Services  Certified Registered Nurse Anesthetists  Childbirth Education Services  Children's Intervention Services  Diagnostic, Screening and Preventive Services (health departments)  Dental Services  Dialysis Services  Durable Medical Equipment (DME) Services  Family Planning Services  Georgia Better Health Care  Health Check (Early and Periodic Screening, Diagnosis and Treatment - EPSDT)  Health Insurance Premium Payment (HIPP)  Health Insurance Premiums (Medicare Parts A & B)  Home and Community-Based Waivers  Home Health Services  Hospice Services  Inpatient and Outpatient Hospital Services  Intermediate Care Facility for the Mentally Retarded Services  Laboratory and Radiological Services  Medicare Crossovers  Mental Health Rehabilitation Services  Non-Emergency Transportation Services  Nurse Midwifery Services  Nurse Practitioner Services  Nursing Facility Services  Oral Surgery  Orthotic and Prosthetic Services  Pharmacy Services  Physician Services  Physician's Assistant Services  Podiatric Services  Pre-Admission Screening/Annual Resident Review  Pregnancy-Related Services  Psychological Services  Rural Health Clinic/Community Health Center Services  Swing-Bed Services  Targeted Case Management Services  Adults with AIDS  Children at Risk for Incarceration  Early Intervention  Perinatal  Adult and Child Protective Services  Therapeutic Residential Intervention  Vision Care Services  Enhanced Primary Care Case Management, SOURCE (Service Options Using Resources in a 
Community Environment) 
Medicaid Services DCH works to make health care available and accessible to indigent Georgians while staying fiscally accountable to the state's citizens. A broad range of services addresses the health care needs of those enrolled in the Medicaid program. 
9 
 
 Georgia Medicaid Patients and Expenditures for FY 1994 through FY 2004 
 
Time Period FY 1994 FY 1995 FY 1996 FY 1997 FY 1998 FY 1999 FY 2000 FY 2001 FY 2002 FY 2003 FY 2004 
 
Patients 1,058,918 1,135,212 1,181,092 1,240,884 1,234,741 1,213,880 1,201,669 1,270,268 1,369,629 1,320,980 1,422,773 
 
Net Payments $2,747,463,083 $3,003,708,266 $3,089,570,328 $3,151,030,885 $3,028,628,870 $3,115,622,863 $3,343,199,902 $3,745,204,923 $4,393,856,380 $4,808,499,159 $5,587,222,638 
 
Net Pay Per Patient $2,594.59 $2,645.94 $2,615.86 $2,539.34 $2,452.85 $2,566.66 $2,782.13 $2,948.36 $3,208.06 $3,640.10 $3,927.00 
 
% Change Year over Year N/A 1.98% -1.14% -2.93% -3.41% 4.64% 8.39% 5.97% 8.81% 13.47% 7.88% 
 
Based on dates of service from July 2003 to June 2004, paid through September 2004, and include claim-based expenditures only. 
 
MEDICAID PROFILE Aid Category Group Breast/Cervical Cancer Screen Aged  with (w/) and without Medicare Blind/Disabled - with and without Medicare Special Low-Income Medicare Beneficiaries Other Waivers Medically Needy Qualified Medicare Beneficiaries Low-Income Medicaid RSM Child RSM Adult Refugee 
 
Patients 2,636 
71,545 211,393 
1,636 15,759 
74 48,888 457,580 609,468 120,972 
1,583 
 
% of Total 0.19% 5.03% 
14.86% 0.11% 1.11% 0.01% 3.44% 
32.16% 42.84% 
8.50% 0.11% 
 
Net Payment $29,400,633 
$1,042,729,651 $2,071,976,358 
$851,399 $171,371,128 
$812,304 $33,882,129 $857,950,926 $937,715,878 $437,234,892 
$3,297,339 
 
% of Total 0.53% 
18.66% 37.08% 
0.02% 3.07% 0.01% 0.61% 15.36% 16.78% 7.83% 0.06% 
 
By Age Under 1 year 1 to 5 years 6 to 20 years 21 to 44 years 45 to 64 years 65+ years 
Continued on the Next Page 
 
1,422,773 100.00% $5,587,222,638 100.00% 
 
172,693 331,067 488,146 272,229 115,076 128,919 1,422,773 
 
12.14% 23.27% 34.31% 19.13% 
8.09% 9.06% 100.00% 
 
$485,786,991 $441,864,044 $947,612,644 $1,311,094,724 $1,080,692,784 $1,320,171,450 $5,587,222,638 
 
8.69% 7.91% 16.96% 23.47% 19.34% 23.63% 100.00% 
 
10 
 
 By Gender Male Female 
 
557,400 865,373 1,422,773 
 
39.18% 60.82% 100.00% 
 
$2,028,220,187 $3,559,002,451 $5,587,222,638 
 
36.30% 63.70% 100.00% 
 
By Residence Rural Urban 
 
572,921 892,358 
 
40.27% $2,330,195,595 62.72% $3,257,027,043 
 
41.71% 58.29% 
 
By Race Unknown White Black American Indian/Alaskan Asian/Pacific Islander Hispanic 
 
1,422,773 100.00% $5,587,222,638 100.00% 
 
125,127 615,017 683,481 
1,200 19,115 15,672 1,422,773* 
 
8.79% 43.23% 48.04% 
0.08% 1.34% 1.10% 100.00%* 
 
$518,885,233 $2,756,013,843 $2,222,634,351 
$4,033,809 $55,239,160 $30,416,242 $5,587,222,638 
 
9.29% 49.33% 39.78% 
0.07% 0.99% 0.54% 100.00%* 
 
Based on dates of service from July 2003 to June 2004, paid through September 2004, and include claim-based expenditures only. *Patients do not necessarily sum to total as members may switch between categories. 
 
Below are descriptions of covered services, providers with paid claims recipients and expenditures by category of service. 
 
Physician Services  Pays for services provided by licensed physicians.  Over 67.8 percent of all members received services from a physician in FY 2004.  Physician services accounted for approximately 11 percent of Medicaid benefit expenditures in FY 
2004. 
 
Physician Services 
 
Category of Service Physician Services Net Payments Subtotal 
 
Providers w/ Paid Claims 
23,105 
 
Unique Patients 
1,170,069 
 
Net Payment $598,974,785 $598,974,785 
 
Net Payment Per Patient 
$511.91 
 
Pharmacy Services  The Drug Utilization Review Board recommends medical criteria standards and educational 
intervention methods for drug utilization review. It also advises DCH about products considered clinically effective for the department's health plans. Pharmacy services cover drugs requiring a prescription, insulin, diabetic supplies and certain nonprescription drugs. However, if a proven, lessexpensive treatment known to be safe and effective for most people does not work for an individual, the doctor may wish to change to another more expensive drug. In such a case, a prior authorization may be required to document such a treatment if necessary, depending on the classification of the drug.  Pharmacy increased its generic utilization in FY 2004 to 50.8 percent over FY 2003 rate of 49.5 percent. The supplemental rebate program was implemented in March 2004 and saved DCH $12,673,996 in total funds between March 1 and June 30, 2004.  Pharmacy services accounted for approximately 19 percent of Medicaid benefit expenditures in FY 2004. 
 
11 
 
 Pharmacy Services 
Category of Service Pharmacy Pharmacy DME Supplier Net Payments Subtotal 
 
Providers w/ Paid Claims 
2,025 
1,920 
 
Unique Patients 1,109,196 
61,559 
 
Net Payment $1,063,618,661 
$11,486,875 $1,075,105,536 
 
Net Payment Per Patient 
$958.91 
$186.60 
 
Hospital Services  Inpatient hospital services are covered when services cannot be provided on an outpatient basis.  Most adult inpatient hospital stays and outpatient surgical procedures must be certified prior to 
admission.  Outpatient hospital services may include emergency room care, outpatient surgery and clinic 
services.  Hospital services accounted for approximately 31 percent of total Medicaid benefit expenditures in FY 
2004. 
 
Hospital Services 
Category of Service Inpatient Hospital Services Outpatient Hospital Services Net Payments Subtotal 
 
Providers w/ Paid Claims 
266 
401 
 
Unique Patients 241,519 
745,500 
 
Net Payment $1,107,688,210 
$597,258,797 $1,704,947,007 
 
Net Payment Per Patient 
$4,586.34 
$801.15 
 
Nursing Facility Services  Covers institutional care for members whose health conditions are such that they are unable to 
remain at home or in the community.  The Department of Human Resources' Office of Regulatory Services regulates nursing home 
licensing and certain quality measures.  Accounted for approximately 19 percent of total Medicaid benefit expenditures in FY 2004. 
 
Nursing Facility Services 
Category of Service Swing-Bed Hospital Services Skilled Care in a Nursing Facility Skilled Care in a State-Owned Nursing Facility State-Owned Intensive Care for Mental Retardation Intensive Care Nursing Facility for Mental Retardation Net Payments Subtotal 
 
Providers w/ Paid Claims 
34 
351 
 
Unique Patients 
226 
40,625 
 
6 
 
339 
 
12 
 
1,111 
 
1 
 
116 
 
Net Payment $326,779 
$946,172,317 
 
Net Payment Per Patient 
$1,445.93 
$23,290.40 
 
$24,933,234 
 
$73,549.36 
 
$101,673,941 
 
$91,515.70 
 
$6,423,669 $1,079,529,940 
 
$55,376.46 
 
Maternal and Child Health Services  Covers prenatal and perinatal care, family planning, pays for children's preventive care through 
Health Check, helps children with physical and developmental problems and assists children at risk.  Represented approximately two percent of total Medicaid benefit expenditures in FY 2004. 
 
12 
 
 Maternal and Child Health Services 
Category of Service Family Planning Services Health Check Services (EPSDT) Pregnancy-Related Services Children-at-Risk Targeted Case Perinatal Targeted Case Management Diagnostic Screening and Prevention Early Intervention Case Management Children's Intervention Services Childbirth Education Program Children's Intervention School Net Payments Subtotal 
 
Providers w/ Paid Claims 
118 2,717 
125 37 
155 246 180 2,312 
18 139 
 
Unique Patients 
23,272 422,039 
11,731 7,905 
38,572 95,039 
6,041 20,786 
575 17,119 
 
Net Payment $2,604,961 
$44,454,365 $1,045,992 $2,353,364 $3,729,364 $5,311,860 $4,719,684 
$46,350,566 $13,591 
$14,605,125 $125,188,872 
 
Net Payment Per Patient 
$111.94 $105.33 
$89.16 $297.71 
$96.69 $55.89 $781.28 $2,229.89 $23.64 $853.15 
 
Other Practitioner Services  Includes: physician's assistant services, Health Check dental program for children under 21, adult 
dental program, vision care, nurse midwifery, oral maxillofacial surgery, podiatry, psychological services, advanced registered nurse practitioners services and licensed clinical social work.  Represented approximately four percent of total Medicaid benefit expenditures during FY 2004. 
 
Other Practitioner Services 
Category of Service Physician's Assistant Services Health Check Dental Program (under 21) Adult Dental Program Vision Care Nurse Midwifery Oral Maxillofacial Surgery Podiatry Psychological Services Advanced Registered Nurse Practitioners Licensed Clinical Social Work Net Payments Subtotal 
 
Providers w/ Paid Claims 
1,184 1,398 
965 842 213 
82 394 754 2,249 
21 
 
Unique Patients 100,075 345,229 
56,811 126,529 
22,277 1,195 
43,355 34,961 153,830 
177 
 
Net Payment $8,856,568 
$134,987,732 $19,060,482 $9,132,648 $13,153,778 $168,726 $3,374,406 $20,241,834 $17,258,722 $16,400 
$226,251,296 
 
Net Payment Per Patient 
$88.50 $391.01 $335.51 
$72.18 $590.46 $141.19 
$77.83 $578.98 $112.19 
$92.66 
 
Mental Health Services  Covers a comprehensive range of services provided by outpatient mental health rehabilitative 
programs.  People with chronic mental illnesses, mental retardation or substance abuse may receive community- 
based services, which enable them to continue living independently in the community. Community care is a less-costly alternative to either hospitalization or nursing home care.  Accounted for approximately two percent of total Medicaid benefit expenditures during FY 2004. 
 
13 
 
 Mental Health Services 
Category of Service Community Mental Health Services Net Payments Subtotal 
 
Providers w/ Paid Claims 
446 
 
Unique Patients 
58,657 
 
Net Payment $93,201,632 $93,201,632 
 
Net Payment Per Patient 
$1,588.93 
 
Waiver Services for Home and Community-Based Care Waiver services include four home and community-based programs that are covered by Medicaid. These waivers are issued by the federal government and allow exceptions to specific Medicaid requirements. Waivers permit the state to pay for home and community-based services as an alternative to institutional care. Each waiver program offers "core" services including the following: service coordination, personal support, home health services, emergency response systems and respite care. Additional services are available under each program. 
 
Home and community-based alternatives accounted for six percent of the total Medicaid benefit expenditures in FY 2004. 
 
The four home and community-based waiver programs are as follows:  The Community Care Services Program helps aged and disabled people remain in their homes or 
return to the community from nursing homes.  The Mental Retardation Waiver Program and the Community Habilitation and Support Services 
Waiver Program help people with developmental disabilities and/or mental retardation remain in their own homes or move to a community residential facility to prevent placement in an Intermediate Care Facility for People with Mental Retardation.  The Independent Care Waiver Program helps adult Medicaid members with severe disabilities live in their own homes or in the community instead of a hospital or nursing home.  Waivered Home Care Services help children who are ventilator-dependent. The children receive inhome care and services. 
 
Other services included the following:  A demonstration project, SOURCE (Service Options Using Resources in a Community Environment), 
links primary care with an array of long-term health services in a person's home or community to avoid preventable hospitalization and nursing home care for frail, older or disabled people. In FY 2004, there were eight SOURCE sites, providing services in 129 counties, more than 4,870 people in Georgia.  Dedicated case management services are used by people needing mental health services and some mental retardation waiver services.  Georgia Pediatric Program (GAPP In-home Private Duty Nursing; GAPP Medically Fragile Daycare) serves medically-fragile members under the age of 21. Members must be medically fragile with multiple systems diagnoses and require continuous skilled-nursing care to be considered for GAPP services. Members served by GAPP are required to meet the same level of care for their medical condition that requires skilled-nursing care equivalent to the care received in an institutional setting, i.e., hospital or skilled-nursing facility, or admission to a hospital or nursing facility. In FY 2004, a total of 656 members received GAPP services. 
 
Waiver Services for Home and Community-Based Care 
 
Category of Service Dedicated Case Management Services Community Care Services Continued on the Next Page 
 
Providers w/ Paid Claims 
4 
449 
 
Unique Patients 
11,789 
12,581 
 
Net Payment $12,812,513 $84,451,067 
 
Net Payment Per Patient 
$1,086.82 
$6,712.59 
 
14 
 
 Independent Care Waiver Services Mental Retardation Waiver Program Community Habilitation and Support Waiver Home Care Services SOURCE GAPP In-Home Private Duty Nursing GAPP Medically-Fragile Daycare Net Payments Subtotal 
 
100 
 
615 
 
$26,741,232 $43,481.68 
 
470 
 
7,676 $137,760,000 $17,946.85 
 
92 
 
1,216 
 
$53,170,620 $43,725.84 
 
14 
 
162 
 
$4,926,813 $30,412.42 
 
144 
 
5,282 
 
$27,643,516 
 
$5,233.53 
 
16 
 
257 
 
$12,715,951 $49,478.41 
 
3 
 
89 
 
$1,607,799 $18,065.16 
 
$361,829,511 
 
Emergency Transportation  Covers Emergency Ground Ambulance and Emergency Air Ambulance Services, which in FY 2004, 
accounted for less than one percent of total Medicaid benefit expenditures. The Non-Emergency Transportation total for two vendors was $65,589,206. Expenditures were 
 
$56,046,022 for Logisticare and $9,543,184 for Southeastrans respectively. This expenditure is a non-claim based-expenditure and is accounted for in "Total Medicaid Expenditures" (page 5 $5,813,756,615) which includes claim-based and non-claim-based expenditures. 
 
Emergency Transportation 
Category of Service Emergency Ground Ambulance Services Emergency Air Ambulance Services Net Payments Subtotal 
 
Providers w/ Paid Claims 
191 
7 
 
Unique Patients 
83,837 
410 
 
Net Payment $20,408,992 $1,104,406 $21,513,398 
 
Net Payment Per Patient 
$243.44 
$2,693.67 
 
Equipment and Devices  Covers the rental or purchase of medical equipment and devices such as: hospital beds, wheelchairs, 
oxygen equipment, walkers, artificial limbs and braces.  Services in this category accounted for approximately one percent of total Medicaid benefit 
expenditures in FY 2004. 
 
Equipment and Devices 
Category of Service Durable Medical Equipment Services Orthotics & Prosthetics/Hearing Services Net Payments Subtotal 
 
Providers w/ Paid Claims 
860 
230 
 
Unique Patients 101,580 
15,118 
 
Net Payment $35,185,062 $9,430,087 $44,615,149 
 
Net Payment Per Patient 
$346.38 
$623.77 
 
All Other Services Covered services such as: ambulatory and surgical centers, rural health clinics, non-emergency transportation (NET), laboratory, x-ray, dialysis, home health, protective services, hospice, therapy and specialized services for specific populations including adults with AIDS and children at risk for incarceration. 
 
All Other Supplemental Security Income (SSI) Services comprised approximately five percent of total Medicaid benefit expenditures in FY 2004. 
 
15 
 
 All Other Services 
Category of Service Home Health Services Independent Laboratory Service Non-Exceptional Transportation (NET) Speech Therapy - Medicare Only Physical Therapy - Medicare Only Rehabilitation Therapy - Medicare Only Federally-Qualified Health Center Hospital-based Rural Health Center Free-Standing Rural Health Clinic Chiropractics - Medicare Only Ambulatory Surgical Center/Birthing Hospice Dialysis Services  Technical Dialysis Services  Professional Targeted Case Management-Aids At Risk of Incarceration Child Protective Services Adult Protective Services Therapeutic Residential Intervention Pre-Admit Screening Resident Net Payments Subtotal 
 
Providers w/ Paid Claims 
86 132 
1 2 73 35 65 56 35 116 113 74 407 364 13 1 1 1 33 1 
 
Unique Patients 
9,585 257,193 
1 20 613 739 39,587 25,871 18,920 776 13,128 4,558 6,633 3,539 999 7,702 34,286 2,642 5,791 
2 
 
Net Payment $8,405,587 
$24,944,367 $62 
$395 $15,421 $13,823 $9,706,497 $4,076,044 $3,668,207 $34,968 $7,353,499 $41,422,299 $27,336,599 $1,199,373 $220,525 $7,361,816 $35,845,141 $3,533,415 $80,927,471 
$0 $256,065,509 
 
Net Payment Per Patient 
$876.95 $96.99 $62.00 $19.75 $25.16 $18.70 
$245.19 $157.55 $193.88 
$45.06 $560.14 $9,087.82 $4,121.30 $338.90 $220.75 $955.83 $1,045.47 $1,337.40 $13,974.70 
$0.00 
 
For all services, the department identifies members with other health insurance in an attempt to ensure Medicaid is payer of last resort as shown below:  Requiring the third party to pay before Medicaid (cost avoidance);  Recouping benefits from the liable third party after the claim has been paid;  Trauma, casualty, or accident-related payment cases (tort recovery);  Billing the liable party;  Paying health insurance premiums for members when it is cost effective; and  Health Insurance Premium Payment (HIPP) Program. 
 
From Casualty From Other Health Insurance Total 
Due to Medicare Due to Other Health Insurance Total 
 
Third Party Liability FY 2004 Totals Dollars Recovered $6,307,970 $16,652,501 $22,960,471 
Cost Avoidance Savings $408,501,515 $148,051,736 $556,553,251 
 
16 
 
 Medicaid Services Distribution FY 2004 
 
All Other Services 4.6% 
Waiver Programs 6.5% 
Other Practitioners 4.0% 
Emergency Transportation 0.4% 
Equipment and Devices 0.8% 
Pharmacy 19.2% 
 
Physicians 10.7% 
 
Physicians Hospital Mental Health Nursing Facilities Maternal & Child Health Pharmacy Equipment and Devices Emergency Transportation Other Practitioners Waiver Programs All Other Services 
 
Maternal & Child Health 2.2% 
 
Hospital 30.5% 
 
Nursing Facilities 19.3% 
 
Mental Health 1.7% 
 
MEDICAID MEMBERS AND EXPENDITURES BY COUNTY 
 
County Appling Atkinson Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb Bleckley Brantley Brooks Bryan Bulloch Burke Butts Calhoun 
 
# of Unique Patients 5,173 2,587 2,500 932 8,918 2,345 8,166 14,626 5,093 4,094 35,193 2,341 3,740 4,074 3,336 10,075 6,905 3,675 1,713 
 
Net Payments $23,090,654 $8,679,300 $11,842,322 $2,656,481 $77,921,285 $7,186,429 $30,224,926 $51,613,865 $20,455,785 $17,278,522 
$152,752,798 $10,249,644 $13,143,607 $16,126,134 $15,467,774 $38,616,761 $23,576,802 $18,042,637 $7,659,774 
 
Payment/ Patient $4,463.69 $3,354.97 $4,736.93 $2,850.30 $8,737.53 $3,064.58 $3,701.31 $3,528.91 $4,016.45 $4,220.45 $4,340.43 $4,378.32 $3,514.33 $3,958.30 $4,636.62 $3,832.93 $3,414.45 $4,909.56 $4,471.56 
 
# of Providers 
3,672 1,820 1,758 
968 4,345 2,480 5,572 6,420 2,583 2,177 7,284 1,901 2,155 1,693 2,192 4,007 2,445 3,418 1,149 
 
% of Total Population 
0.36% 0.18% 0.18% 0.07% 0.63% 0.16% 0.57% 1.03% 0.36% 0.29% 2.47% 0.16% 0.26% 0.29% 0.23% 0.71% 0.49% 0.26% 0.12% 
 
17 
 
 County Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson DeKalb Decatur Dodge Dooly Dougherty Douglas Early Echols Effingham Elbert Emanuel Evans Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham Hall Hancock 
 
# of Unique Patients 6,366 2,885 17,928 7,124 2,414 41,213 816 4,939 12,726 16,536 1,128 49,332 2,159 58,609 10,667 11,292 8,426 4,074 11,504 2,227 6,481 2,356 2,072 97,127 7,766 4,446 2,969 26,539 13,995 4,083 870 5,841 4,502 6,578 2,868 3,704 5,040 20,273 6,628 4,065 136,070 4,293 585 12,684 8,895 5,922 3,338 68,403 5,582 25,862 2,346 
 
Net Payments $17,865,533 $17,667,200 $66,470,876 $27,570,634 $8,436,341 
$179,760,280 $2,288,624 
$20,404,893 $48,586,947 $66,474,651 
$4,624,753 $144,538,621 
$8,830,850 $213,416,394 
$39,439,357 $42,772,038 $32,987,877 $17,095,876 $40,905,372 
$8,392,160 $27,163,830 
$9,774,943 $7,558,694 $355,779,530 $29,337,053 $21,163,111 $12,863,979 $94,615,603 $49,000,790 $15,571,643 $2,155,990 $21,023,713 $19,943,044 $30,681,160 $10,899,562 $16,481,638 $20,104,158 $101,416,314 $26,902,808 $18,962,366 $533,574,995 $18,919,232 $4,299,985 $52,684,799 $31,305,753 $18,543,859 $12,584,478 $204,754,594 $22,286,995 $92,805,685 $11,126,002 
 
Payment/ Patient $2,806.40 $6,123.81 $3,707.66 $3,870.11 $3,494.76 $4,361.74 $2,804.69 $4,131.38 $3,817.93 $4,020.00 $4,099.96 $2,929.92 $4,090.25 $3,641.36 $3,697.32 $3,787.82 $3,915.01 $4,196.34 $3,555.75 $3,768.37 $4,191.30 $4,148.96 $3,648.02 $3,663.03 $3,777.63 $4,760.03 $4,332.76 $3,565.15 $3,501.31 $3,813.78 $2,478.15 $3,599.33 $4,429.82 $4,664.21 $3,800.41 $4,449.69 $3,988.92 $5,002.53 $4,058.96 $4,664.79 $3,921.33 $4,407.00 $7,350.40 $4,153.64 $3,519.48 $3,131.35 $3,770.07 $2,993.36 $3,992.65 $3,588.50 $4,742.54 
 
# of Providers 
2,263 1,930 7,373 2,533 1,487 6,015 
991 2,414 7,080 5,720 1,200 12,550 1,469 14,338 3,697 3,636 3,055 1,871 5,327 1,916 2,523 1,413 2,603 17,383 2,680 2,370 2,045 5,659 8,030 1,816 
763 2,240 2,187 3,269 1,802 2,526 4,171 6,996 4,768 3,038 20,261 3,400 1,081 3,849 3,927 1,937 2,225 13,958 2,843 8,155 1,930 
 
% of Total Population 
0.45% 0.20% 1.26% 0.50% 0.17% 2.90% 0.06% 0.35% 0.89% 1.16% 0.08% 3.47% 0.15% 4.12% 0.75% 0.79% 0.59% 0.29% 0.81% 0.16% 0.46% 0.17% 0.15% 6.83% 0.55% 0.31% 0.21% 1.87% 0.98% 0.29% 0.06% 0.41% 0.32% 0.46% 0.20% 0.26% 0.35% 1.42% 0.47% 0.29% 9.56% 0.30% 0.04% 0.89% 0.63% 0.42% 0.23% 4.81% 0.39% 1.82% 0.16% 
 
18 
 
 County Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion McDuffie McIntosh Meriwether Miller Mitchell Monroe Montgomery Morgan Murray Muscogee Newton Oconee Oglethorpe Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Quitman Rabun Randolph Richmond 
 
# of Unique Patients 5,495 2,615 4,185 2,330 15,109 16,850 2,261 7,641 2,135 3,481 5,132 2,568 2,350 3,238 2,954 1,911 11,468 3,054 10,763 1,489 2,316 20,226 3,251 3,877 4,663 1,827 5,634 2,384 5,287 1,612 6,392 3,407 1,928 2,691 7,162 37,471 14,249 2,088 1,993 9,369 4,971 3,706 4,063 2,148 7,941 1,936 3,242 717 2,407 2,267 45,059 
 
Net Payments $25,901,099 $10,828,234 $18,691,885 $8,176,477 $48,957,268 $63,432,908 $11,584,218 $32,327,967 $7,445,605 $13,762,964 $21,658,648 $9,896,327 $11,407,952 $12,449,324 $11,856,564 $8,668,820 $45,872,313 $10,675,106 $36,994,117 $5,073,967 $8,305,625 $88,310,462 $13,264,091 $19,734,443 $19,198,939 $7,463,695 $21,227,600 $7,931,999 $21,009,751 $8,580,364 $24,643,797 $17,190,400 $7,166,878 $10,439,703 $24,562,411 
$147,386,420 $49,009,397 $8,774,692 $7,667,227 $32,311,989 $16,769,186 $16,565,022 $18,619,429 $8,573,964 $33,307,297 $8,459,978 $11,580,665 $2,047,506 $11,986,716 $9,404,443 
$207,093,249 
 
Payment/ Patient $4,713.58 $4,140.82 $4,466.40 $3,509.22 $3,240.27 $3,764.56 $5,123.49 $4,230.86 $3,487.40 $3,953.74 $4,220.31 $3,853.71 $4,854.45 $3,844.76 $4,013.73 $4,536.27 $4,000.03 $3,495.45 $3,437.16 $3,407.63 $3,586.19 $4,366.19 $4,080.00 $5,090.13 $4,117.29 $4,085.22 $3,767.77 $3,327.18 $3,973.85 $5,322.81 $3,855.41 $5,045.61 $3,717.26 $3,879.49 $3,429.55 $3,933.35 $3,439.50 $4,202.44 $3,847.08 $3,448.82 $3,373.40 $4,469.78 $4,582.68 $3,991.60 $4,194.35 $4,369.82 $3,572.07 $2,855.66 $4,979.94 $4,148.41 $4,596.05 
 
# of Providers 
3,821 1,992 2,285 2,034 7,809 5,140 1,536 4,545 2,345 2,496 2,369 1,814 1,782 2,125 2,455 1,192 4,382 1,753 4,475 1,504 1,626 6,063 2,745 2,486 2,468 1,365 2,412 1,637 3,386 1,202 2,407 2,862 1,669 2,421 2,701 6,738 6,955 1,759 1,502 6,104 2,764 3,055 2,352 2,229 3,748 1,581 2,813 
827 2,071 1,467 5,889 
 
% of Total Population 
0.39% 0.18% 0.29% 0.16% 1.06% 1.18% 0.16% 0.54% 0.15% 0.24% 0.36% 0.18% 0.17% 0.23% 0.21% 0.13% 0.81% 0.21% 0.76% 0.10% 0.16% 1.42% 0.23% 0.27% 0.33% 0.13% 0.40% 0.17% 0.37% 0.11% 0.45% 0.24% 0.14% 0.19% 0.50% 2.63% 1.00% 0.15% 0.14% 0.66% 0.35% 0.26% 0.29% 0.15% 0.56% 0.14% 0.23% 0.05% 0.17% 0.16% 3.17% 
 
19 
 
 County Rockdale Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth Unique Count Total 
 
# of Unique Patients 10,518 917 3,699 2,558 13,160 5,311 1,368 9,129 1,504 451 4,742 2,199 3,145 3,099 11,359 9,372 7,995 1,314 1,759 14,334 2,734 1,912 2,913 5,942 10,992 10,017 9,665 1,639 4,635 6,295 537 1,416 3,553 16,776 2,237 2,356 2,130 4,910 
1,422,773 
 
Net Payments $37,816,802 $2,949,507 $14,282,048 $10,625,522 $49,485,483 $24,140,875 $7,213,071 $38,259,404 $4,131,851 $1,590,541 $22,255,635 $ 9,288,519 $17,481,235 $11,110,975 $57,503,741 $36,566,761 $38,862,435 $8,826,462 $7,643,348 $56,215,116 $10,891,557 $8,528,256 $15,412,906 $24,835,389 $49,131,930 $34,914,690 $48,027,446 $7,620,967 $20,674,140 $27,399,554 $1,576,561 $6,226,832 $15,473,434 $59,574,401 $12,379,367 $9,236,942 $7,900,560 $17,518,192 
$5,587,222,638 
 
Payment/ Patient $3,595.44 $3,216.47 $3,861.06 $4,153.84 $3,760.30 $4,545.45 $5,272.71 $4,190.97 $2,747.24 $3,526.70 $4,693.30 $4,223.97 $5,558.42 $3,585.34 $5,062.39 $3,901.70 $4,860.84 $6,717.25 $4,345.28 $3,921.80 $3,983.74 $4,460.38 $5,291.08 $4,179.63 $4,469.79 $3,485.54 $4,969.21 $4,649.77 $4,460.44 $4,352.59 $2,935.87 $4,397.48 $4,355.03 $3,551.17 $5,533.91 $3,920.60 $3,709.18 $3,567.86 
 
# of Providers 
6,058 1,027 2,222 1,346 5,704 3,153 1,123 3,009 1,442 
842 2,680 2,172 2,378 1,435 4,026 3,272 3,505 1,487 1,486 5,531 1,602 1,993 2,290 2,942 3,123 5,805 3,447 1,341 2,535 2,871 
715 1,506 2,627 3,916 2,004 2,034 1,718 2,300 
 
% of Total Population 
0.74% 0.06% 0.26% 0.18% 0.92% 0.37% 0.10% 0.64% 0.11% 0.03% 0.33% 0.15% 0.22% 0.22% 0.80% 0.66% 0.56% 0.09% 0.12% 1.01% 0.19% 0.13% 0.20% 0.42% 0.77% 0.70% 0.68% 0.12% 0.33% 0.44% 0.04% 0.10% 0.25% 1.18% 0.16% 0.17% 0.15% 0.35% 
 
$3,927.00 
 
41,512 100.00% 
 
Based on dates of service from July 2003 to June 2004, paid through September 2004, and include claim-based expenditures only. *Patients and providers do not necessarily sum to total as they may switch between categories. 
 
PeachCare for Kids The PeachCare for Kids Program is the Georgia version of the federal Children's Health Insurance Program that provides medical and dental coverage for children of working families whose incomes are too high to qualify for Medicaid, but who do not have health insurance. In FY 2004, uninsured children were eligible for PeachCare for Kids if their families' incomes were up to 235 percent of the federal poverty level, but above Medicaid income guidelines. For a family of four in 2004, 235 percent of the federal poverty level was $44,302. 
 
20 
 
 PEACHCARE FOR KIDS Total Members* Total Patients Average Members Per Year Member Months** Total Expenditures Expenditures Per Member Expenditures Per Patient Providers with Paid Claims Number of Paid Claims 
 
276,536 230,894 201,074 2,412,885 $258,474,336 $934.69 $1,119.45 
23,592 3,089,186 
 
*Members are those who are eligible for and enrolled in the Medicaid or PeachCare for Kids Program. Patients are those members who have received any type of service under these programs. **Member months are the sum of members by month with any coverage type. Based on dates of service from July 2003 to June 2004, paid through September 2004, and include claim-based expenditures only. 
 
PeachCare Enhanced Program Web Site The PeachCare for Kids Program developed an enhanced program Web site at www.peachcare.org. After the creation of this site, PeachCare parents could create a username and password and then log onto "My Account." This enabled parents to check the status of accounts, confirm premium balances, pay premiums online with a credit or debit card or an electronic check, order premium coupon books and update account information. Enhancements also included a large online list of frequently asked questions. Families have been able to apply for PeachCare for Kids online since 2002. This online application was one of the first of its kind in the country. 
 
Back to School PeachCare for Kids Enrollment In FY 2004, PeachCare for Kids collaborated with the Department of Education's Division of School Nutrition Services to distribute 1.6 million flyers to students in public and private schools throughout the state. The flyers were given to parents with the back-to-school enrollment kits during the fall registration. A dramatic increase in applications made at www.peachcare.org occurred because of this effort. Requests for mail-in applications increased greatly as well. 
 
Enrollees The PeachCare for Kids Program was successful in reducing the number of uninsured children in Georgia. Data show 228,000 children were enrolled at the close of FY 2004. 
 
By Age Under 1 year 1 to 5 years 6 to 13 years 14 to 18 years 
 
PEACHCARE FOR KIDS PROFILE 
 
Patients 
 
% of Total 
 
Expenditures 
 
1,865 68,179 123,007 51,019 230,894 
 
0.81% 29.53% 53.27% 22.10% 100.00% 
 
$1,609,499 $69,266,352 $123,542,655 $64,055,829 $258,474,336 
 
% of Total 
0.62% 26.80% 47.80% 24.78% 100.00% 
 
By Gender Male Female 
Continued on the Next Page 
 
117,644 113,314 230,894 
 
50.95% 49.08% 100.00% 
 
$138,762,217 $119,712,119 $258,474,336 
 
53.69% 46.31% 100.00% 
 
21 
 
 By Residence Rural Urban 
 
84,918 147,574 230,894 
 
36.78% 63.91% 100.00% 
 
$100,656,156 $157,818,179 $258,474,336 
 
38.94% 61.06% 100.00% 
 
By Race Unknown White Black American Indian/Alaskan Asian/Pacific Islander Hispanic 
 
22,451 119,103 
69,821 58 
6,042 18,726 230,894* 
 
9.72% 51.58% 30.24% 
0.03% 2.62% 8.11% 100.00%* 
 
$23,036,025 $148,992,576 
$61,087,069 $54,313 
$6,775,322 $18,529,030 $258,474,335 
 
8.91% 57.64% 23.63% 
0.02% 2.62% 7.17% 100.00%* 
 
Based on dates of service from July 2003 to June 2004, paid through September 2004, and include claim-based expenditures only. *Patients do not necessarily sum to total as members switch between categories. 
 
Premiums and Services Families with children who were at least six years old paid a $10 monthly premium for one child or a $15 monthly premium for two or more children when their incomes were below 150 percent of the federal poverty level (FPL) and $20 for two or more children at or above 150 percent of the FPL. The plan required no premium for children aged five years or younger. 
 
The plan pays for preventive services and acute medical care as well as prescription drugs, vision and dental care. PeachCare for Kids Program covers most of the same services covered by Medicaid, with the exception of non-emergency transportation, targeted case management, nursing facilities and community-waiver programs. 
 
Category of Service Physician Services Physician Services Net Payments Subtotal 
Hospital Services Inpatient Hospital Services Outpatient Hospital Services Net Payments Subtotal 
Mental Health Services Community Mental Health Services Net Payments Subtotal 
Maternal & Child Health Services Family Planning Services Health Check Services (EPSDT) Continued on the Next Page 
 
Providers w/ Paid Claims 
 
Unique Patients 
 
Net Payment Net Payment Per Patient 
 
13,489 
 
178,071 
 
$46,193,785 $46,193,785 
 
$259.41 
 
168 
 
3,325 $20,518,576 
 
$6,171.00 
 
235 
 
82,944 $45,970,691 
 
$554.24 
 
$66,489,267 
 
217 
 
4,411 
 
$4,536,887 
 
$1,028.54 
 
$4,536,887 
 
117 2,341 
 
1,605 79,363 
 
$194,928 $5,122,927 
 
$121.45 $64.55 
 
22 
 
 Category of Service Pregnancy-Related Services Children-at-Risk Targeted Case Perinatal Targeted Case Management Diagnostic Screening and Prevention Early Intervention Case Management Children's Intervention Services Childbirth Education Program Children's Intervention School Net Payments Subtotal 
 
Providers w/ Paid Claims 
3 4 5 210 60 1,253 3 134 
 
Unique Patients 
3 16 
5 3,794 
106 2,896 
9 2,759 
 
Net Payment $169 
$2,392 $363 
$146,093 $57,179 
$3,718,769 $36 
$1,916,979 $11,159,835 
 
Net Payment Per Patient 
$56.33 $149.50 
$72.60 $38.51 $539.42 $1,284.11 
$4.00 $694.81 
 
Pharmacy Services Pharmacy Pharmacy DME Supplier Net Payments Subtotal 
 
1,915 1,352 
 
177,052 5,976 
 
$61,634,788 $693,604 
$62,328,392 
 
$348.12 $116.06 
 
Equipment and Devices 
DME Services Orthotics and Prosthetics/Hearing Services 
Net Payments Subtotal 
 
356 
 
4,390 
 
$916,621 
 
142 
 
1,305 
 
$638,063 
 
$1,554,684 
 
$208.80 $488.94 
 
Emergency Transportation Emergency Ground Ambulance Services 
Emergency Air Ambulance Services 
Net Payments Subtotal 
 
155 
 
2,243 
 
$593,582 
 
$264.64 
 
5 
 
52 
 
$168,470 
 
$3,239.81 
 
$762,052 
 
Other Practitioner Services 
Physician's Assistant Services Health Check Dental Program (under 21) 
Vision Care 
Nurse Midwifery 
Oral Maxillofacial Surgery 
Podiatry 
Psychological Services Advanced Registered Nurse Practitioners 
Net Payments Subtotal 
 
629 
1,319 670 74 30 261 621 
1,270 
 
12,709 
132,623 35,211 196 200 1,703 7,052 
22,733 
 
$1,071,298 
$51,133,517 $2,680,953 $21,120 $26,172 $297,929 $4,124,323 
$2,031,103 $61,386,415 
 
$84.29 
$385.56 $76.14 
$107.76 $130.86 $174.94 $584.84 
$89.35 
 
Waiver Program Services Dedicated Case Management Services Continued on the Next Page 
 
2 
 
9 
 
$250 
 
$27.78 
 
23 
 
 Category of Service Net Payments Subtotal 
 
Providers w/ Paid Claims 
 
Unique Patients 
 
Net Payment $250 
 
Net Payment Per Patient 
 
All Other Services Home Health Services Independent Laboratory Services Federally-Qualified Health Center Hospital-based Rural Health Center Free-Standing Rural Health Clinic Chiropractics - Medicare Only Ambulatory Surgical Center/Birthing Hospice Dialysis Services  Technical Dialysis Services  Professional At Risk of Incarceration Child Protective Services Net Payments Subtotal 
 
27 
 
71 
 
$34,831 
 
$490.58 
 
87 
 
22,049 
 
$1,089,347 
 
$49.41 
 
54 
 
3,370 
 
$743,417 
 
$220.60 
 
53 
 
3,031 
 
$490,459 
 
$161.81 
 
30 
 
2,061 
 
$372,754 
 
$180.86 
 
1 
 
1 
 
$3 
 
$3.00 
 
57 
 
1,903 
 
$1,291,460 
 
$678.64 
 
2 
 
2 
 
$11,054 
 
$5,527.00 
 
5 
 
4 
 
$26,012 
 
$6,503.00 
 
3 
 
3 
 
$3,086 
 
$1,028.67 
 
1 
 
1 
 
$173 
 
$173.00 
 
1 
 
2 
 
$169 
 
$84.50 
 
$4,062,765 
 
Unique Count Totals 
 
23,592* 
 
230,894* $258,474,332 
 
$1,119.45* 
 
Based on dates of service from July 2003 to June 2004, paid through September 2004, and include claim-based expenditures only. *Patients and providers do not necessarily sum to total as they may be eligible for more than one category. 
 
24 
 
 PeachCare Services Distribution FY 2004 
 
Waiver Programs 0.0% 
 
All Other Services 1.6% 
 
Other Practitioners 23.7% 
 
Emergency Transportation 0.3% 
 
Equipment and Devices 0.6% 
 
Pharmacy 24.1% 
 
Maternal & Child Health 4.3% 
 
Physicians 17.9% 
 
Hospital 25.7% 
 
Physicians Hospital Mental Health Maternal & Child Health Pharmacy Equipment and Devices Emergency Transportation Other Practitioners Waiver Programs All Other Services 
 
Mental Health 1.8% 
 
PEACHCARE MEMBERS AND EXPENDITURES BY COUNTY 
 
County Appling Atkinson Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb Bleckley Brantley Brooks Bryan Bulloch Burke Butts 
 
# of Unique Patients 782 323 478 130 592 669 2,142 3,363 743 707 2,869 261 835 585 846 1,253 687 709 
 
Net Payments $937,098 $373,106 $659,890 $145,088 $495,983 $817,350 
$2,359,688 $3,679,249 
$840,232 $885,081 $2,869,509 $292,869 $1,052,606 $584,884 $1,217,124 $1,605,099 $756,760 $732,926 
 
Payment/ Patient $1,198.34 $1,155.13 $1,380.52 $1,116.06 $837.81 $1,221.75 $1,101.63 $1,094.04 $1,130.86 $1,251.88 $1,000.18 $1,122.10 $1,260.61 $999.80 $1,438.68 $1,281.00 $1,101.54 $1,033.75 
 
# of Providers 
608 328 368 211 398 775 1,516 1,690 482 555 1,202 296 592 423 733 775 549 755 
 
% of Total Population 
0.34% 0.14% 0.21% 0.06% 0.26% 0.29% 0.93% 1.46% 0.32% 0.31% 1.24% 0.11% 0.36% 0.25% 0.37% 0.54% 0.30% 0.31% 
 
25 
 
 County Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson DeKalb Decatur Dodge Dooly Dougherty Douglas Early Echols Effingham Elbert Emanuel Evans Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham 
 
# of Unique Patients 204 1,036 331 2,983 1,148 386 4,737 82 565 4,270 1,631 95 8,440 274 13,225 1,522 1,487 2,080 728 2,303 461 670 457 657 16,468 1,011 563 347 2,141 3,348 345 171 1,429 723 820 351 1,195 1,289 2,387 2,165 850 12,409 1,090 101 1,773 1,757 923 407 21,609 1,408 
 
Net Payments $217,573 
$1,149,381 $392,180 
$3,997,212 $1,405,785 
$540,231 $5,567,509 
$105,957 $664,575 $5,167,832 $1,667,130 $102,422 $7,886,023 $405,646 $13,497,778 $2,027,737 $1,641,253 $2,465,427 $986,408 $3,056,889 $487,143 $709,737 $577,096 $746,534 $15,880,970 $1,125,346 $611,791 $359,382 $2,154,675 $3,877,254 $490,968 $185,944 $1,886,579 $832,426 $1,257,881 $412,049 $1,661,039 $1,474,511 $3,122,740 $2,777,392 $1,112,174 $12,215,090 $1,371,783 $163,245 $2,089,969 $2,075,974 $956,464 $441,455 $24,049,630 $1,528,959 
 
Payment/ Patient $1,066.53 $1,109.44 $1,184.83 $1,340.00 $1,224.55 $1,399.56 $1,175.32 $1,292.16 $1,176.24 $1,210.27 $1,022.15 $1,078.13 $934.36 $1,480.46 $1,020.63 $1,332.28 $1,103.73 $1,185.30 $1,354.96 $1,327.35 $1,056.71 $1,059.31 $1,262.79 $1,136.28 $964.35 $1,113.10 $1,086.66 $1,035.68 $1,006.39 $1,158.08 $1,423.10 $1,087.39 $1,320.21 $1,151.35 $1,534.00 $1,173.93 $1,389.99 $1,143.92 $1,308.23 $1,282.86 $1,308.44 $984.37 $1,258.52 $1,616.29 $1,178.78 $1,181.54 $1,036.26 $1,084.66 $1,112.95 $1,085.91 
 
# of Providers 
233 450 345 1,721 630 293 1,329 207 541 2,262 832 134 3,144 239 4,344 671 758 919 526 1,266 540 439 333 674 4,897 546 413 339 921 2,025 334 193 780 496 646 319 664 1,038 1,105 1,441 708 5,937 844 243 741 879 479 409 4,829 785 
 
% of Total Population 
0.09% 0.45% 0.14% 1.29% 0.50% 0.17% 2.05% 0.04% 0.24% 1.85% 0.71% 0.04% 3.66% 0.12% 5.73% 0.66% 0.64% 0.90% 0.32% 1.00% 0.20% 0.29% 0.20% 0.28% 7.13% 0.44% 0.24% 0.15% 0.93% 1.45% 0.15% 0.07% 0.62% 0.31% 0.36% 0.15% 0.52% 0.56% 1.03% 0.94% 0.37% 5.37% 0.47% 0.04% 0.77% 0.76% 0.40% 0.18% 9.36% 0.61% 
 
26 
 
 County Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion McDuffie McIntosh Meriwether Miller Mitchell Monroe Montgomery Morgan Murray Muscogee Newton Oconee Oglethorpe Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Quitman 
 
# of Unique Patients 5,345 114 1,116 530 722 483 4,020 2,436 379 1,670 463 621 612 286 230 778 457 323 1,193 912 968 279 247 2,658 932 334 993 240 779 427 597 191 890 658 345 630 1,454 3,338 2,895 628 463 3,593 593 1,007 816 480 1,408 214 538 57 
 
Net Payments $5,825,469 $97,643 $1,416,299 $461,809 $781,591 $637,552 $4,160,523 $2,628,941 $536,445 $2,028,184 $476,174 $784,490 $776,245 $341,817 $260,505 $905,956 $514,118 $397,842 $1,384,626 $1,092,648 $1,034,750 $312,916 $270,474 $3,208,717 $1,189,071 $346,200 $1,549,687 $273,632 $950,241 $529,708 $665,380 $247,252 $1,216,248 $636,799 $405,019 $749,731 $1,857,416 $3,622,058 $3,441,547 $741,554 $487,378 $4,127,783 $641,459 $1,250,589 $947,500 $649,344 $1,659,828 $215,901 $576,341 $65,584 
 
Payment/ Patient $1,089.89 $856.52 $1,269.09 $871.34 $1,082.54 $1,319.98 $1,034.96 $1,079.20 $1,415.42 $1,214.48 $1,028.45 $1,263.27 $1,268.37 $1,195.16 $1,132.63 $1,164.47 $1,124.99 $1,231.71 $1,160.63 $1,198.08 $1,068.96 $1,121.56 $1,095.04 $1,207.19 $1,275.83 $1,036.53 $1,560.61 $1,140.13 $1,219.82 $1,240.53 $1,114.54 $1,294.51 $1,366.57 $967.78 $1,173.97 $1,190.05 $1,277.45 $1,085.10 $1,188.79 $1,180.82 $1,052.65 $1,148.84 $1,081.72 $1,241.90 $1,161.15 $1,352.80 $1,178.86 $1,008.88 $1,071.26 $1,150.60 
 
# of Providers 
1,878 175 951 491 501 499 
2,238 1,059 
351 1,286 
543 439 493 335 266 598 498 303 683 560 617 359 285 873 701 339 733 312 629 351 678 190 656 599 355 645 651 1,027 1,564 512 452 2,360 528 815 463 512 940 221 464 
89 
 
% of Total Population 
2.31% 0.05% 0.48% 0.23% 0.31% 0.21% 1.74% 1.06% 0.16% 0.72% 0.20% 0.27% 0.27% 0.12% 0.10% 0.34% 0.20% 0.14% 0.52% 0.39% 0.42% 0.12% 0.11% 1.15% 0.40% 0.14% 0.43% 0.10% 0.34% 0.18% 0.26% 0.08% 0.39% 0.28% 0.15% 0.27% 0.63% 1.45% 1.25% 0.27% 0.20% 1.56% 0.26% 0.44% 0.35% 0.21% 0.61% 0.09% 0.23% 0.02% 
 
27 
 
 County Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth Unique Count Total 
 
# of Unique Patients 763 217 3,513 2,289 161 434 287 1,452 870 127 815 151 48 570 265 392 216 1,455 1,314 1,003 349 262 1,697 393 287 797 807 1,396 2,403 1,341 171 448 923 93 225 938 3,807 254 330 248 853 
 
Net Payments $964,639 $244,766 
$3,616,981 $2,195,092 
$224,146 $646,017 $333,493 $1,335,558 $1,658,642 $144,707 $1,149,542 $184,856 
$54,994 $680,034 $312,346 $467,200 $241,338 $1,292,314 $1,510,805 $1,210,914 $381,953 $329,027 $1,765,490 $658,387 $279,259 $1,041,004 $824,966 $1,480,495 $2,941,515 $1,732,334 $262,866 $430,550 $1,084,202 $105,955 $316,862 $1,116,318 $3,841,999 $405,778 $377,679 $246,915 $1,117,722 
 
230,894 $258,474,336 
 
Payment/ Patient $1,264.27 $1,127.95 $1,029.60 $958.97 $1,392.21 $1,488.52 $1,162.00 $919.81 $1,906.48 $1,139.43 $1,410.48 $1,224.21 $1,145.71 $1,193.04 $1,178.66 $1,191.84 $1,117.31 $888.19 $1,149.78 $1,207.29 $1,094.42 $1,255.83 $1,040.36 $1,675.29 $973.03 $1,306.15 $1,022.26 $1,060.53 $1,224.10 $1,291.82 $1,537.23 $961.05 $1,174.65 $1,139.30 $1,408.28 $1,190.10 $1,009.19 $1,597.55 $1,144.48 $995.63 $1,310.34 
 
# of Providers 
504 207 1,244 1,406 190 441 189 937 556 158 447 268 123 567 386 418 259 587 532 597 324 294 706 402 384 491 425 685 1,681 726 221 354 526 135 318 658 998 368 383 342 623 
 
$1,119 
 
23,592 
 
% of Total Population 
0.33% 0.09% 1.52% 0.99% 0.07% 0.19% 0.12% 0.63% 0.38% 0.06% 0.35% 0.07% 0.02% 0.25% 0.11% 0.17% 0.09% 0.63% 0.57% 0.43% 0.15% 0.11% 0.73% 0.17% 0.12% 0.35% 0.35% 0.60% 1.04% 0.58% 0.07% 0.19% 0.40% 0.04% 0.10% 0.41% 1.65% 0.11% 0.14% 0.11% 0.37% 
100.00% 
 
Based on dates of service from July 2003 to June 2004, paid through September 2004, and include claim-based expenditures only. 
 
Indigent Care Trust Fund The Indigent Care Trust Fund (ICTF), which completed its fourteenth year of operation in FY 2004, funds and supports programs and facilities serving medically-indigent patients in Georgia. 
 
Contributions made to the ICTF in FY 2004 by non-federal sources included the following: 
 
28 
 
  Intergovernmental transfers from hospitals participating in the Disproportionate Share Hospital (DSH) Program. The DSH Program helped compensate hospitals for their uncompensated indigent care; 
 Nursing home provider fees;  Penalties for non-compliance with Certificate of Need (CON) requirements;  Ambulance license fees; and  Fees collected from the initial sale of breast cancer license tags. 
The ICTF was also allowed to retain for use interest earned from funds contributed into the trust fund. 
The fund source contributions match is approximately 60:40 for benefit expenditures and 50:50 for administrative expenditures. No money from Georgia's general treasury was used. 
In FY 2004, the use of the ICTF was limited to any one or a combination of the following:  To expand Medicaid eligibility and services;  For programs that supported rural and other health care providers, primarily hospitals, which served 
the medically indigent; and/or  For primary health care programs for medically indigent citizens and children in Georgia. 
Two exclusions existed in FY 2004 as shown below:  Any nursing home provider fees remitted to the ICTF had to be matched with federal Medicaid funds 
and made available to provide support to nursing homes that disproportionately served the medically indigent.  Certain proceeds from the sale of breast cancer license tags were to be used to fund screening and treatment-related programs for people with breast cancer who were also medically indigent. Programs included the following: education, screening, grants-in-aid to cancer patients, pharmacy assistance programs for cancer patients and other projects to encourage public support for the special license plate and the activities it funded. 
 
FY 2004 Expenditures Disproportionate Share Hospital Payments Medicaid Payments to Nursing Homes Medicaid Expansion for Pregnant Women and Children Ambulance Medicaid Rate Subsidy Programs to Support the Medically Indigent Breast Cancer Initiatives Total 
 
$424,724,498 $241,946,052 
$59,415,157 $5,555,808 $1,140,171 $277,990 
$733,059,676 
 
In FY 2004, DSH payments comprised 57.9 percent of ICTF expenditures; nursing home payments were 33.0 percent; breast cancer/medically indigent programs were 0.3 percent of expenditures; Medicaid expansion was 8.1 percent and ambulance rates were 0.8 percent of total expenditures. 
 
Facility Name Appling Hospital Athens Regional Medical Center Atlanta Medical Center Bacon County Hospital Barrow Community Hospital Berrien County Hospital 
 
County Appling Clarke Fulton Bacon Barrow Berrien 
 
DSH Payment 
$508,798 $13,164,979 
$5,130,802 $884,189 $439,015 $483,606 
 
Primary Care Plan Obligation 
$76,320 $1,974,747 
$769,620 $132,628 
$65,852 $72,541 
 
Intergovernmental Transfers (IGTs) 
$254,399 $6,582,490 
$0 $442,095 
$0 $0 
 
29 
 
 Facility Name BJC Medical Center Bleckley Memorial Hospital Brooks County Hospital Burke Medical Center Calhoun Memorial Hospital Camden Medical Center Central State Hospital Medical/Surgical Charlton Memorial Hospital Chestatee Regional Hospital Children's Healthcare of Atlanta at Egleston Children's Healthcare of Atlanta at Scottish Rite Cobb Memorial Hospital Coffee Regional Medical Center Colquitt Regional Medical Center Crawford Long Hospital of Emory University Crisp Regional Hospital DeKalb Medical Center Dodge County Hospital Donalsonville Hospital, Inc. Dorminy Medical Center Early Memorial Hospital East Georgia Regional Medical Center Elbert Memorial Hospital Emanuel Medical Center Emory Dunwoody Medical Center Emory Peachtree Regional Hospital Evans Memorial Hospital Fairview Park Hospital Fannin Regional Hospital Flint River Community Hospital Floyd Medical Center Georgia Baptist Meriwether Hospital Grady General Hospital Grady Memorial Hospital Habersham County Medical Center Hamilton Medical Center Higgins General Hospital 
 
County Jackson Bleckley Brooks Burke Calhoun Camden 
Baldwin Charlton Lumpkin 
Dekalb 
Fulton Franklin Coffee Colquitt 
Fulton Crisp Dekalb Dodge Seminole Ben Hill Early 
Bulloch Elbert Emanuel DeKalb Coweta Evans Laurens Fannin Macon Floyd Meriwether Grady Fulton Habersham Whitfield Haralson 
 
DSH Payment $1,196,350 
$450,873 $659,179 $301,035 $485,951 $1,778,273 
 
Primary Care Plan Obligation 
$179,453 $67,631 $98,877 $45,155 $72,893 
$266,741 
 
Intergovernmental Transfers (IGTs) 
$598,175 $225,437 $329,590 $150,518 $242,976 $889,137 
 
$7,740,269 $865,481 
$1,423,968 
 
$1,161,040 $129,822 $213,595 
 
$3,870,135 $432,741 $0 
 
$6,409,043 
 
$961,356 
 
$0 
 
$2,408,996 $2,016,680 $5,937,566 $1,764,900 
 
$361,349 $302,502 $890,635 $264,735 
 
$0 $0 $2,968,783 $882,450 
 
$2,946,070 $1,682,796 $5,383,071 $1,901,395 $1,054,669 
$962,609 $1,090,151 
 
$441,911 $252,419 $807,461 $285,209 $158,200 $144,391 $163,523 
 
$0 $841,398 $2,691,536 $950,698 
$0 $481,305 $545,076 
 
$926,329 $988,126 $1,376,988 $518,371 $625,896 $1,415,545 $465,867 $913,496 $669,962 $6,648,712 $1,326,619 $1,388,270 $151,104,843 $1,732,991 $1,616,054 $857,526 
 
$138,949 $148,219 $206,548 
$77,756 $93,884 $212,332 $69,880 $137,024 $100,494 $997,307 $198,993 $208,241 $22,665,726 $259,949 $242,408 $128,629 
 
$0 $494,063 $688,494 
$0 $0 $707,773 $0 $456,748 $0 $3,324,356 $663,310 $694,135 $75,552,422 $866,496 $0 $428,763 
 
30 
 
 Facility Name Hughes Spalding Children's Hospital Hutcheson Medical Center Irwin County Hospital Jasper Memorial Hospital Jeff Davis Hospital Jefferson Hospital John D. Archbold Memorial Hospital Liberty Regional Medical Center Louis Smith Memorial Hospital McDuffie Regional Medical Center Meadows Regional Medical Center Medical Center of Central Georgia Medical College of GA Hospitals & Clinics Memorial Health University Med. Ctr. Memorial Hospital of Adel Memorial Hospital of Bainbridge Miller County Hospital Minnie G. Boswell Memorial Hospital Mitchell County Hospital Monroe County Hospital Murray Medical Center Northeast Georgia Medical Center Oconee Regional Medical Center Phoebe Worth Medical Center Phoebe Putney Memorial Hospital Polk Medical Center Putnam General Hospital Rabun County Memorial Hospital Roosevelt Warm Springs Institute for Rehabilitation Satilla Regional Medical Center Screven County Hospital Smith Northview Hospital South Fulton Medical Center South Georgia Medical Center Southeast Georgia Regional Medical Center Southwest Hospital and Medical Center Stephens County Hospital Sumter Regional Hospital, Inc. 
 
County Fulton Catoosa Irwin Jasper Jeff Davis Jefferson Thomas Liberty Lanier McDuffie Toombs Bibb 
Richmond Chatham Cook Decatur Miller Greene Mitchell Monroe Murray Hall Baldwin Worth Dougherty Polk Putnam Rabun 
Meriwether Ware Screven Lowndes Fulton Lowndes 
Glynn 
Fulton Stephens Sumter 
 
DSH Payment $4,249,644 $5,394,668 
$802,523 $378,318 $648,633 $473,974 $4,825,824 $2,489,141 $650,536 $449,033 $2,216,949 $23,022,098 
 
Primary Care Plan Obligation 
$637,447 $809,200 $120,378 
$56,748 $97,295 $71,096 $723,874 $373,371 $97,580 $67,355 $332,542 $3,453,315 
 
Intergovernmental Transfers (IGTs) 
$2,124,822 $2,697,334 
$401,262 $189,159 $324,317 $236,987 $2,412,912 $1,244,571 
$0 $224,517 $1,108,475 $11,511,049 
 
$27,627,835 $19,247,439 
$488,152 $1,501,369 
$608,471 $524,909 $973,013 $375,223 $1,785,553 $8,826,642 $2,534,827 $1,472,432 $7,326,668 $1,753,210 $561,764 $889,052 
 
$4,144,175 $2,887,116 
$73,223 $225,205 
$91,271 $78,736 $145,952 $56,283 $267,833 $1,323,996 $380,224 $220,865 $1,099,000 $262,982 $84,265 $133,358 
 
$13,813,918 $9,623,720 $0 $750,685 $304,236 $262,455 $486,507 $187,612 $892,777 $4,413,321 $1,267,414 $0 $3,663,334 $876,605 $280,882 $444,526 
 
$1,196,280 $2,986,684 
$456,007 $1,184,783 $3,461,998 $3,980,925 
 
$179,442 $448,003 
$68,401 $177,717 $519,300 $597,139 
 
$598,140 $1,493,342 
$228,004 $0 $0 
$1,990,463 
 
$4,919,877 
 
$737,982 
 
$2,459,939 
 
$1,113,017 $2,377,330 $2,242,794 
 
$166,953 $356,600 $336,419 
 
$0 $1,188,665 $1,121,397 
 
31 
 
 Facility Name Sylvan Grove Hospital Tanner Medical Center/Villa Rica Tattnall Community Hospital Taylor Regional Hospital The Medical Center Tift Regional Medical Center Union General Hospital University Hospital Upson Regional Medical Center Walton Medical Center Washington County Regional Medical Center Wayne Memorial Hospital West Georgia Medical Center Wheeler County Hospital Wills Memorial Hospital Totals 
 
County Butts Carroll Tattnall Pulaski Muscogee Tift Union Richmond Upson Walton 
Washington Wayne Troup Wheeler Wilkes 
 
DSH Payment 
$834,443 $984,198 $807,117 $495,782 $13,746,911 $1,941,875 $251,165 $8,423,124 $2,023,112 $802,620 
 
Primary Care Plan Obligation 
$125,166 $147,630 $121,068 
$74,367 $2,062,037 
$291,281 $37,675 
$1,263,469 $303,467 $120,393 
 
Intergovernmental Transfers (IGTs) 
$417,222 $492,099 
$0 $0 $6,873,456 $970,938 $125,583 $4,211,562 $1,011,556 $0 
 
$1,193,968 $1,300,760 $2,535,906 
$779,397 $940,216 $424,724,498 
 
$179,095 $195,114 $380,386 $116,910 $141,032 $63,708,676 
 
$596,984 $650,380 $1,267,953 
$0 $470,108 $193,166,687 
 
Nursing Home Provider Fees FY 2004 Enrolled 
A.G. Rhodes Home, Inc. - Cobb A.G. Rhodes Home at Wesley Woods, Inc. A.G. Rhodes Home, Inc. AHC Decatur Albany Health Care, Inc. Altamaha Healthcare Center Alvista Healthcare Center, Inc. Appling Convalescent Center Appling Nursing Home Arrowhead Healthcare Center Ashburn Health Care Ashton Woods Nursing Home and Rehabilitation Center Athena Rehabilitation of Clayton Athens Heritage Home, Inc. Augusta Hills Nursing and Rehabilitation Center, Inc. Austell Health Care, Inc. Autumn Breeze Health Care Center Avalon Health & Rehabilitation Center Azalea Trace Nursing Center Azalealand Nursing Home Bagwell Nursing Home of Carrollton, Inc. doing business as (dba) Oak Mountain Village Health Center Bainbridge Healthcare Banks-Jackson-Commerce Nursing Home 
 
FY 2004 Total $307,421 $365,054 $376,991 $301,534 $507,610 $169,909 $251,609 $197,328 $88,525 $296,955 $197,739 $380,762 $601,389 $243,112 $300,241 $318,451 $296,130 $241,484 $327,596 $261,382 
$105,568 $274,404 $364,482 
 
32 
 
 Enrolled Baptist Village, Inc. Bayview Nursing Home Beaulieu Convalescent Center, Inc. Bel Arbor Nursing Center Berrien Nursing Center Bethany Home Nursing Center of Vidalia Bethany Home Nursing Center of Millen Beverly Health and Rehabilitation Center - Jesup Beverly Healthcare - Decatur Beverly Healthcare - Glenwood Beverly Healthcare - Kennestone Beverly Healthcare - Northside Beverly Healthcare -Tifton Beverly Health and Rehabilitation - Jonesboro Beverly Healthcare Beverly Manor of Augusta Blair House Nursing and Rehabilitation Center Blue Ridge Health Care Center, Inc. Bolingreen Nursing Center Boswell-Parker Nursing Center Brentwood Terrace Health Center Brian Center Nursing Care of Austell Brian Center Nursing Care of Canton Brian Center Nursing Care of Jeffersonville Brian Center Nursing Care of La Grange Brian Center Nursing Care of Lumber City Brian Center Nursing Care of Powder Springs Brian Center Nursing Care of St. Simon Island Brian Center Nursing Care of Thomasville Briarwood Nursing Center Brightmoor Health Care, Inc. Brown Memorial Convalescent Center Brownwood Nursing Home, Inc. Bryan County Health and Rehabilitation Center Bryant Nursing Center Calhoun Health Care Center, Inc. Calhoun Nursing Home Camellia Gardens of Life Care Candler Hospital Subacute Unit Canton Nursing Center, Inc. Carrollton Manor Nursing Home, Inc. Cedar Springs Health and Rehabilitation Chaplinwood Nursing Home Chatsworth Health Care Center Chattahoochee Health Care Center, Inc. dba Dogwood Health & Rehabilitation Chatuge Regional Nursing Home CHC Carrollton Nursing and Rehabilitation Center, Inc. 
 
FY 2004 Total $706,902 $174,740 $410,432 $277,141 $272,948 $515,985 $265,326 $227,832 $189,669 $630,088 $349,950 $537,298 $261,861 $41,446 $231,662 $237,181 $277,660 $252,844 $311,395 $55,765 $267,128 $464,280 $252,930 $196,694 $350,122 $227,793 $527,133 $299,144 $134,065 $262,722 $388,516 $443,528 $277,629 $262,165 $206,274 $278,358 $171,292 $163,522 $3,661 $272,014 $274,014 $278,483 $289,696 $322,789 $206,653 $337,834 $429,681 
 
33 
 
 Enrolled Cherry Blossom Health Care Center Christian City Convalescent Center, Inc. Chulio Hills Health and Rehabilitation Church Home for the Aged (Christ Sanctified) Clarke Health Care Center, Inc. Claxton Nursing Home, Inc. Clinch Healthcare Center Coastal Manor Cobb Healthcare Center College Park Health Care Center Cordele Health and Rehabilitation Center, Inc. Cornerstone Health and Rehabilitation Center Countryside Health Center Covington Manor Nursing Home Crestview Nursing Facility Crisp Regional Nursing and Rehabilitation Center Crystal Springs Nursing Home Cumming Nursing Center Dade Health and Rehabilitation Dawson Manor Nursing Home Decatur Health Care Center, Inc. Delmar Gardens of Gwinnett, Inc. Delmar Gardens of Smyrna Dublinair Nursing Home Eagle's Nest Truck Station, Inc. (Moss Oaks) Early Memorial Nursing Home Eastview Nursing Center Eatonton Health and Rehabilitation Center Effingham County Extended Care Facility Elberta Health Care Emanuel Medical Center Nursing Home Emory Adventist Nursing Home Emory Nursing Center Fairburn Health Care Center, Inc. Family Life Enrichment Center, Inc. Fifth Avenue Health Care Fitzgerald Nursing Home Florence Hand Home Forrest Lake Health Care, Inc. Fort Gaines Nursing Home Fort Oglethorpe Health Care, Inc. Fort Valley Healthcare Center Four County Health Care Franklin Health Care Center Friendship Health Care Fulton Health and Rehabilitation Center, Inc. Garden Terrance 
34 
 
FY 2004 Total $220,527 $557,792 $237,770 $151,402 $251,488 $199,147 $225,278 $185,074 $353,373 $268,520 $229,398 $443,606 $164,117 $206,661 $126,306 $398,955 $161,915 $245,691 $181,410 $207,945 $196,199 $150,009 $313,657 $408,592 $171,314 $377,257 $262,244 $258,861 $314,794 $165,900 $150,190 $204 $122,263 $333,501 $220,641 $268,264 $223,310 $391,438 $264,032 $180,592 $304,286 $173,176 $240,610 $168,009 $234,867 $316,414 $646,693 
 
 Enrolled Gateway Health Care Gibson Health and Rehabilitation Center Gilmer Nursing Home Glendale Nursing Home Glenn-Mor Nursing Home Glenvue Nursing Home Gold City Health and Rehabilitation Center Gordon Health Care Center Gracemore Nursing Center Grandview Health Care Center Gray Nursing Home Green Acres Nursing Home Greene Point Health Care Gwinnett Extended Care Center Habersham Home Hamilton House Nursing Center Hartley Woods Health and Rehabilitation Center Hartwell Health Care Center HCP III Athens, Inc. HCP III Bremen, Inc. HCP III Cedartown, Inc. HCP III Cummings, Inc. HCP III Eastman, Inc. HCP III Hartwell, Inc. HCP III Macon, Inc. HCP III Pine Knoll, Inc. HCP III Rockmark, Inc. HCP III Roswell, Inc. HCP III Savannah, Inc. HCP III Shamrock, Inc. HCP III Social Circle, Inc. HCP III Woodstock, Inc. Heardmont Nursing Home Heritage Inn Health and Rehabilitation Center Heritage Inn of Barnesville Heritage Inn of Sandersville Heritage Park of Savannah, Inc. HGW Corporation dba Forsyth Nursing Home Hilltop Nursing Home, Inc. Hospitality Care Center IHS of Atlanta at Buckhead (of Lester) Ideal Health Care Center IHS of Atlanta at Shoreham IHS of Briarcliff Haven, Inc. Jennings Healthcare, Inc. Jesup Healthcare Center Joe-Anne Burgin Nursing Home 
35 
 
FY 2004 Total $156,727 $285,539 $280,804 $243,950 $187,047 $428,695 $197,359 $332,357 $147,709 $167,358 $149,536 $289,610 $194,565 $230,443 $242,378 $329,283 $294,507 $281,411 $307,064 $320,264 $276,335 $400,875 $279,724 $319,906 $391,903 $330,971 $142,146 $521,016 $342,934 $264,987 $160,842 $432,694 $173,272 $236,576 $321,736 $177,073 $305,820 $198,941 $195,643 $174,542 $212,108 $226,922 $353,328 $310,612 $268,738 $152,984 $231,479 
 
 Enrolled Johnson County Nursing Home, Inc. Keysville Nursing Home, Inc. Lafayette Healthcare Center, Inc. Lafayette Nursing and Rehabilitation Center Lake Crossing Health Center Lakeland Villa Convalescent Center Lakeshore Heights Nursing Center, Inc. Laurel Baye Healthcare of Decatur Laurel Baye Healthcare of Lake Lanier Laurel Baye Healthcare of Macon Laurel Park at Henry Medical Center Lee County Health Care Life Care Center Life Care Center of Gwinnett Life Care Center of Lawrenceville Lilburn Geriatric Center, Inc. Lillian G. Carter Nursing Center Lowndes County Health Services, Inc. dba Crestwood Nursing Home Lowndes County Health Services, Inc. dba Heritage House Nursing Home Lowndes County Health Services, Inc. dba Holly Hill Nursing Home Lowndes County Health Services, Inc. dba Lakehaven Nursing Home, Inc. Lowndes County Health Services, Inc. dba Parkwood Developmental Center Lynn Haven Nursing Home Madison Health and Rehabilitation (Beverly Hospital Nursing and Rehabilitation Center) Magnolia Manor Methodist Nursing Center Magnolia Manor South Nursing Center ManorCare of Marietta Nursing and Rehabilitation Maple Ridge Health Care Center Marietta Health and Rehabilitation Center, Inc. Mariner Health of Northeast Atlanta Marion Memorial Nursing Home McRae Manor Nursing Home Meadowbrook Nursing Home, Inc. Meadows Nursing Center Medical Arts Health Facility Memorial Convalescent Center Memorial Manor Nursing Home Memorial Nursing Home Meriwether Nursing Home Metter Nursing Home, Inc. Middle Georgia Nursing Home Midway Health Care Center Miller Nursing Home Mitchell Convalescent Center Molena Nursing Home, Inc. Montezuma Health Care Center Moultrie Healthcare, Inc. dba Sunrise Nursing Home 
36 
 
FY 2004 Total $148,805 $175,773 $260,019 $445,139 $248,641 $175,522 $247,582 $375,026 $308,387 $227,664 $171,943 $167,163 $268,023 $391,437 $306,374 $362,513 $274,914 $210,800 $246,680 $266,032 $227,450 $336,331 $276,889 
$188,294 $626,827 $193,981 $263,927 $206,819 $302,588 $300,490 $191,107 $376,236 $384,232 
$72,220 $323,020 $270,338 $327,444 $250,541 $153,717 $239,766 $220,584 $359,422 $275,257 $147,275 $189,416 $227,962 $157,969 
 
 Enrolled Mountain Healthcare Center, Inc. Mountain View Health and Rehabilitation Center Muscogee Manor and Rehabilitation Center Nancy Hart Nursing Center National Health Care of Rossville New Horizons North New Horizons West New London Health Center NHC Healthcare of Ft. Oglethorpe Nurse Care of Atlanta, Inc. Oak Manor Nursing Home, Inc. Oak View Nursing Home Oak View Nursing Center Oceanside Nursing and Rehabilitation Center Oconee Health Care Oconee Regional Medical Center Skilled-Nursing Unit Old Capitol Inn Healthcare Center, Inc. Osceola Nursing Home Palemon Gaskins Memorial Nursing Home Palmyra Nursing Home, Inc. Park Place Nursing Facility Parkside at Hutcheson Medical Center Parkview Manor (SCHM Parkview, Inc.) Parkwood Nursing and Rehabilitation Center Paulding Memorial Nursing Center Peachbelt Health and Rehabilitation Center Peake Healthcare Center, Inc. Pelham Parkway Nursing Home Phoebe Putney Memorial Hospital (SNF) Pierce County Nursing Home Pine Manor Nursing Home, Inc. Pinehill Nursing Center, Inc. Pineview Health Care Center, Inc. Pinewood Manor Nursing Home Pinewood Nursing Center Pleasant View Nursing Center Premier Subacute and Rehabilitation Center Presbyterian Home, Quitman, Inc. Presbyterian Village, Inc. Providence Healthcare of Sparta Providence Healthcare of Thomaston Pulaski Nursing Home, Inc. Quiet Oaks Health Care Center Quinton Memorial Health Care Center Regency Park Health Care Center Ridgewood Manor Nursing Home River Willows Nursing Center 
37 
 
FY 2004 Total $158,977 $252,300 $151,632 $195,570 $307,297 $310,037 $333,323 $382,189 $357,597 $576,083 $468,035 $276,865 $429,126 $223,053 $139,372 $2,662 $331,941 $233,534 $91,952 $694,374 $280,738 $347,331 $529,932 $461,796 $468,373 $251,163 $313,027 $327,474 $1,997 $226,023 $340,954 $244,192 $230,705 $291,091 $316,913 $352,252 $84,871 $530,056 $301,691 $173,763 $289,000 $213,308 $183,076 $332,787 $263,555 $305,268 $280,865 
 
 Enrolled Riverside Health Care Center Riverside Nursing Center of Thomaston Riverview Nursing and Rehabilitation (Chatham NH) Roberta Healthcare Center Rockdale Healthcare Center Rosemont at Stone Mountain Rosewood Nursing Center, Inc. Ross Memorial Health Care Center Sadie G. Mays Health and Rehabilitation Center Salem Nursing and Rehabilitation Center of Augusta, Inc. Satilla Care Center Savannah Beach Nursing and Rehabilitation Center Savannah Rehabilitation and Nursing Center Savannah Specialty Care Center Scenic View Convalescent Center, Inc. Sears Manor Nursing Home Seminole Manor Nursing Home Shady Acres SHCM Bonterra, Inc. Shepherd Hills Health Care Center, Inc. Smith Medical Nursing Care Center Southeast Georgia Regional Medical Center Southern Medical of North Macon, Inc. Southern Traditions Southland Care Center Southland Nursing Home Spalding Health Care, Inc. Sparta Health Care Center Specialty Care of Marietta Spring Valley Health Care Center, Inc. St. Joseph's Hospital Transitional Care Unit St. Mary's Convalescent Center St. Mary's Hospital Long-Term Care Facility Starcrest of Cartersville Statesboro Nursing Home, Inc. Summerhill Elderliving Home SunBridge Care and Rehabilitation for Atlanta SunBridge Care and Rehabilitation for Cartersville SunBridge Care and Rehabilitation for Folkston SunBridge Care and Rehabilitation for Fountain City SunBridge Care and Rehabilitation for Golden Isles SunBridge Care and Rehabilitation for Griffin SunBridge Care and Rehabilitation for Hazelhurst SunBridge Care and Rehabilitation for Riverdale SunBridge Care and Rehabilitation for Seven Hills SunBridge Care and Rehabilitation for Statesboro SunBridge Care and Rehabilitation for Mount Berry 
38 
 
FY 2004 Total $389,481 $214,159 $556,851 $226,732 $239,889 $382,670 $296,343 $264,602 $120,305 $397,018 $268,452 $145,103 $273,449 $225,191 $287,057 $264,137 $87,239 $450,485 $323,998 $299,608 $164,448 $4,120 $504,630 $125,679 $339,402 $443,312 $166,963 $219,576 $326,341 $154,303 $2,940 $225,636 $323,730 $341,926 $254,747 $407,597 $278,509 $298,797 $218,835 $476,636 $220,325 $374,073 $197,969 $394,816 $270,170 $176,625 $262,213 
 
 Enrolled SunBridge Care Center for Moran Lake Swainsboro Nursing Home, Inc. Sylvester Health Care, Inc. Syl-View Health Care Center, Inc. Tattnall Healthcare Center Taylor County Health Care The Bell Minor Home, Inc. The Fountainview Center for Alzheimer's Disease The Oaks Nursing Home, Inc. The Retreat Nursing Home The Seasons Health and Rehabilitation Center The William Breman Jewish Home Thomaston Health and Rehabilitation Thomson Manor Nursing Home Tift Health Care, Inc. Toccoa Nursing Center, Inc. Toombs Nursing Home Toomsboro Nursing Center, Inc. Traditions Health and Rehabilitation Center Treutlen County Nursing Home Tucker Nursing Center Twin Fountain Home Twin Oaks Convalescent Center Twin View Healthcare Center Union County Nursing Home University External Care/Westwood University External Care/Kentwood Walton Medical Center Convalescent Unit Warner Robins Rehabilitation Center Warrenton Health and Rehabilitation Center Washington County Extended Care Facility Waycross Health and Rehabilitation Center West Lake Manor (Richmond NH) Westbury Medical Care Home, Inc. Westminster Commons Westview Nursing and Rehabilitation Center Westwood Nursing Center Wildwood Health Care, Inc. Wilkes Health Care Center, Inc. Willowwood Nursing Center Winder Nursing, Inc. Windermere Nursing Home Winthrop Manor Nursing Center Wood Dale Health Care Center Woodlands (Moultrie Nursing Center) Wrightsville Manor Total 
39 
 
FY 2004 Total $261,846 $237,150 $300,908 $321,959 $178,619 $213,656 $279,429 $344,365 $140,332 $159,390 $452,609 $287,942 $306,768 $397,693 $475,353 $504,020 $384,746 $170,342 $524,189 $151,983 $331,472 $338,369 $250,167 $306,449 $459,613 $420,481 $162,275 $177,176 $291,979 $319,785 $185,192 $252,261 $214,355 $558,674 $126,067 $241,493 $126,364 $132,871 $115,756 $290,017 $471,318 $269,465 $273,185 $235,616 $144,031 $263,274 
$97,101,076 
 
 Upper Payment Limits Upper Payment Limits (UPLs) are available to eligible hospitals and nursing homes. These reimbursements "fill the gap" between what Medicaid paid and what Medicare would have paid. The state receives intergovernmental transfers (IGTs) from participating public hospitals and nursing homes which are used to match federal UPL funds available. UPL payments are then made back to the eligible hospital or nursing home. 
 
For Nursing Homes in FY 2004: Nursing Home 
Allen Hall (Intermediate Care Facility for the Mentally Retarded  ICF/MR) Appling Convalescent Center Appling Nursing Home Azalea Trace Nursing Center Banks-Jackson-Commerce Medical Center Nursing Home Boswell-Parker Nursing Center Brentwood Terrace Health Center Bryant Nursing Center Calhoun Nursing Home Chatuge Regional Nursing Home Cherry Blossom Health Care Coastal Manor Crestview Health and Rehabilitation Center Crisp Regional Nursing and Rehabilitation Center Dawson Manor Nursing Home East Central Georgia (ICF/MR) Early Memorial Nursing Home Effingham County Extended Care Facility Emanuel County Medical Center Nursing Home Florence Hand Home Four County Health Care Georgia Baptist Meriwether Nursing Home Glenn-Mor Nursing Home Glenvue Nursing Home Gracewood Development Center (ICF/MR) Gray Nursing Home Greene Point Health Care Gwinnett Extended Care Center Habersham Nursing Home Hamilton House Nursing and Rehabilitation Center Hartwell Health Care Center Heritage Inn of Barnesville Heritage Inn of Sandersville Ideal Health Care Center 
 
FY 2004 Payments 
$139,649 $1,175,335 
$500,230 $2,000,533 
$2,156,119 $257,734 
$1,785,462 $1,072,551 $1,040,749 $1,890,639 $1,220,985 
$621,605 $5,575,538 $1,449,371 $1,342,227 $1,577,534 $2,605,292 $1,971,833 
$221,253 $707,044 $1,312,028 $729,009 $1,017,480 $3,034,071 $2,896,946 $1,143,022 $1,080,676 $1,050,358 $1,069,977 $1,194,336 $1,675,557 $1,754,769 $840,730 $1,362,778 
 
FY 2004 IGTs 
$52,997 $979,446 $416,858 $1,667,111 
$1,796,766 $214,778 
$1,487,885 $893,793 $867,291 
$1,575,533 $1,017,488 
$518,004 $4,646,282 $1,207,809 $1,118,523 
$598,674 $2,171,077 $1,643,194 
$184,378 $589,203 $1,093,357 $607,508 $847,900 $2,528,393 $1,099,391 $952,518 $900,563 $875,298 $891,648 $995,280 $1,396,298 $1,462,308 $700,608 $1,135,648 
 
40 
 
 Nursing Home Joe-Anne Burgin Nursing Home Kentwood Nursing Home Laurel Park Nursing Home Lee County Health Care Lillian G. Carter Nursing Center Lynn Haven Nursing Home Marion Memorial Nursing Home Meadows Nursing Center Memorial Manor Nursing Home Miller Nursing Home Mitchell Convalescent Center Montezuma Health Care Center Muscogee Manor and Rehabilitation Center New Horizons - North New Horizons - West Northwest Georgia Regional Hospital (ICF/MR) Oak View Nursing Home, Inc. Oakview Nursing and Rehabilitation Center Oconee Health Care Palemon Gaskins Memorial Nursing Home Parkside at Hutcheson Medical Center Pecan Manor (ICF/MR) Pelham Parkway Nursing Home Phoebe Putney Memorial Hospital Skilled-Nursing Facility (SNF) Piedmont Hall (ICF/MR) Pierce County Nursing Home Providence Healthcare of Sparta Providence Healthcare of Thomaston Riverside Nursing Center Of Thomaston Rose Haven Nursing Facility Satilla Care Center Shady Acres Convalescent Center S.E. Georgia Health System  Transitional Care Unit Sparta Health Care Center St. Mary's Convalescent Center Starcrest of Cartersville Starcrest Of Lithonia Taylor County Health Care The Retreat Thomson Manor Nursing Home Toombs Nursing Home 
 
FY 2004 Payments $1,326,000 $1,272,396 $416,054 $1,299,456 $1,425,817 $1,663,087 $1,084,460 $187,458 $1,315,910 $1,530,338 $715,514 $1,629,060 $5,246,996 $1,996,744 $2,465,676 $460,673 $1,237,762 $2,634,103 $686,652 $182,154 $1,562,422 $617,046 $2,003,968 
$7,324 $1,227,259 
$780,060 $692,126 $1,452,707 $1,027,461 $855,102 $1,142,072 $4,159,573 
$13,992 $1,157,583 $1,704,382 $3,167,247 $4,251,032 
$985,253 $448,957 $2,761,717 $1,856,217 
 
FY 2004 IGTs $1,105,000 $1,060,330 $346,712 $1,082,880 $1,188,181 $1,385,906 $903,717 $156,215 $1,096,592 $1,275,282 $596,262 $1,357,550 $4,372,497 $1,663,953 $2,054,730 $174,825 $1,031,468 $2,195,086 $572,210 $151,795 $1,302,018 $234,169 $1,669,973 
$6,103 $465,745 $650,050 $576,772 $1,210,589 $856,218 $324,511 $951,727 $3,466,311 
$11,660 $964,653 $1,420,318 $2,639,373 $3,542,527 $821,044 $374,131 $2,301,431 $1,546,848 
 
41 
 
 Nursing Home Treutlen County Nursing Home Twin Fountains Home Twin Oaks Convalescent Center, Inc. Union County Nursing Home Washington County Extended Care Facility Wellstar Paulding Nursing Center Westwood Nursing Center Total 
For Hospitals in FY 2004: Hospital 
Appling Hospital Athens Regional Medical Center Bacon County Hospital BJC Medical Center Bleckley Memorial Hospital Brooks County Hospital Burke County Hospital Camden Medical Center Candler County Hospital Central State Hospital - Medical/Surgical Charlton Memorial Hospital Chatuge Regional Hospital Clinch Memorial Hospital Coffee Regional Medical Center Colquitt Regional Medical Center Crisp Regional Hospital DeKalb Medical Center Dodge County Hospital Dorminy Medical Center Early Memorial Hospital Effingham Hospital Elbert Memorial Hospital Emanuel Medical Center Evans Memorial Hospital Fannin Regional Hospital Floyd Medical Center Georgia Baptist Meriwether Hospital Grady General Hospital Grady Memorial Hospital Gwinnett Medical Center Habersham County Medical Center 
 
FY 2004 Payments $850,692 
$2,351,966 $1,670,218 $1,853,114 
$827,940 $2,614,996 $2,786,133 $123,078,289 
FY 2004 Payments $536,851 
$18,231,855 $380,148 $691,096 $350,452 $319,554 $409,730 $811,203 $491,906 $91,685 $226,167 $37,980 $714,465 
$2,125,427 $2,516,988 
$855,316 $24,924,786 
$2,358,839 $856,409 $854,710 $185,601 $891,815 $967,293 $986,534 $681,022 
$5,815,838 $431,434 
$1,291,083 $211,885,428 
$3,228,568 $387,392 
 
FY 2004 IGTs $708,910 
$1,959,972 $1,391,848 $1,544,262 
$689,950 $2,179,163 $2,321,778 $99,037,053 
FY 2004 IGTs $447,376 
$15,193,213 $0 
$575,913 $0 $0 
$341,442 $676,003 $409,922 
$83,350 $0 $0 $0 
$1,771,189 $2,097,490 
$712,763 $20,770,655 
$1,965,699 $713,674 $0 $0 $743,179 $806,078 $822,112 $567,518 
$4,846,532 $0 
$1,075,903 $176,571,190 
$2,690,473 $322,827 
 
42 
 
 Hospital Hart County Hospital Henry Medical Center Higgins General Hospital Houston Medical Center Hughes Spalding Children's Hospital Hutcheson Medical Center Irwin County Hospital Jeff Davis Hospital Jefferson Hospital Jenkins County Hospital Joan Glancy Memorial Hospital John D. Archbold Memorial Hospital Liberty Memorial Hospital Louis Smith Memorial Hospital McDuffie County Hospital Meadows Regional Medical Center Medical Center of Central Georgia Medical College of Georgia Hospitals and Clinics Memorial Health University Medical Center Memorial Hospital Miller County Hospital Minnie G. Boswell Memorial Hospital Mitchell County Hospital Monroe County Hospital Morgan Memorial Hospital Murray Medical Center Newton General Hospital Northeast Georgia Medical Center Northside Hospital Northside Hospital - Cherokee Oconee Regional Medical Center Peach Regional Medical Center Perry Hospital Phoebe Putney Memorial Hospital Phoebe Worth Hospital Polk Medical Center Putnam General Hospital Rabun County Memorial Hospital Rockdale Hospital Roosevelt Warm Springs Institute for Rehabilitation Satilla Regional Medical Center Screven County Hospital 
 
FY 2004 Payments $668,554 
$1,498,778 $436,357 
$4,044,602 $11,130,469 
$3,478,534 $655,451 $312,160 $443,277 $100,713 $467,485 
$3,077,708 $712,422 $429,775 $505,428 
$1,321,010 $31,671,143 $70,852,609 $43,794,883 
$611,873 $687,041 $156,693 $871,272 $187,159 $380,457 $451,193 $1,618,266 $9,580,523 $17,112,598 $1,397,522 $1,397,698 $454,638 $914,376 $6,114,487 $449,733 $331,505 $158,730 $250,734 $4,525,219 $2,109,616 $1,729,567 $144,337 
 
FY 2004 IGTs $557,128 
$1,248,982 $0 
$3,370,502 $9,275,391 $2,898,778 
$546,209 $260,133 $369,398 
$0 $389,571 $2,564,757 $593,685 
$0 $421,190 $1,100,842 $26,392,619 $59,389,847 $36,495,736 $509,894 
$0 $0 $0 $0 $0 $375,994 $1,348,555 $7,983,769 $14,260,498 $1,164,602 $1,164,748 $0 $761,980 $5,095,406 $0 $0 $0 $208,945 $3,771,016 $1,917,833 $1,441,306 $0 
 
43 
 
 Hospital South Georgia Medical Center Southeast Georgia Regional Medical Center Southern Regional Medical Center Southwest Georgia Regional Medical Center Stephens County Hospital Stewart Webster Hospital Sumter Regional Hospital Sylvan Grove Hospital Tanner Medical Center/Carrollton Tanner Medical Center/Villa Rica Tattnall Memorial Hospital Taylor Telfair Regional Hospital The Medical Center Tift General Hospital Union General Hospital University Hospital Upson Regional Medical Center Washington County Regional Medical Center Wayne Memorial Hospital WellStar Cobb Hospital WellStar Douglas Hospital WellStar Kennestone Hospital WellStar Paulding Hospital WellStar Windy Hill Hospital West Georgia Medical Center Wheeler County Hospital Wills Memorial Hospital Total 
 
FY 2004 Payments $7,140,105 $6,231,432 
$16,709,531 $305,290 
$1,417,887 $63,033 
$3,254,675 $511,767 
$4,282,784 $1,355,346 
$366,864 $180,077 $15,105,345 $1,800,821 $207,497 $14,364,647 $3,165,192 $524,696 $2,026,594 $12,558,977 $2,023,668 $10,743,528 $637,531 
$56,544 $3,218,839 
$329,585 $325,077 $620,681,502 
 
FY 2004 IGTs $5,950,088 $5,192,860 
$13,924,609 $0 
$1,181,573 $0 
$2,712,229 $0 
$3,568,987 $1,129,455 
$0 $0 $12,587,788 $1,500,684 $172,914 $11,970,539 $2,637,660 $437,247 $1,688,828 $10,465,814 $1,686,390 $8,952,940 $531,276 $47,120 $2,682,366 $0 $0 $509,105,182 
 
General Counsel Division  Collaborated with the State Health Care Fraud Control Unit to secure criminal convictions in six 
cases, with restitution ordered of approximately one million dollars.  Partnered with the State Health Care Fraud Control Unit and the National Association of Medicaid 
Fraud Control Units to obtain almost eight million dollars in restitution from pharmaceutical companies for abusive and fraudulent billing and marketing practices. Recovered an additional 6.7 million dollars from Georgia providers for inappropriate billings.  Began a comprehensive revision of the regulations governing the Certificate of Need Program for the first time in more than 25 years. 
 
The General Counsel Division is responsible for the administration of the following sections' work: 
 
 The Legal Services Section provides legal services for all aspects of the Medicaid, Georgia Better Health Care, Managed Care, Program Integrity and the PeachCare for Kids Programs, including the following: representation of the department in administrative proceedings, litigation support to the Department of Law, research and drafting of Medicaid and PeachCare policy and procedures and 
 
44 
 
 Provider Enrollment. The section provides counsel for all in-house Medicaid matters including rule changes, program administration, reimbursement and claims issues and statutory amendments. 
 The Certificate of Need (CON) Section administers the CON Program, which approves the development and expansion of health care services and facilities. The program requires providers to obtain a CON before offering new services, purchasing major medical equipment or constructing new facilities. Several of the facilities, which must comply with the CON rules, include the following: hospitals, nursing homes, home health agencies, outpatient surgery centers and freestanding surgery centers for diagnostic imaging and radiation therapy. 
 
Certificate of Need and State Health Planning Program Administrative Costs and Certificate of Need Activity 
State Fiscal Year 2004 
 
Administrative Costs and Revenues 
 
Expenditures 
 
$2,124,611 
 
Revenue Collected (fees and indigent/charity care commitment shortfalls) Certificate of Need Activity 
 
$3,331,014 
 
CON Applications Received 
 
142 
 
Proposed Capital Expenditures 
 
$1,313,074,544 
 
CON Applications Approved 
 
106 
 
Capital Expenditures Approved 
 
$1,238,020,158 
 
CON Applications Denied 
 
28 
 
CON Applications Withdrawn or Cancelled 
 
8 
 
Savings from Denied, Withdrawn, or Cancelled Applications 
 
$87,761,889 
 
CON Applications Appealed (administratively and/or judicially) 
 
35 
 
Requests for Determination/Letter of Non-Reviewability 
 
230 
 
Prepared by: Data Resources and Analysis Section, Division of Health Planning, Office of General Counsel 
 
45 
 
 Certificate of Need Project Summary 
 
for Applications Submitted During State Fiscal Years 1994 to 20041 
 
Fiscal Year Applications Applications Applications 
 
Submitted Submitted Approved 
 
Denied 
 
1994 
 
127 
 
84 
 
24 
 
1995 
 
143 
 
83 
 
28 
 
1996 
 
76 
 
59 
 
8 
 
1997 
 
71 
 
50 
 
13 
 
1998 
 
93 
 
45 
 
36 
 
1999 
 
95 
 
69 
 
14 
 
2000 
 
85 
 
77 
 
2 
 
2001 
 
91 
 
72 
 
8 
 
2002 
 
117 
 
105 
 
4 
 
2003 
 
130 
 
103 
 
16 
 
2004 
 
142 
 
106 
 
28 
 
Totals 
 
1,170 
 
853 
 
181 
 
1 Reflects CON activity for each fiscal year as of January 25, 2006. 
 
Applications Withdrawn 
19 32 9 8 12 12 6 11 8 11 8 136 
 
Decisions Appealed 
37 29 22 28 37 11 1 24 12 29 35 265 
 
Decisions Reversed 
9 7 3 3 3 4 1 13 4 2 3 52 
 
Total Costs of Projects Reviewed $260,435,530 $379,440,268 $420,946,923 $333,674,960 $188,123,943 $465,163,126 $666,854,009 $598,024,749 $673,532,080 $578,867,062 
$1,313,074,544 $5,878,137,194 
 
Healthcare Costs 
Avoided2 $123,358,966 $107,032,416 $41,706,298 $154,837,181 $96,616,041 $149,132,645 $90,539,810 $192,353,811 $115,615,945 $69,753,626 $87,761,889 $1,228,708,628 
 
2 Costs associated with health care construction, equipment, and services that were avoided because CON applications were denied, withdrawn, or 
 
Cf 
 
f 
 
f 
 
Prepared by: Data Resources and Analysis Section, Division of Health Planning, Office of General Counsel 
 
46 
 
 Type of Facility or Service General Hospitals 
Specialty, Psychiatric and State Hospitals Cardiac Catheterization 
 
Georgia Healthcare at a Glance State Fiscal Year 2004 
 
Supply 154 hospitals 24,305 capacity beds 3 beds per 1,000 population 
 
2004 Utilization 915,713 admissions 4,376,969 inpatient days 500 days per 1,000 population 
 
27 hospitals 4,807 capacity beds 
 
43,221 admissions 884,936 inpatient days 
 
117 authorized cardiac catheterization labs or rooms (97 diagnostic-only and 20 diagnostic and therapeutic providers) 
 
75,678 diagnostic cardiac catheterizations 25,561 interventional or therapeutic cardiac catheterizations 
 
Open Heart Surgery Obstetrical Services (hospital) Ambulatory Surgery at Hospitals 
 
20 programs 
 
9,523 open heart surgeries 1 surgery per 1,000 population 
 
1,833 capacity beds 
 
140,365 admissions 145,214 deliveries 
 
128 dedicated outpatient operating rooms 715 shared outpatient and inpatient operating rooms 
 
505,248 surgery patients 600,469 outpatient surgeries 
 
Ambulatory Surgery at Freestanding Centers 
 
144 surgery rooms 
 
119,143 surgery patients 214,668 ambulatory surgeries 193,683 surgeries at multi-specialty ambulatory surgery centers 
 
General Nursing Homes Home Health Agencies 
 
363 homes 39,619 capacity beds 42 beds per 1,000 age 65 + 
104 agencies 159 counties served by 1 or more home health agency 
 
Personal Care Homes (25 bed or more 252 personal care homes 
 
only) 
 
15,318 capacity beds 
 
16 beds per 1,000 ages 65 + 
 
39,675 admissions 12,472,316 patient days 13,200 days per 1,000 age 65 + 
114,914 patients 2,325,727 visits 20 visits per patient 13 patients per 1,000 population 
10,837 patients 5,800 admissions 11 patients per 1,000 age 65 + 
 
Notes: Supply numbers reflect existing and approved services as of December 6, 2004 from Division of Health Planning inventories. Utilization reflects data reported for Calendar Year 2004 on Division of Health Planning facility surveys. 
Population from 2004 projected population of Georgia residents from the Governor's Office of Planning and Budget Resident Population Projections 2000-2010. Projected Georgia population for 2004 is 8,761,523 total residents with 944,841 residents ages 65 
 
Prepared by: Data Resources and Analysis Section, Division of Health Planning, Office of General Counsel 
 The Health Planning Section collects health care data, helps to develop policies for health care services and provides staff support for the Health Strategies Council, its subcommittees and its technical advisory committees. Data collected help to ascertain current resources and future needs 
 
47 
 
 for buildings, facilities and services across Georgia including the following: nursing homes, hospitals, personal care homes, freestanding ambulatory surgery centers, as well as radiation and cardiovascular, positron emission tomography and home health services. 
 The Health Planning Review Board, an independent body whose membership is appointed by the Governor, hears appeals from administrative reviews that grant or deny applications for Certificates of Need. The board selects individual hearing officers from a panel it maintains. 
 The Health Strategies Council adopts the state Health Plan to address Georgia's health care system for financial, geographic, cultural and administrative accessibility; reviews and makes recommendations on proposed rules governing the Certificate of Need Program and studies longterm, comprehensive approaches for health insurance coverage of all. The council is an independent body whose membership is appointed by the Governor. 
 The Program Integrity Section performs all necessary investigations into allegations of misconduct, fraud, waste and abuse in the Medicaid and SHBP programs. The section conducts investigations regarding conduct of employees, vendors, providers and members. Six teams comprise the unit as follows: Investigations, Hospital, Pharmacy, Physician Services, Waivers and Professional Services. 
In calendar year 2004, Program Integrity pursued 668 investigations which yielded one arrest, eight indictments and five convictions. Program Integrity's FY 2004 savings, recoupment, collections and restitution were over $12.5 million. 
State Health Benefit Plan Division During FY 2004, the operating units accomplished the following:  Processed more than 249,634 coverage transactions for Health Plan members;  Responded to more than 142,873 phone calls, 1,439 emails and 1,239 pieces of correspondence;  Received 110,473 eligibility calls from Health Plan members;  Responded to 32,400 calls from Human Resources staff at payroll locations;  Received 641 appeals and closed 642 during the fiscal year (because of a carry-over from the 
previous year);  Monitored claims processing and customer service centers to verify quality of work being provided 
met standards for accuracy and timeliness;  Reviewed clinical standards and practices used within cost-containment programs, including the 
following: programs for medical and behavioral health utilization management, case management, prior approval, organ and tissue transplants and demand management;  Processed 2,233 HIPAA requests for release of information; and  Produced and mailed nearly 200,000 Preferred Provider Organization (PPO) and Indemnity Identification cards during the year. 
Coverage Options The State Health Benefit Program offered a Preferred Provider Organization (PPO), Indemnity and four Health Maintenance Organization (HMO) options during FY 2004: 
 The PPO option allowed members the choice of using either in-network or out-of-network providers, with a higher level of benefit coverage available when in-network providers were used. The Georgia PPO provider network consisted of over 14,000 participating physicians and 153 acute-care hospitals. Nationally, the PPO provider network included over 385,000 physicians and 3,300 hospitals. Members could also have selected the PPO Choice option, which had the same benefits as the PPO option but allowed members to nominate eligible out-of-network providers to be reimbursed as if the provider was participating within the network. 
 The Indemnity option is a traditional fee-for-service plan that generally provides the same benefit coverage level no matter which qualified medical provider the member used. This option used contracted health care providers and this action protected members from balance billing. Participating 
48 
 
 providers were located within the state of Georgia. 
 The HMO option was available to members who either lived or worked in a county within an approved service area. HMO choices for FY 2004 included the following: United Healthcare, BlueChoice, CIGNA and Kaiser Permanente. Eligible HMO option members could also select an HMO Consumer Choice option, which had the same benefits as the respective HMO, but allowed members to nominate eligible out-of-network providers to be reimbursed as if the provider were participating within the HMO's network. Some members with full Medicare coverage were also able to select the HMO Medicare + Choice option, which would replace the member's traditional Medicare coverage with enhanced HMO benefits. Except in emergencies, HMO participants were required to use network providers to receive coverage. 
Open Enrollment and Retiree Option Change Period Activity The following projects were completed prior to the close of the 2003 fiscal year in preparation for the 2004 plan year:  Processed 58,352 total transactions for Health Plan coverage effective July 1, 2003 -- transactions 
processed on the Health Plan's Web site included option changes, terminations and enrollments;  Conducted 13 Meeting Leader Training sessions throughout the state, trained more than 900 benefit 
representatives in state agencies and school systems;  Held 23 benefit fairs across the state and met with 6,000 active and 5,000 retired members of the 
Health Plan and answered related questions;  Distributed 414,000 active Health Plan Decision Guides to more than 1,000 payroll locations and 
sent approximately 2,388 information packages to members paying directly for their coverage;  Sent more than 66,122 retired members a special package containing complete plan information and 
personalized change forms and  Sent 1,733 packets to members on COBRA and Leave without Pay. 
Covered Lives The table below describes plan membership by employment group and active or retired status. Total covered lives included members, spouses and other dependents. Those in the classification of "miscellaneous" or "other" represent members of local school boards. 
 
Plan Member Group 
State Employees  Active State Employees  Retired Teachers  Active Teachers  Retired School Service Personnel  Active School Service Personnel  Retired Miscellaneous  Retired/Active Total 
 
Covered Lives 
 
Employees 
 
Dependents 
 
% of Total Lives 
 
144,096 38,718 
234,524 46,934 
147,287 19,025 3,147 
633,731 
 
68,460 26,103 102,171 33,412 67,396 13,905 
1,941 313,388 
 
75,636 12,615 132,353 13,522 79,891 
5,120 1,206 320,343 
 
22.7% 6.1% 
37.0% 7.4% 
23.2% 3.0% 0.5% 
 
Active Retired Miscellaneous Total 
 
525,907 104,677 
3,147 633,731 
 
238,027 73,420 1,941 
313,388 
 
287,880 31,257 1,206 
320,343 
 
83.0% 16.5% 
0.5% 100.0% 
 
In FY 2004, active teachers and school service personnel accounted for approximately 60 percent of the covered lives; active state employees represented approximately 23 percent. Overall, retirees comprised nearly 105,000 covered lives, which represented 16.5 percent of the entire plan population. 
 
49 
 
 Statistical Summary The table below explains the total expenditures by type of health plan and by a breakdown of subgroups of people covered: 
 
Total FY 2004 Expenditures PPO & Indemnity Option Expenditures HMO Claims HMO Premiums Contracts Administrative Support 
 
$1,853,633,931 $1,201,621,023 
$129,401,345 $424,235,254 
$93,047,707 $5,328,602 
 
Total Covered Lives School System Employees, Retirees and Dependents State Employees, Retirees and Dependents Miscellaneous 
 
633,731 447,770 182,814 
3,147 
 
Average Expenditure Per Covered Life 
 
$2,924.95 
 
Managed Care and Quality Division In FY 2002, DCH began to look at ways to improve the delivery and cost-efficiency of health care for Medicaid and PeachCare for Kids members. The Managed Care and Quality Division became responsible for leading the various stages of planning for this effort.  In February 2003, DCH issued a Request for Information asking for comprehensive ideas to redesign 
the Medicaid program to improve quality and provider accountability while reducing the growth of expenditures. Over 40 responses were received. 
 
For the remainder of the year, DCH, in conjunction with the Governor's Office, evaluated various models of managed care delivery systems in other states for their possible effectiveness in Georgia. 
 
Health Improvement Programs As part of the department's reorganization in 2002, offices that were charged with improving the health of designated groups were brought together in a single section called the Health Improvement Programs. This section includes the Offices of Women's Health, Minority Health and Rural Health and the Commission on Men's Health. The Commission on Men's Health is administratively attached to the department. 
 
Office of Women's Health The Office of Women's Health (OWH) envisions quality health and access to health care for all women in Georgia. The OWH works to improve women's health status and quality of life through education, research, policy development and coordination of women's health programming. OWH has an 11member advisory council composed of statewide representatives from major public and private organizations who are interested and experienced in women's health issues. Council members serve twoyear terms. 
 
Women's Health Month OWH sponsored many activities for Women's Health Month, including the following:  The Susan G. Komen Breast Cancer Foundation Greater Atlanta Affiliate - Annual "Race for the 
Cure";  Screenings for DCH employees took place (asthma, stroke risk assessment, blood pressure, etc.); 
and 
 
50 
 
  The Department of Community Health and the Department of Human Resources held a wellness walk for employees of the Two Peachtree Building. This effort encouraged healthy living for employees. 
Susan G. Komen Breast Cancer Foundation Research Grants Program  Funds from the Komen grant were used to initiate the Navigator Program in metropolitan Atlanta. 
Navigator volunteers went out in their communities, disseminated breast cancer information and solicited 100 signatures from women who pledged to have a mammogram.  Funds from the grant were also used for computer training for 100 low-income, African-American women from the Urgent Care Center at Grady Health Systems, as well as 52 others. 
Office of Minority Health The Office of Minority Health (OMH) helps minority communities reach a high level of health and wellness. The office also works to eliminate the discrepancy in health status between minority and nonminority populations in Georgia. 
OMH focuses on the following:  Identifying, assessing and analyzing issues related to the health of minority populations;  Working with public and private organizations to address specific minority community health needs;  Monitoring state programs and policies and procedures to assure that they are inclusive and 
responsive to minority community health needs; and  Facilitating the development and implementation of research enterprises and scientific investigations 
to produce minority-specific findings. 
The office has a 12-member advisory council and each member serves a two-year term. IN H 
 Georgia's Response to Health Disparities by Addressing Cultural Competence and Equity in Health Care (GRACE) Symposium and Initiative held on April 28, 2004, convened health care stakeholders to address health disparities and cultural competence. There were 225 total participants in this initial meeting. One hundred-seven people made written commitments to continue to work with the OMH and this initiative. The ensuing work of the symposium, known as the GRACE Initiative, continues to address health disparities with a focus on cultural competence, workforce diversity and the elimination of disparities for communities of color for cardiovascular disease and diabetes. 
 Lifeline to Health is an ongoing monthly, one-hour radio program that encourages listeners to reduce health risks and improve and maintain their health. The program features interactive call-in segments, health and fitness news and feature stories on timely health issues - particularly about ethnic minorities and medically underserved populations in Georgia. Ten shows on various health topics aired in FY 2004. o Of particular significance was a curriculum developed on diabetes disease management funded by the Benton Foundation. 
 The HIV/AIDS Take Action Keep Educated (TAKE) Project helps minority community-based organizations develop strong programs to combat the spread of HIV/AIDS in Georgia. Through skills development, technical assistance and help in obtaining funding, the project gives organizations the resources they need to be successful. The project studies the impact of HIV/AIDS on minority populations in Georgia through surveillance and epidemiological activities. In FY 2004, the project reached 206 individuals through technical assistance training, 117 through regional minority health networks, which developed action plans that address issues and barriers and increase participation in local planning for HIV/AIDS services and program resources and 132 through HIV/AIDS data requests. Funding for the HIV/AIDS project comes from a State and Territorial HIV/AIDS Demonstration Grant by the U.S. Office of Minority Health. 
 Minority Health Research - The OMH contracted with the National Center for Primary Care to conduct research and data analysis on health disparities in Georgia. Plans are to release the publication as a series in various formats both locally and nationally to a variety of stakeholders. 
51 
 
 Office of Rural Health Services (ORHS) The Office of Rural Health Services works to improve access to health care in rural and underserved areas to reduce health status disparities of the populations in Georgia. The office has the following objectives:  Empowering communities to strengthen and maintain the best possible health care using existing 
resources;  Building strong partnerships to meet local and regional needs;  Providing incentives to local areas to implement integrated service delivery systems; and  Acting as the single point of contact for all regional issues related to health care. 
The office has a 21-member advisory council, and each member of the initial council serves a three-year term, with the length of any subsequent terms determined by lottery, subject to review. 
The ORHS focused on building regional rural health systems, increasing the number of community and migrant health centers, supporting rural hospitals and identifying ways to make health care available to Georgians in underserved rural and urban areas. 
Major projects were:  Developed and distributed 400 copies of the The Georgia 2001 Rural Health Chartbook: Impact of 
State/Federal Resources on Services. The chartbook contains a wide range of information on population health and the health care delivery system in rural and urban Georgia.  The Georgia Farmworker Health Program (GFHP) developed and implemented a "Quality Assurance/Continuous Quality Improvement Plan" in May 2004.  GFHP provided services to 13,077 migrant and seasonal farm workers and their dependents in FY 2004, which accounted for 18,771 medical encounters and 19,737 enabling encounters such as: outreach services, medical interpreting, transportation and health education provided by non-medical personnel.  The National Health Service Corps provided loan repayment/scholarships to 43 medical/dental providers in underserved areas of Georgia.  The J-1 Visa Waiver Program placed 30 medical providers in underserved areas of Georgia. 
Commission on Men's Health (CMH) The Commission on Men's Health works to improve the health status of men in the state of Georgia. It has an 11-member advisory board, and its terms are two years for legislative members and three years for non-legislative members. 
The focus of the commission is to:  Develop strategies, public policy recommendations, and programs, including community outreach and 
public/private partnerships that are designed to educate Georgia's men on the benefits of regular physician check-ups, early detection and preventive screening tests and healthy lifestyle practices;  Improve health outcomes in diseases such as: prostate and testicular cancer, cardiovascular diseases including heart attacks, high-blood pressure, stroke, depression, suicide and diabetes;  Monitor state and federal policy and legislation that may affect areas of men's health;  Recommend assistance, services and policy changes that will further the goals of the commission; and  Submit a report of the commission's findings and recommendations to the Governor, the President of the Senate and the Speaker of the House of Representatives. 
In FY 2004, CMH:  Strengthened the health care safety net of Georgia's men;  Created new access points through community development, expansion and partnerships;  Mobilized a workforce to meet the needs of communities; and  Worked to provide excellent services to men by continuously improving the quality of patient care, 
service delivery, the health care workforce and health outcomes in the delivery systems that support men's health issues. 
52 
 
 The CMH followed the six National Health Collaboratives (immunizations, cardiovascular disease, cancer, Diabetes, HIV/AIDS, and asthma). Other major initiatives included:  Partnering with Focus on Men's Health. More than 6,000 men were educated and over 3,500 had 
medical screenings during the last three and a half years;  Partnering with Georgia Prostate Cancer Coalition. Over 3,000 men were educated; and  Working with the W.K. Kellogg Foundation to develop an initiative in Georgia focusing on the Silent 
Health Crisis of men. Partnerships  The CMH collaborated with over 114 colleges and universities, churches and other faith-based 
organizations, governmental agencies, hospitals and health systems, professional associations, private individuals, proprietary and volunteer organizations. Campaigns and Conferences  In FY 2004, the CMH hosted the first Statewide Men's Health Symposium. This symposium teaches health care providers and other affiliates about the importance and effective promotion of men's health issues and awareness, including networking and fostering partnerships. One hundred twentyfive people participated.  CMH created the model for "Men on the Move" in Albany, Georgia. Approximately 1,258 men were surveyed on cardiovascular disease, cholesterol, behavior modification, diet, tobacco cessation, exercise and screenings such as diabetes and cancer. Resource Center  The CMH also served as an information and referral service on men's health issues, distributing over 40,000 copies of the popular Health Guide for Georgia's Men. Conclusion The Georgia Department of Community Health continues to face the challenges of rising costs and enrollment growth in Medicaid and PeachCare for Kids, as well as the escalating health needs of our state employees. DCH will continue to develop a smooth transition for the Medicaid and PeachCare members into managed care programs to help them better achieve healthy lives and to reduce costs to the state. Through streamlining processes and innovative programs, DCH will continue to improve health care for all Georgians in the department's charge and care. 
53