Annual report, fiscal year 1996: necessary medical services for Georgia's needy

Dept. of Medical Assistance 2 Peachtree St. NW Atlanta, GA 30303-3159 Phone 404-656-4479 Fax 404-651-6880
Annual Report, Fiscal Year 1996
s Necessary Medical Servicesfor Georgia
Needy

Table of Contents

Changes in FY'96 in Georgia

4

Georgia Department ofMedical Assistance Abstract

4

Department of Medical Assistance Board Members

5

Overview of the Department Organization

6

Highlights of Fiscal Year 1996

7

The Georgia Coalition/or Health

7

Program Highlights

8

Long-Term Care; Institutional vs. Home and Community-Based

10

Children's Medical Services

11

Medicaid Funding

12

State and Federal Funding

12

Funding disbursement

. 12

Benefits expenditures by category of service

13

Budget Growth vs. Per-Recipient Costs

/3

Savings from Cost Containment Measures

14

Third Party liability:

14

Third Party Claim Cost Avoidance:

/4

Third Party Claim Cost Avoidance-Medicare:

/4

Services Provided to Medicaid Recipients

15

Physician Services

/5

Pharmacy Services

/5

Hospital Services

/5

Nursing Facility Services

/5

Maternal and Child Health Services

15

Other Practitioner Services

/6

Waiver Services for Home and Community-Based Care

/6

Transportation

16

Equipment and Devices

16

Mental Health Care Services

16

All Others

16

Indigent Care Trust Fund

19

Map ofIndigent Care Trust Fund hospitals Hospitals Participating in the Indigent Care Trust Fund in FY96 Recipients

20

l 21
J

J

22

I

J

Table ofRecipients and Expenditures by Aid Category Welfare Reform and Medicaid

23

1

I

24

!

)

Charts and Graphs:

25

j

Recipient and Expenditure Charts, by Age, Ethnicity, Gender, Aid Category and Location ofResidence 26

l
)

A History ofMedicaid Benefits Expenditures

28

i

FY96 Administrative Expenditures

29

Recipients by Aid Category by Type ofService

30

Benefits Paid by Aid Category by Type ofService

31

Percentage ofExpenditures, Recipients, and Average Yearly Payment per Recipient, by Aid Category

32

j

Percentage ofTotal Recipients Utilizing Each Service

33

Average Payment for Services Per Recipient

35

Percentage of Total Expenditures for Each Category ofService

37

Providers with Paid Claims, by Category ofService Analysis ofRecipients and Expenditures by Recipients' Counties

39 41

\

Maps: Populations, Eligibles, Recipients by County

45

Changes in FY'96 in Georgia
Budgetary constraints have encouraged efforts already begun at the Department to emphasize the provision of quality medical care that also responsibly conserves state and Federal funds. Those efforts focus on managed care, preventive care, and funding more alternatives to nursing home care, including in-home and community care options. Cost-saving measures that will take effect in FY'97 include these changes to nursing home reimbursements: dramatic lowering of the amount of corporate home office salaries that will be paid by taxpayers; cessation of some administrative cost reimbursements; and a limit on the number of nursing home beds for which Medicaid will pay. Hospital reimbursements will be changed as well to reflect more recent information and rates based more on the cost of service. Physician reimbursements will also change to become more consistent with payments made to physicians by other states' Medicaid agencies.

Georgia Department of Medical Assistance Abstract

Total FY96 Expenditures

Benefits $3,089,570,328

Indigent Care Trust Fund $ 391,707,906 Medicare Premiums $ I 16,494,059 Administration $ I02,345,260

Average Yearly Benefit per Recipient

Total: Unduplicated Count of Recipients

1,181,092

Categorically Needy Medically Needy

775,278 3,852

Right from the Start

376,234

Qualified Medicare Beneficiaries

25,728

Average Number of Monthly Eligibles Enrolled Providers (as of June 30, 1996)

974,145 63,423

Providers with Paid Claims Number of Medicaid Claims Processed

26,243 53,701,522

$3,700,117,553
$2,615.86 65.6% of Recipients 0.3% 31.9% 2.2%

4

Mrs. Beauty P. Baldwin Acting Chairperson/Secretary 3755 Green Bay Drive Lawrenceville, GA 30245 FAX: 770-921-6133
Mrs. Carol H. Fullerton 639 5th Avenue Albany, GA 31701 FAX: 912-436-6358
Mr. Lamond Godwin Peachtree Asset Management One Peachtree Center, Suite 4500 303 Peachtree St., NE Atlanta, GA 30308 Office: 404-215-33 70 FAX: 404-215-3399
Marjorie M. Smith, MD Morehouse School of Medicine Department of Pathology 720 Westview Dr., SW Atlanta, GA 303 10 Office: 404-752-1771 FAX: 404-752-1108
Mr. Hulett D. Sumlin 195 Nacoochee Dr. NW Atlanta, GA 30305
Ms. Marjorie P. Smith OMA Commissioner 2 Peachtree St. NE, Suite 40-100 Atlanta, GA 30303 Office: 404-656-44 79 FAX: 404-657-5238
5

<:>verview <>f the Department Organization
During FY 96, OMA reorganized its Divisions and their responsibilities. The Division of Chronic Care Services is responsible for programs that include institutional and home and community-based services for the frail elderly and disabled. The Division of Professional Services oversees reimbursements to and regulation of certain specific providers, including pharmacists and pharmacies, physicians, etc. The Division of Maternal and Child Health coordinates programs and services intended to benefit pregnant women and children. The Division of Reimbursement Services works with hospitals, nursing homes, and other providers to determine appropriate rates and methods of reimbursement. The Division of Legal and Regulatory Services includes the Office of Investigation and Compliance, which works with the State Healthcare Fraud Control Unit to identify and prosecute potential Medicaid fraud casesin Georgia. The Division of Systems Management is responsible for DMA's information management and computer systems, including the development of "intranet" services for the agency and more efficient methods of sharing and verifying information internally. The Division of Managed Care oversees the administration and regulation of Georgia Better Health Care and DMA's growing HMO program. This Division also works on qualify assurance monitoring of managed care programs OMA is involved with. The Division of General Administration performs administrative functions for the various offices included in DMA's organization. This Division includes the Budget office, which is responsible for administering the funds used by DMA's various programs.
6

The Georgia Coalition for Health held numerous public forums around the state to encourage citizen participation in its efforts to formulate recommendations for Medicaid reform in Georgia. For acute physical healthcare, the Coalition recommended:
strengthening the Department's primary care case management program (GBHC) as a framework for better care management and new disease management activities;
offering voluntary HMO membership as an option for more Medicaid beneficiaries, primarily in the urban and suburban areas where HMOs are active and have established networks;
contracting with providers to accept partial risk, as a transition to full capitation; offering technical assistance to existing Medicaid providers to help them restructure the
delivery system to achieve the efficiency required to participate in a managed care environment. For chronic ~nd long-term care, the Coalition recommended: applying for a Federal waiver to allow more community-based options for the elderly and people with chronic diseases and disabilities; revising the process of screening and reassessment for nursing home care and other alternatives to better match service settings with individuals' needs; developing a single system of case management to better coordinate chronic care services; continually adjusting over time the supply of nursing home beds, and develop communitybased service options, in response to the needs of Medicaid recipients; developing a public/private sector cooperative chronic-care information system to monitor changing needs and health status, patterns of service use, cost and quality; initiating pilot/demonstration studies of service and reimbursement options making available technical assistance to help providers move toward effective and efficient integrated systems of chronic and long-term care. At its meeting on December 4, 1996, the OMA Board received these recommendations and forwarded them to the Governor for consideration.
7

Program Highlights

The Medicaid Program provided health care to more than one in seven Georgians or 16 percent of the state's population. The number of recipients increased by 4 percent over FY 95.

703,131 children received medical care because of Medicaid, at an average cost per child of$1,388 per year. The number of children (under age 21) covered by Medicaid increased by 5 percent and accounted for 59 percent of all recipients.

139,078 adults aged 65 or older received Medicaid benefits in FY'96, at an average cost of $6,218 per recipient.

49,617 adults received nursing-home care paid for by Medicaid at an average cost per recipient of $12,865 per year.

Administrative costs accounted for less than 3% of total Medicaid expenditures.

26,243 providers filed 53.7 million claims during the year. Almost 80 percent were paid in less than IO days. Nearly 98 percent were paid in less than 20 days.
Cost avoidance measures and collections saved nearly $857 million 1.

Rebate agreements with pharmaceutical manufacturers saved the state an estimated $53.9 million in FY 96.

Georgia Better Health Care (GBHC) was instituted in October 1993 by the Department of

Medical Assistance (DMA). GBHC matches Medicaid recipients to a primary care physician

or provider (PCP) who provides a "medical home," delivering and coordinating each Medicaid

recipient's health care services. For those recipients who are eligible, GBHC enrollment is

mandatory, unless they choose-instead-to enroll in one ofDMA's HMO programs. Georgia

!

Better Health Care expanded to cover 51 counties during FY 96. By July 1996, 368,636 Medicaid recipients in those counties were enrolled in GBHC. Savings over traditional fee-for-

service Medicaid exceeded expectations; DMA estimates that, since its inception in October

1993, GBHC has saved the Department more than $32 million; in FY96 alone, the program

saved DMA and Georgia taxpayers nearly $20million. By the end of December 1997, GBHC

will be available to all Medicaid recipients who qualify for the program.

DMA instituted its Medicaid HMO program, with Family Plus as its first provider and Foundation Health working independently to inform recipients about the program and their options. By July 1996 3,473 Medicaid recipients in the 5-county metropolitan Atlanta area had enrolled in DMA's HMO program. 6 other potential providers had applied to become Medicaid HMO providers, and expansion of the program into an additional 19 counties was planned for early I997.

In FY'97, more money was allocated for long-term care alternatives than has ever been disbursed by Medicaid in one fiscal year in Georgia. $26 million in combined state and Federal funds will go to enhance existing programs and fund pilot programs for alternatives to nursing home care: adult daycare centers; respite care for primary caregivers; assisted living centers; community care options.

1 See details on page 14.

8

Through the Vaccines for Children program, Georgia Medicaid helped provide essential disease prevention to more than 140,000 Georgia children. 61 % of all vaccinations are given to Medicaid eligible patients (140,357 preschool children, 761,451 inoculations). Nearly 100% of the providers of Vaccines for Children are Medicaid providers. 77% of the vaccinations needed in Georgia in FY96 were provided by the VFC program.

DMA 's Office of Investigations and Compliance investigated more than 300 fraud cases in

FY'96. Working with state and Federal prosecutors, the Office has obtained 27 fraud

!

convictions involving more than $3 million in illegally obtained reimbursements since January

I

1994. 225 fraud referrals have been made to the State Health Care Fraud Control Unit

)

(HCFCU) in the past year, 44 of those from DMA investigators. The state unit has obtained 6

convictions, 2 of those from DMA referrals. At the end ofFY'96, HCFCU had 13 indictments

awaiting trial; IO of those cases initiated with DMA investigations.

9

During State Fiscal Year 1996, more money than ever before was directed into DMA's waiver programs for the disabled, the chronically ill, and the frail elderly. These programs--Community Care, Independent Care, and the Mental Retardation Waiver Program---emphasize personal and health care alternatives that keep recipients in their homes and home communities, rather than in institutions. $26M additional funding was directed into these alternatives, for total waiver program expenditures of $87,744,912 for the year. By contrast, institutional care received $765,165,492 in the same time period, an increase of$35 million from FY95.

Long-Term Care Expenditures, FY96

Community CareOther

5%

1 %

Mental
Retardation Waiver 5%

Nursing Home Intermediate
Care, MR 15%

Nursing Facility Services 74%

10

The medical care of more than half Georgia's children is provided by Medicaid. 703,131 Georgia Medicaid recipients in FY96 were under 21; 71,965 were infants under 1 year old, while 121,109 were between the ages of 15 and 20.

Recipients by Age Category, FY96

65 - 84 years
9%

85 + Under 1
3% 6%

45 - 64 years 7%

1 - 5 years 21%

21 44 years 22%

years 10%

years 22%

Georgia's Medicaid expenditures on children under age 21 are the second-highest in the Southeast (including Alabama, Florida, Kentucky, Mississippi, North Carolina, South Carolina and Tennessee), according to U.S. statistics from the Department of Health and Human Services.
Costs per recipient for ~hildren start out at $2,456 a year for infants and decrease to $910 a year as the child enters adolescence. Costs rise again to $2,263 between the ages of 15 and 20 and, generally, as a Medicaid recipient ages, increase as the person's medical needs increase. Those 85 years old and older receive benefits worth, on average, $9,363 per year.

Expenditure per Recipient by Age Group, FY96

'tll).OUO \)II
$'1,111)() 1)1)
Li3,0ll0 Ill) $7 0()() ()I)
$(i,1100 ()()
is.ouo 110
$4 [11)0 IHI
1::i.000 (II)
$2,0illl.1111
t I ,Olli\ 011
$-

-_-,r.

.2 en

.2

c""o

+

.2

en r-

11

, ~-~~::r,.,,..,-._l -~--.: . ,, , . -' -- ., "
. , .Me~Iaid Fu11ding
State and Federal Funding
Medicaid is funded by state and Federal dollars. In FY 96, DMA's budget comprised about 10.9 percent of the total state budget. The Department's total expenditures of $3,700,117,553 consisted of$1,403,430,556 in state funds and $2,296,686,997 in Federal funds. The total budget also includes $391,707,906 from the Indigent Care Trust Fund2.
The largest share of Medicaid costs is paid by the Federal government. Georgia's Medicaid program receives various levels of Federal reimbursement for different services and functions. For example, the Federal government pays 90% of the cost of family planning services and 62% of most other programs' benefits. Computer costs are 75% Federally funded, while most other administrative costs receive just 50% Federal funding.

Funding disbursement
Benefits and the Indigent Care Trust Fund comprised just over 94% of all FY 96 expenditures. Administrative costs totaled less than 3% ofDMA's budget.

Medicaid Expenditures, FY 96

Medicare Premiums
3% Indigent Care
Trust Fund 11%

Administration 3%

Benefits Payments
83%

2 More information on the Indigent Care Trust Fund is available on page 19.
12

In FY 96, payments for services for Medicaid recipients totaled $3,089,570,328. The majority of those payments went to hospital care, both inpatient and outpatient. The second-largest category of service was for nursing facility services. Other providers, physicians, and prescribed drugs consumed the remainder of Georgia's Medicaid benefits.
Benefits by Category of Service

Other Care 17%
Drugs 10%

Hospitals 34%

NF 25%
Budget Growth vs. Per-Recipient Costs
Georgia's Medicaid budget grew more slowly than it has in IO years in FY96, and at a slower rate than the number of recipients. The recipient population grew 4%, to 1,181,092; the benefits budget grew by 2.9%3, to $3,089,570,328. Per-recipient costs decreased-for the first time this decadeby 1.1 %. Managed care, tougher fraud and abuse provisions, and a stabilizing recipient base were factors in the slowed growth of the Department's budget and recipients.

Recipients

1,200,000 ,.,,,.,,.,..,,....,....,,,,....,.,,
1,000,000 800,000 600,000 400,000 200,000 0 +-"-....;..:+-'---+-""""'--+----+-----....:+----~

c:: c::

c:: c::

$4.0 $3.0 $2.0 $1.0 $-

Benefits Paid (in millions)

3 See pages 15 and 16 for detailed infonnation about benefits, and page 29 for administrative expenditures for FY 96.
13

Third Party Liability: Because Medicaid is designated "payor of last resort," DMA works with providers and eligibility staff to identify coverage for medical care through insurance or other liability sources where appropriate. More than IO percent of Medicaid recipients have other insurance coverage. And in many accidental injury cases, a third party is liable for medical costs and some expense can be recovered. In FY96, $21,574, 79 I was recovered by OMA through third party liability recovery efforts. Third Party Claim Cost Avoidance: Claims must go to other insurance or liability sources before being submitted to Medicaid for payment. In FY96, such recoveries totaled $52,783,377 for OMA. Third Party Claim Cost Avoidance-Medicare: Similarly, recipients who are covered by both Medicaid and Medicare often have claims from which Medicaid cai:i recover some costs. Such claims must be submitted to Medicare for payment, and DMA avoids unnecessary expense by ensuring that, when Medicare shares responsibility for some portion of a claim, Medicare pays first. In FY96, $783,08 I,988 was recovered by DMA through Medicare third party claim cost avoidance efforts.
14

Physician Services Medical care provided by participating physicians accounted for 14% of the Medicaid benefits budget in FY96; $451,424,880 was spent on services and visits reimbursed under the ResourceBased Relative Value Scale used by Medicare. 81% of Georgia Medicaid recipients visited participating physicians last year.
Pharmacy Services Medicaid recipients in Georgia receive benefits covering prescribed and some over-the-counter drugs. Some require prior approval, in which case the Georgia Pharmacy Foundation acts as the prior approval agent to review and process such requests. 10% ofDMA's benefits budget was paid for pharmacy services in FY96, a total of $310,490,124. 76% of recipients received benefits under this category of service. Rebate agreements with pharmaceutical manufacturers saved the state an estimated $53.9 million in FY 96. Hospital Services Inpatient and outpatient hospital services are covered by Medicaid. Most inpatient hospital stays must be pre-certified before the patient is actually admitted to the hospital. Some outpatient services must be pre-certified as well. Inpatient reimbursement is determined by a flat rate for each hospital admission, specific to the hospital, based on the hospital's reported costs. During FY96, prospective per-case rates were calculated using FY92 as a base year with inflation factored into the rates. Exceptions to the flat rate can be made for particularly lengthy inpatient stays (called "day outliers") and unusually costly admissions (called "cost outliers") for any Medicaid recipient. Hospital costs accounted for 34% of Georgia Medicaid's FY96 benefits budget; $812,904,865 for inpatient care, and $258,004,427 for outpatient care. 16% of recipients used inpatient hospital services during FY96, and 53% required outpatient hospital care.
Nursing Facility Services Medicaid covers institutional care, including nursing services, room, board, and personal care for 85% of Georgians who require nursing home care. In FY96, 25% of Georgia's Medicaid benefits budget paid for nursing facility services; $638,324,012 for nursing facility services for the elderly and disabled, $126,104,887 for nursing facility services required for the severely mentally retarded. 4% of recipients used nursing facility services.
Maternal and Child Health Services 2.3% of Georgia's Medicaid budget went to Maternal and Child Health services in FY96-a total of$71,840,758. The majority of those expenditures went to family planning services and to HealthCheck, a program that provides preventive health care for children under age 21.
Other Maternal and Child Health services help pregnant women with prenatal and perinatal care, help children with physical and developmental problems, and assist Children at Risk through the Family Connection.
15

Other Practitioner Services Services in this category include preventive and routine dental services for adults and children, optometric services, podiatry, psychology services, and the care provided by nurse midwives, nurse practitioners, physician's assistants and certified registered nurse anesthetists. Also included in this category are reimbursements to county health departments for diagnostic, screening and preventive services.
The total amount from the FY96 benefits budget reimbursed to providers in this category was $78,029,380.
Waiver Services for Home and Community-Based Care Georgia Medicaid has four home and community-based programs for which the Federal government has waived certain provisions of Medicaid law. These waivers allow the state to offer non-institutional care to recipients who would otherwise qualify for nursing home care or other institutionalization. Waiver programs include the Community Care Services Program, with several options for home and community-based care of the frail elderly; the Independent Care program, which serves disabled adults in their own homes and communities; the Mental Retardation waiver program, which serves recipients with special needs, and the Independent Care program for Traumatic Brain Injuries, which serves a small population with very particular medical requirements.
In FY96, Governor Miller and the state legislature budgeted more for these programs than has been budgeted before--$26 million more than the previous year (a 39% increase). That increase reflects a demand by Medicaid recipients for more options to institutional care; a demand that is reflected by the community in general when family members require long-term or chronic care. The total budget for such services for FY96 for $87,744,912, less than 3% ofDMA's benefits budget. Nearly 14,000 people receive waiver program services.
Transportation To assist recipients in accessing medical services, Medicaid covers both emergency and nonemergency transportation services. Changes in reimbursement procedures and claims processing for non-emergency transportation services have resulted in considerable savings for OMA; FY95 expenditures in that category were $84,150,484, while FY96's NET expenditures totaled $45,602,622. Expenditures per recipient dropped from $366.05 in FY95 to $254.64 per recipient in FY96. 179,087 people used Medicaid NET services in FY96.
Equipment and Devices Medicaid covers the rental or purchase of medical equipment including hospital beds, wheelchairs, " oxygen equipment, and walkers. Medicaid also covers devices such as artificial limbs, braces, glasses and artificial eyes. The total reimbursements under this category of service for FY96 were $36,852,640. 128,032 people received durable medical equipment or devices through this category of service in FY96.
Mental Health Care Services More than 54,000 Medicaid recipients received mental health care in FY96 from 95 paid providers, totaling $68,332,440 for the year.
All Others Georgi'a Medicaid pays for services ranging from ambulatory surgical centers and rural health clinics to laboratory, x-ray, dialysis and hospice services. Expenditures for care provided in these categories for FY96 totaled $119,317,550.
16

Physician Services

14,981

951,811

$474.28 C

$451,424,880

11/itiiNt~-Mit!!!.MlmJii!!ffli-t-iMMa

Prescribed Drugs

2,006

896,041

$346.51

$310,490, 124

tm.fifftifiii~~~,1}Ktm~~~Mtrtt1.mmmt;t;o/~~n~:':J~~1t~zttun,fi~;w~---1+M

Hospital Services *

, Hospital, Inpatient Hospital, Outpatient
Total Hospital

453

185,243

$4,388.32

$812,904,865

710

625,472

412.50

258,004,427

$1,070,909,292

* Includes out-of-state providers.

Nursing Facilities Nursing Home Intermediate Care - MR Nursing Facility Services Swing Bed Services
Total Nursing Facilities

12

1,848

$68,238.58

$126,104,887

342

49,617

12,865.03

638,324,012

11

451

1,633.24

736,593

$765, 165,492

Waiver Services Community Care Independent Care Mental Retardation Waiver Model Waiver
Total Waiver Services

351

11,925

$3,426.28

$40,858,390

48

93

46,104.88

4,287,754

169

1,651

23,451.58

38,718,554

25

152

25,527.72

3,880,214

$87,744,912

Maternal & O,ild Health

Childbirth Education Program

7

248

$39.93

Children at Risk Case Management

10

1,970

391.90

O,ildren's Intervention Services

593

6,790

850.08

Early Intervention Case Management

54

3,432

631.02

Family Planning*

46

92,486

328.68

HEALTH CHECK (EPSDn

877

297,920

85.97

Perinatal Case Management

98

49,161

105.94

Pregnancy-Related Services

100

19,856

91.06

Pregnant Substance Abuse Day Treatment

5

63

1,484.44

Total Maternal and Child Health

$9,903 772,045 5,772,043 2,165,644 30,398,106 25,613,093 5,208,244 1,808,160
93,520 $71,840,758

*Family Planning totals include recipients and expenditures also recorded in other categories of service, including but not limited to physician services, prescribed drugs, and inpatient and outpatient hospital services.

17

Other Practitioner Services Certified Registered Nurse Anesthetists Dental, Adult Dental, Child Dental Oral Surgery Diagnostic, Screening & Preventive Service Nurse Midwife Nurse Practitioner Optometry Physician's Assistant Podiatry Psychology Other (Medicare Coinsurance & Deductibles)
Total Other Practitioner Services

670 784 970
50 35 144 179 559 274 189 623

32,475 44,179 213,525
585 72,850 11,025 24,198 90,547 17,466 39,499 29,784
6,676

$129.69 82.53
135.17 276.10
37.72 490.89
65.05 49.33 91.71 82.12 614.43 569.60

Mental Health Services Mental Health Clinic Mental Health Case Management
Total Mental Health Services

72

51,004

$1,267.65

23

3,868

950.62

$4,211,709 3,646,080
28,861,867 161,518
2,747,628 5,412,066 1,574,192 4,466,316 1,601,727 3,243,583 18,300,041 3,802,653 $78,029,380
$64,655,445 3,676,995
$68,332,440

Transportation Ambulance Non-Emergency Transportation
Total Transportation
Equipment & Devices Durable Medical Equipment Eyeglasses Orthotics/Prosthetics
Total Equipment and Devices

215

78,015

$239.02

761

179,087

254.64

$18,647,258 45,602,622

1,945 175

81,275 37,927
8,834

$377.13 25.82
591.08

$30,651,573 979,460
5,221,607 $36,852,640

All Others

Adults with AIDS

16

1,436

$261.20

Ambulatory Surgical

51

3,386

320.81

At Risk of Incarceration

1,329

339.36

Dialysis

275

624

10,140.38

Federally Qualified Health Centers

19

31,635

197.23

Georgia Better Health Care

1,088

368,636

17.48

HMO

1

3,473

185.17

Home Health

91

12,152

1,440.03

Hospice

4

1,428

5,672.93

Laboratory/Radiology

99

207,249

79.35

PASARR

2,707

1,122.83

Protective Services, Adult

3,184

1,422.51

Protective Services, Child

24,187

902.62

Qualified Medicare Beneficiaries

33

151.91

Rural Health Clinic

37

25,224

147.48

Therapeutic Residential Intervention

17

811

27,363.32

Therapy Services (Physical, Occup., Speec

258

1,267

306.72

T-o~t-a~l -A--ll Others ~- ----
TOTALS

- ~... - - ----

'

'.

---.,-- ----"'I--,, -

_..,.____., __ ....,

y --~-,--.

-

, . 26,243, ' 1,181,092

$2,615.86

$375,079

1,086,275

451,006

6,327,595

6,239,234

6,444,741

643,093

17,499,236

8,100,947

16,444,766

3,039,495

4,529,265

21,831,600

5,013

3,719,938

22,191,651

388,616

$119,317,550

-

~--,--

---~

$3,089,570,328

18

Georgia's Indigent Care Trust Fund is in its seventh year ofoperation. Its primary purpose is to improve access to health care for indigent Georgians. Funds have been used by hospitals to recruit physicians for underserved areas; to place nurses in local schools and to offer health prevention, maintenance and education services. For smaller, rural hospitals, the fund is also used to relieve some of the financial burden of providing uncompensated care to indigent patients. About of the hospitals participating in the Fund are located in rural areas of Georgia. The financial assistance provided by the ICTF monies can relieve an otherwise heavy burden on such hospitals' budgets. Hospitals must use at least 15 percent of their trust fund receipts to provide and expand primary care services as described in plans approved by the Department and each hospital's respective district health director. In FY96, 74 hospitals participated in the Indigent Care Trust Fund. Intergovernmental transfers from these hospitals (and other sources of revenue) totaled $162,177,246. Federal matching dollars totaled $246,443,429, for a total trust fund amount of$408,620,675. $391,707,906 of that amount was spent in FY96, and $ I6,9 I2,769 reserved for FY96 expenditures to be paid in FY97.
19

Hospitals Participating in the Indigent Care Trust Fund - Fiscal Year 1996
20

Hospitals Participating in the Indigent Care Trust Fund in FY96:

Appling General Archbold Memorial Athens Regional Medical Center Bacon County Banks-Jackson-Commerce Barrow Medical Center Berrien County Bleckley Memorial Bulloch Memorial Burke County Camden Cartersville Medical Center Coffee Regional Colquitt Regional Crawford Long Crisp Regional Dodge County Donalsonville Dooly Medical Center Dorminy Early Memorial Elbert Memorial Egleston Children's Emanuel County Evan.s Memorial Fairview Park Floyd Medical Center Georgia Baptist Grady General Grady Memorial Hamilton Hughes Spalding Hutcheson Medical Center Irwin County Jasper Memorial Jeff Davis Liberty Memorial

Louis Smith Memorial Meadows Memorial Medical Center of Columbus Medical Center of Central Georgia Medical College of Georgia Medical Surgical Center Memorial of Adel Memorial of Bainbridge Memorial Medical Center Minnie G. Boswell Mitchell County Oconee Regional Peach Perry General Phoebe Putney Roosevelt Warm Springs Institute Satilla Scottish Rite Children's Medical Center Smith South Fulton South Georgia Medical Center Southeast Georgia Medical Center Southwest Community Southwest Georgia Stewart-Webster Sumter Regional Tanner Medical Center (Villa Rica) Tattnall Memorial Taylor Regional Tift General University Upson County Walton Medical Center Wayne Memorial West Georgia Medical Center Wheeler Worth County

21

In FY 96, Medicaid paid for health care services for l, 181,092 individuals. Payments for services totaled $3,089,570,328 or $2615.86 per recipient. Categorically Needy recipients are those who received cash assistance under the Aid to Families with Dependent Children (AFDC) program or the Supplemental Security Income (SSI) program. In FY96, this category accounted for 48% of Georgia Medicaid recipients. The cost per recipient was $2,588.64. Categorically Needy recipients who are not receiving cash assistance include pregnant women who would be eligible for AFDC if their child were born and living with them; families who have lost cash assistance because of increased income; aged, blind and disabled persons who have lost SSI because of increased Social Security payments, including residents of nursing homes whose incomes exceed SSI limits; and disabled children living at home or children in foster care and adoptive homes. In FY96, this category accounted for 18% of Georgia Medicaid recipients, at a cost of$4,490.86 per recipient. Qualified Medicare beneficiaries receive benefits from Medicare and Medicaid under the Medicare Catastrophic Coverage Act of 1988. This category accounted for 2% of Georgia Medicaid recipients in FY96. The cost per recipient was $1,057.66. Medically Needy recipients are pregnant women, children, aged, blind and disabled persons who would otherwise be categorized as Categorically Needy. Their incomes or resources exceed the AFDC poverty requirements. Incurred medical expenses may help a person "spend down" to this category. It covers less than 1% of Georgia Medicaid recipients, at a cost per person of $3,318.21. Right from the Start Medicaid is intended specifically for children and pregnant women. It covers children up to age 18 whose family incomes do not exceed specific limits, and pregnant women who net family incomes do not exceed specific poverty level limits. RSM represented 32% of all recipients of Georgia Medicaid in FY96. The cost per child equaled $1,164.89; the cost per pregnant woman was $3,411.39.
22

Categorically Needy Receiving Cash Assistance .Aged Blind Disabled Children in Farrilies Vlith Dependent Children J.ldults in Farrilies Vlith Dependent Children Total for Eligibility Category

Expenditures

$ 129,231,101

$

12, 1 8 6 , r o 5

$ 883,174,237

$ 222,665,363

$ 213,181,100

$ 1,460,438,406

Expenditures

Recipients per Recipient

46,740 $

2,764.89

2,710 $

4,496.90

171,902 $

5,137.66

235,248 $

946.51

107,571 $

1,981.77

564,171 $

2,588.64

Categorically Needy Not Receiving Cash Assistance .Aged Blind Disabled Children in Farrilies Vlith Dependent Children J.ldults in Farrilies Vlith Dependent Children Other Children Total for Eligibility Category

Expenditures.

$ 397,765,223

$ 164,879,919

$ 200,43:l,377

$ 101,009,744

$

68,744,792

$

15,161,420

$ 948,051,475

Expenditures

Recipients per Recipient

29,262 $

13,593.23

13,611 $

12,113.73

15,m $

12,707.18

100,038 $

1,010.31

46,528 $

1,477.49

5,895 $

2,571.91

211,107 $

4,490.86

Qualified Medicare Beneficiary .Aged Disabled Total for Eligibility Category

Expenditures

$

18,633,997

$

8,577,406

$

27,211,403

Expenditures

Recipients per Recipient

18,219 $

1,022.78

7,500 $

1,142.28

25,728 $

1,057.66

Medically Needy .Aged Blind Disabled Children in Farrilies Vlith Dependent Children J.ldults in Farrilies Vlith Dependent Children Other Children Total for Eligibility Category

Expenditures

$

1,006,612

$

700,116

$

9,072,924

$

428,015

$

100,300

$

1,374,754

$

12,781,7~

Expenditures

Recipients per Recipient

669 $

1,639.18

479 $

1,461.62

2,222 $

4,003.22

125 $

3,424.12

54 $

2,024.24

3:)3 $

4,537.14

3,852 $

3,318.21

Expenditures

Right From The Start Medicaid

Expenditures Recipients per Recipient

RSM Child

$ 333, 104,049

285,953 $

1,164.89

RSMJ.ldult

$ ~7.983,265

90,281 $

3,411.39

Total for Eligibility Category

$ 641,037,314

376,234 $

1,703.96

(

Source: HCFA report 2082 for FY96.

23

'\1\/~lfare: Ref&rm: .. .. ,.;,,.,_.,,;.,.,_.,~, /~

a~d Medicai'd.

The Personal Responsibility and Work Opportunity Reconciliation Act of 1996

Congress passed this welfare reform legislation August 22, 1996. While it did not affect social service programs in Georgia during Fiscal Year I996, it will have an effect on such services-including, to some degree, Medicaid-in the coming fis~al years.

The bill eliminates the Federal entitlement program of Aid to Families with Dependent Children (AFDC), replacing it with a block grant to the states. The new law also makes changes to child care, the food stamp program, the Supplemental Security Income (SSI) program, benefits for legal immigrants and the Child Support Enforcement program.

The changes that will affect Medicaid are those changes in the AFDC and SSI programs. Eligibility requirements for those programs have a direct impact on Medicaid eligibility. Changes will not be instituted, in the majority of cases affected by the new law, until 1997.

24

Chartsand Graphs
Recipient and Expenditure Charts; by Age, Ethnicity, Gender, Aid Category and Location of Residence A History of Medicaid Benefits Expenditures FY96 Administrative Expenditures Recipients by Aid Category by Type of Service Benefits Paid by Aid Category by Type of Se~ice Percentage of Expenditures, Recipients, and Average Yearly Payment per Recipient, by Aid Category Percentage of Total Recipients Utilizing Each Service Average Payment for Services Per Recipient Percentage of Total Expenditures for Each Category of Service Providers with Paid Claims, by Category of Service Analysis of Recipients and Expenditures by Recipients' Counties
25

Recipients by Age Group

65- 84 85

years

3%

9%

45-64

0- 5years 27%

7%

21 - 44 years 22%

6-20 years 32%

Recipients by Ethnicity, FY96

Other

1% Unknow,

Hispanic

4%

Caucasian 39%

AfricanAmerican
54%
Recipients by Gender, FY96

Expenditures by Age Group

65- 84 years 18%

85 10%

0- 5 years 15%
6- 20 years 17%

years 14%

years 26%
_ _ _ _ _ _ ___J

Expenditures by Ethnicity, FY96

Hispanic Unknow,

1%

7%

Other

Caucasian 49%

AfricanAmerican
42%
__ ___Ji
Expenditures by Gender, FY96

26
.__

Recipients by Aid Category

OtherMedically

Right from the Start
32%

Needy Aged <1% So/o Blind 1%
Disabled 17%

AFDC 42%
Medicaid Recipients by Rural/Urban Location

Benefits by Aid Category

Right from the Start

OtherMedically
Needy <1%

AFDC 20%

Blind 6%

35%

Medicaid Expenditures by Rural/Urban Location of Recipients

urban 62%

rural 39%

urban 61%
v
I
I
1

27

Fiscal Year

A HISTORY OF MEDICAID BENEFITS EXPENDITURES *

Cash **
Benefit
Payments

Percentage Change

Payments ***
by Date
of Service

Percentage Change

1970

$73,766,763

1971

$128,527,366

74%

1972

$141,138,792

10%

1974

$182,989,393

30%

1973

$187,774,982

3%

1975

$266,136,883

42%

1976

$268,858,408

1%

1977

$318,029,162

18%

$308,142,782

1978

$343,319,187

8%

$338,228,610

10%

1979 .$375,653,922

9%

$377,658,055

12%

1980

$435,292,735

16%

$444,155,517

18%

1981

$519,934,060

19%

$536,560,178

21 %

1982

$542,306,612

4%

$545,307,185

2%

1983

$613,392,777

13%

$608,309,046

12%

1984

$624,861,133

2%

$668,128,193

10%

1985

$694,279,055

11 %

$739,671,854

11 %

1986

$785,486,760

13%

$820,893,065

11 %

1987

$900,119,766

15%

$932,536,868

14%

1988 $1,039,092,121

15%

$1,086,605,506

17%

1989 $1,202,158,160

16%

$1,240,277,978

14%

1990 $1,385,905,937

15%

$1,486,563,690

20%

1991 $1,730,756,706 +

25%

$1,776,285,458 +

19%

I

1992 $2,090,163,405 + 1993 $2,380,785,409 +

21 % 14%

$2,108,822,516 + $2,409,067,203 +

19% 14%

1994 $2,747,463,083 +

15%

$2,803,617,573 +

16%

1995 $3,003,708,266 +

9%

$3,020,833,794 +

8%

1996 $3,089,570,328 +

3%

$3,063,285,252 (est)

1%

*

Figures include Medicare copayments and deductibles, but exclude Medicare premium payments.

**

Paid during each fiscal year. In this Annual Report all "expenditures," "benefits" or "payments" are

cash benefits payments, with the exception of "payments by date of service."

"* * +

Expenditures for services provided in each fiscal year. Since FY77, based on the Attorney General's ruling, payments have been made from the budget for the same year in which the. Medicaid service was rendered. Final expenditure- amounts are not known until some time after a fiscal year .has ended, since providers have six months from the month of service to file a claim. Date of service figures are expenditures as of June 30, 1994, for FY87-FY95; FY96 is an estimate. Note that the figures for fiscal years before 1987 were revised to exclude Medicare premium payments.
Does not include Indigent Care Trust Fund amounts of: $88,855,058 in FY 91, $246,891,441 in FY 92, $246,477,987 in FY 93, $344,976,776 in FY 94, $420,296,638 in FY 95, and $391,707,906 in FY96.

28

FY 96 ADMINISTRATIVE EXPENDITURES

Function Contracts:
OHR lnteragency Contract Fiscal Agent Computer Services Georgia l\/1edical Care Foundation Contract

Expenditures

$

38,871,645

19,375,138

4,976,388

Percent of Total
38.5% 19.2%
4.9%

Divisions: Legal & Regulatory Services General Administration Systems Management Commissioner's Office Professional Services Reimbursement Services Long Term Care Maternal & Child Health Managed Care

5,119,860 6,413,485 12,455,198 3,942,592 2,425,003 1,990,079 1,248,046 1,816,548 2,280,605

5.0% 6.4% 12.4% 3.9% 2.4% 2.0% 1.2% 1.8% 2.3%

TOTAL ff

$ 100,914,587

100.0%

Federal funds only. State matching funds appear in the Department of Human Resources budget. Services provided through this contract include eligibility determination, administration and case management for the community care program, recipient appeal hearings, and certification of facilities for participation in Medicaid.
.. Total figure does not include the cost associated wth Nurse Aide Training program mandated by Congress. In FY96, the cost of the program V\8S $1,430,673. These funds 111ere paid directly to nursing homes, but 111ere matched 50/50 federal/state instead of the normal federal participation rate for Medicaid benefits.

Type of Premium

FY 96 MEDICARE PREMIUMS Expenditures

Percent of Total

100% State Premium, Part B State-Federal Premiums, Parts A & B
State Share Federal Share
Total Medicare Premiums

$

8,731,300

$ 41,025,282 $ 66,737,477
$ 116,494,059

7.5%
35.2% 57.3% 100.0%

The State pays the Part B premiums for Medicare/Medicaid individuals \/\llo are eligible for Part B benefits
and also pays the Part A premiums for certain QMB individuals w,o are enti11ed to Part A benefits.

29

RECIPIENTS BY AID CATEGORY BY TYPE OF SERVICE FY96

Type of Meclcal Service

~65 or Over

Blind

Disabled

Other Aduts

Other Ctildren

Unduplicated Total

Comrrunity Health Services

8,335

336

12,408

811

959

22,849

Dental

3,479

793

26,649

35,445 191,255

257,621

Farrily Aanning

0

198

5,322

70,971

15,995

92,486

HEALTH CHECK (EPSDD

0

146

9,776

3,379 284,617

297,918

Hospital, Inpatient

26,031

4,006

46,783

62,733

43,289

182,842

Hospital, Outpatient

50,824

6,490

123,830

144,923

297,001

623,068

Laboratory/Radiology

3,198

792

33,043

100,660

67,930

205,623

f\/ental Health Services

1,302

251

30,228

15,310

34,264

81,355

Nursing Facility Intermediate Care-MR

29

10

1,806

0

1,846

Nursing Facility Services

23,518

10,332

7,686

9

2

41,547

Other Care +

47,890

9,540

121,798

139,000 347,513

665,741

Other Practitioners ++

24,789

5,201

37,125

38,591

106,717

212,423

) Aiysician

85,834

12,455

170,764

200,196 478,558

947,807

J

Prescribed Drugs

68,328

13,408

163,376

192,116 458,238

895,466

Rural Health Oinic

2,046

166

4,834

4,204

13,878

25,128

Total Recipients

94,890

16,800

197,406

244,434 627,562 1,181,092

Source: l\rnJal Statistical Report on Medical Care IHCFA 2082) for FY95. Aid category subtotals are not available for "other" service types on the HCFA 2082 report (see notes below). There """re 376,716 "Right from the Start" and "Medically Needy" recipients included in the "Other" subtotals: 90,33 pregnant women and 286,381 chldren.
Includes home health and comrrunty care, independent ca-e, mental retardation and model waiver services.
Includes dialysis recipients. Facility and laboratory recipients are under outpatient hospital and professional fees we under physician.
Includes rural health specialty code 57 comrrunty health centers.
+ Includes am.Its with AIDS case management, antJulance, amWatory surgical, at risk of incarceration, chldlirth ed.Jcation program, chldren at risk, clildren's intervention services, diagnostic,screenng and preventive services, durable mecielll eqt.iprnent, early intervention case management,
Georgia Better Health Care, hospice, non-emergency transportation, optometries-eyeglasses, orthotics & prosthetics, PASARR, perinatal case management, pregnant substance abuse day treatment, pregnancy-related services, protective services for adults and chldren, therapeutic residential intervention, therapy services for eligibles less than 21 years of age and therapists programs.
+ + Includes certified registered nurse anestt-etists, chropractors, rurse mid'Mves. rurse practitioners, optometrists, JXlysician's assistants, podiatrists and psycholopists.

30

BENEFITS PAID BY AID CATEGORY BY TYPE OF SERVICE FY96

Type of MJdlcal Servtce

Age65 orOwr

Blind

lllsabled

01her Adul1S

0lher Ollldran

To1al Payna,1S

Comrunity Health Services Demal

$26,148,792 Dl,432

$1,170,463 66,611

$74.~713 3,007,922

~Dl

$2,0CG,872

$1(5,244, 148

3,664,849

25,632,651

32,Eel,465

Farrily Planning ~ALTli Cl-ECK (EPSDT) Hospital, lnpa11ent Hospital, Ou1pa1lent " Labora1Dry/Radiology
Mlmal Health Services "*
lllnslng Facility Intermediate Car~ l\&Jrsing Facility Services
01her Care +
Olher Pr8Cli1ioners ++
Physician " Prescribed Drugs Rural Health Clnlc

0

43,962

0

9,365

2a8l3.235

6,795,2al

13,3:8,618

3,0:!7,CXl!

174,431

84,cm

1,519,893

270,335

1,854,487

825,347

357,924,159 140,836,960

21,729,700

5,387,438

1,189,373

269,478

29,363,552

6,041,849

64,021,429

12,861,021

201,510

1a457

1,11a403

27,482.071

1,743,670

596,979

189,377

24,s,a201

257,0CB,766 270,484.712 237,cm.413

00,517,168

67,874,796

n,198,471

3,797,759

9,648,320

2.562.262

51,150,172

6,CB3,864

15,537,410

123,412.036

0

13,017

140,192,495

44,558

62.443

11,,626,,00

17,263,001

61,407,114

5,967,215

a759,7B9

22. lCB,310

11as1s,400 144,387,li 144,779,815

144, 199,228

32.91a467

55,929,231

812,!lli

645,256

2,015,459

3),398, 100 25,612,928 lm,243,412 251,987,001 16,2ffi,866 74,571,674 126,104,887 639,00),8'.li 192,414,022 3a295, 165
443.079,crn
3:8,929,376 3,EB3,587

To1al Payman1S +++

$546,598,617 $177,766,ffi:l $1,101,254,870 $590, 146,833 $673,lm,345 $3,cal,570,328

Sa.rte: 1v1nua Statisoca ~ ai f.la1ical ea-a (1-CFA :re2) lo" FY93. M:l:!icae ~ il1l <in.ditles ere irdiml, txJt rd M:l:!icae ~LIT6, \\llidl v.ee$116,5fi8,345 in FY93. Aidcategay~s 118 rd availat:leb"'Clher' Sll'lioot)l)85 oo the HCfA:m2 ~ (see rdes tElo/4. Plr,nml
of $653,008,001 rrale b" 'Right flan the St<ft' ;r,d 'Mldically Needy' ra:ipEl1fS ere irdiml in the 'Oller" Slttxas: SD!,002,574 b"IJll!J1clll 'MJT8 il1l $.134,91>,818 lo"dlildren
lrdlXles lure heath ;r,d cxmnrity cae, irdepEnlent cae, l1'B1lal l'bdalia1 ;r,d ntxls w.i\/8" SEIMlllS
" lrdlXles dialysisexpinitures. Fa::ility ;r,d lmatayexperditures 118 urderoo1patiErlt t-osptal il1l ixofesso,aJ fees ereurderJ:tiysiciir,
- lrdlXles nra heath specialty cxxJe 57 -amrunity health renters
+ lrdlXles alulls \\ith AIDS case ~ . ~iml, arbJatay sugica, al risk of irca-aralicn, chilcilrth EW:alioo iJOJlllT1, childrm al risk dlildrm's inter.9ltioo services, clia;Jrmc,saeerirg a'tl l)"EMll1tive ssvilllS, ~ rimca equiplB1!, 8cl1y interventiai case ~
Qugia Better 1-'eath ea-a, tu;re, raHmJglJ1(,)' ~ o o . ~ a s s e s . atl'dics &,rn;thetics, PASIIRR, pllinaal case
ITTraJIIT8ll, i:regrml Slbstlrol abuse day treatrrenl, ~ a t a i services, ~Yll services fa oouils ;r,d chikien, ~ residential intsvElltiCJl, ~ ssvilllS lo" eligi~es less ltm 21 ~ of <JJ8 ;r,d ~sis IJll9lllT6
++ lrdlXles rertifia:J registeral nurse anesthetists, chirqra::tors, rn,se rri!Mi\135, nurse ~ . ~ . J:tiysici111's assislalts, jXdatrists ;r,d Pl)\'.tdogisls.
+++ DJes rd irdude Indigent Care Trust Furd ITTOUnt of$391,707,0Ci

31

Percentage of Expenditures, Percentage of Recipients, and Average

Yearly Payment Per Recipient by Basis of Eligibility, FY 1996

By Aid Category Aged Blind Disabled AFDC Right from the Start Other-Medically Needy TOTALS

Payments

$ 546,726,984

$ 177,766,663

$ 1,101,254,870

$ 621,359,743

$ 641,087,314

$

1,374,754

$ 3,089,570,328

%of total 17.7% 5.8% 35.6% 20.1% 20.8% 0.0%
100.0%

Recipients 94,890 16,800
197,406 495,459 376,234
303 ,.181,092

Avg.Pd.per % of total Recipient
8.0% $ 5,761.69 1.4% $ 10,581.35 16.7% $ 5,578.63 41.9% $ 1,254.11 31.9% $ 1,703.96 0.0% $ 4,537.14 100.0% $ 2,615.86

Source: Annual Statistical Report on Medical Care (HCFA 2082) for SFY 1996.
* Most aged and a portion of the blind are covered by Medicare, so expenditures do not reflect the total cost
of health care. Medicare coinsurance and deductibles are included.
* * Includes recipients who receive cash assistance and those who do not. * * * Does not include Indigent Care Trust Fund.

From FY 1987 to FY1991, the growth in Medicaid's budget in Georgia and the growth in the number of recipients climbed steadily each year; from 1990 to 1991, for instance, budget growth was 25% ($1,385,905,937 to $1,730,756,706) and recipient growth was 18% (733,702 to 848,029). Starting in 1992, that growth slowed; for FY1996, growth was slower than it has been since 1987. DMA's budget from 1995 to 1996 increased only 3%, and the number of recipients increased only 4%. Per-recipient costs actually decreased 1.1 %.
j

Comparison: Percent Change in Expenditures vs. Recipients, FY1987 to 1996

% Change in Expenditures, FY87 to FY96

% Change in Recipients, FY87 to FY96
20% -

5%
0%+-~-+--+--+--+--+-~\~~
--

32

PERCENTAGE OF TOTAL RECIPIENTS UTILIZING EACH SERVICE

Category of Service

FY93

FY94

FY95

FY96

Adults with AIDS Case Management

<0.1% <0.1% <0.1% <0.1%

Ambulance

7%

7%

7%

7%

Ambulatory Surgical

0%

0%

0% <0.1%

At Risk of Incarceration

0%

0% <0.1%

Certified Registered Nurse Anesthetists

2%

3%

3%

Childbirth Education Program

<0.1% <0.1% <0.1%

Children at Risk

2%

1%

0% <0.1%

Children's Intervention Services

0%

0% <0.1 %

Community Care

1%

1%

1%

1%

Dental, Adult

5%

4%

4%

4%

Dental, Child

18%

19%

19%

18%

Dental Oral Surgery

<0.1% <0.1% <0.1% <0.1%

Diagnostic, Screening & Preventive Services

4%

4%

6%

6%

Dialysis

0%

0%

0% <0.1%

Durable Medical Equipment

5%

6%

7%

7%

Early Intervention Case Management

0%

0%

0% <0.1%

Family Planning

9%

9%

9%

3%

Federally Qualified Health Centers

0%

3%

Georgia Better Health Care

6%

15%

31%

HEALTH CHECK (EPSDT)

25%

25%

27%

25%

Home Health

1%

1%

1%

1%

Hospice

<0.1%

0%

0% <0.1%

Hospital, Inpatient

18%

21 %

17%

16%

Hospital, Outpatient Independent Care Services Laboratory /Radiology Mental Health Case Management Mental Health Clinic

56% <0.1%
15%

54% <0.1%
18%

53% <0.1%
18%

53%
<0.1%
18%

l

0%

0%

0% <0.1%

6%

4%

4%

4%

\

Mental Retardation Waiver Program

<0.1 % <0.1%

0% <0.1%

Model Waiver Services

<0.1% <0.1% <0.1% <0.1%

Non-Emergency Transportation

15%

20%

20%

15%

Nurse Midwife

1%

1%

1%

1%

Nurse Practitioner

1%

1%

2%

2%

Nursing Facility Intermediate Care-MR

0%

0%

0% <0.1%

Nursing Facility Services

5%

4%

4%

4%

Optometries-Eyeglasses

4%

4%

4% <0.1%

Optometry

6%

7%

7%

8%

Orthotics/Prosthetics

1%

1%

1%

1%

Other Coinsurance and Deductibles *

1%

1%

1% <0.1%

33

PERCENTAGE OF TOTAL RECIPIENTS UTILIZING EACH SERVICE

Category of Service
PASARR Perinatal Case Management Physician Physician's Assistant Podiatry Pregnancy-Related Services Pregnant Substance Abuse Day Treatment Prescribed Drugs Protective Services, Adult Protective Services, Child Psychology Rural Health Clinic Swing Bed Services Therapeutic Residential Intervention Therapy Services (Physical, Occup, Speech)

FY93
2% 84%
0% 4% 1% <0.1% 79%
2% 1% <0.1%
100%

FY94
4% 83%
1% 4% 2% <0.1 % 77%
1% 3% 4% <0.1% <0.1% 0% 100%

FY95
0% 4% 82% 1% 3% 2% <0.1% 76% 0% 2% 3% 4% <0.1% 0% 0% 100%

FY96
,0.1% 4%
81 % 1% 3% 2%
<0.1% 76%
<0.1% 2% 3% 2%
<0.1% <0.1% <0.1%
100%

Source: "Medicaid Expenditures by Recipient's County of Residence" report and previous Annual Reports.
* Other Coinsurance and Deductibles includes Physical, Rehabilitation, and Speech therapies, and Chiropractor.

34

AVERAGE PAYMENT FOR SERVICES PER RECIPIENT

Type of Service

FY 93

FY 94

FY 95

FY96

Adults with AIDS Case Management

$213.14 $174.87 $225.29

$261.20

Ambulance

$103.25

$202.09 $230.53

$239.02

Ambulatory Surgical

$302.59 $338.26 $338.39

$320.81

At Risk of Incarceration

$144.87 $138.67

$339.36

Certified Registered Nurse Anesthetists

$131.78 $135.83

$129.69

Childbirth Education Program

$31.36

$41.69

$39.93

Children at Risk

$99.50 $221.66 $404.04

$391.90

Children's Intervention Services

$1,111.73 $1,302.38

$850.08

Community Care

$2,564.72 $2,614.99 $3,020.45 $3,426.28

Dental, Adult

$79.93

$80.72

$81.38

$82.53

Dental, Child

$135.46

$140.12 $137.45

$135.17

Dental Oral Surgery

$89.00 $268.44 $239.98

$276.10

Diagnostic, Screening & Preventive Services

$47.49

$45.10

$41.86

$37.72

Dialysis

$8,933.76 $9,210.56 $9,645.17 $10,140.38

Durable Medical Equipment

$395.66 $354.06 $375.15

$377.13

Early Intervention Case Management .

$567.89 $628.24 $602.87

$631.02

Family Planning

$445.99 $519.27 $345.09

$328.68

Federally Qualified Health Centers

$96.84

$197.23

HEALTH CHECK (EPSDT)

$88.87

$92.12

$87.20

$85.97

Home Health

$1,048.71 $1,310.92 $1,466.55 $1,440.03

Hospice

$4,181.50 $4,232.00 $5,184.75 $5,672.93

Hospital, Inpatient

$3,914.21 $3,366.69 $4,101.21 $4,388.32

Hospital, Outpatient Independent Care Services

$353.92

$368.51

$392.29

$412.50

I

$23,813.47 $43,648.40 $53,216.23 $46,104.88

Laboratory/Radiology Mental Health Case Management

$70.43

$65.97

$74.50

$998.95 $1,184.04 $1,200.37

$79.35 $950.62

1

I

Mental Health Clinic Mental Retardation Waiver Program

$863.83 $1,099.26 $1,189.62 $1,267.65 $37,143.88 $34,146.21 $27,960.42 $23,451.58

l

Model Waiver Services

$28,765.59 $26,531.45 $25,484.17 $25,527.72

Non-Emergency Transportation

$314.55 $402.32 $366.05

$254.64

Nurse Midwife

$700.84 $571.92 $514.95

$490.89

Nurse Practitioner

$57.44

$63.12

$64.05

$65.05

Nursing Facility Intermediate Care-MR

$66,057.36 $63,614.12 $65,659.76 $68,238.58

Nursing Facility Services

$11,750.24 $13,821.38 $14,837.61 $12,865.03

Optometries-Eyeglasses

$21.03

$25.59

$25.21

Optometry

$49.65

$51.49

$52.47

$60.27

Orthotics/Prosthetics

$609.25

$596.56 $571.78

$591.08

Other Coinsurance and Deductibles

$564.33 $632.18 $553.93

35

AVERAGE PAYMENT FOR SERVICES PER RECIPIENT

Type of Service
PASARR Perinatal Case Management Physician Physician's Assistant Podiatry Pregnancy-Related Services Pregnant Substance Abuse Day Treatment Prescribed Drugs Protective Services, Adult Protective Services, Child Psychology Qualified Medicare Beneficiaries Rural Health Clinic Swing Bed Services Therapeutic Residential Intervention Therapy Services (Physical, Occup, Speech) Total Average Payment per Recipient Annual Percent Change

FY 93
$85.15 $431.14
$56.28 $56.40 $95.41 $2,933.00 $285.49
$575.30
$116.07 $569.22
$2,521.01 2.28%

FY 94

FY 95

FY96

$835.12 $1,122.83

$106.29 $106.63 $105.94

$445.12 $470.49 $474.28

$84.01 $109.15

$91.71

$58.22

$71.52

$82, 12

$101.43

$91.66

$91.06

$2,072.56 $1,720.46 $1,484.44

$310.86 $325.01 $336.47

$6,330.23 $1,422.51

$819.43 $938.92 $902.62

$562.77 $682.74 $614.43

$117.00 $151.91

$151.78 $166.92 $147.48

$1,130.08 $1,338.56 $1,633.24

$6,168.70 $32,403.81 $27,363.32

$490.11 $750.57 $306.72

$2,594.59 $2,645.94 $2,615.86

2.92%

1.98%

-1.14%

Source: "Benefits and Recipients by Category of Service" and previous Annual Reports. Amounts do not include Indigent Care

fu~~~-

.

I
1-

36

PERCENTAGE OF TOTAL EXPENDITURES FOR EACH CATEGORY OF SERVICE

Category of Service

FV93

FV94

FV95

FV96

Adults with AIDS Case Management

<0.1 % <0.1% <0.1% <0.1%

Ambulance

0%

1%

1%

1%

Ambulatory Surgical

<0.1% <0.1% <0.1% <0.1%

At Risk of Incarceration

<0.1 % <0.1% <0.1%

Certified Registered Nurse Anesthetists

0%

0%

0%

Childbirth Education Program

<0.1% <0.1% <0.1%

Children at Risk

0%

0% <0.1% <0.1%

Children's Intervention Services

<0.1%

0%

0%

Community Care

1%

1% ,

1%

1%

Dental, Adult

0%

0%

0%

0%

Dental, Child

1%

1%

1%

1%

Dental Oral Surgery

<0.1% <0.1% <0.1% <0.1%

Diagnostic, Screening & Preventive Services

0%

0%

0% <0.1%

Dialysis

0%

0%

0% <0.1%

Durable Medical Equipment

1%

1%

1%

1%

Early Intervention Case Management

<0.1%

0%

0% <0.1%

Family Planning

2%

2%

1% <0.1%

Federally Qualified Health Centers

<0.1%

0%

Georgia Better Health Care

<0.1 %

0%

0%

HEALTH CHECK (EPSDT)

1%

1%

1%

1%

Home Health

1%

1%

1%

1%

Hospice

0%

0%

0%

0%

Hospital, Inpatient Hospital, Outpatient Independent Care Services Laboratory/Radiology

28%

28%

26%

26%

I

8%

8%

8%

8%

<0.1%

0%

0%

0%

0%

0%

0%

1%

)

Mental Health Case Management

0%

0%

0%

0%

Mental Health Clinic

2%

2%

2%

2%

Mental Retardation Waiver Program

1%

1%

1%

1%

Model Waiver Services

0%

0%

0%

0%

Non-Emergency Transportation

2%

3%

3%

1%

Nurse Midwife

0%

0%

0%

0%

Nurse Practitioner

<0.1'% <0.1% <0.1% <0.1%

Nursing Facility Intermediate Care-MR

5%

4%

4%

4%

Nursing Facility Services

22%

21%

20%

21%

0 ptometrics-Eyeg Iasses

<0.1% <0.1 % <0.1% <0.1%

Optometry

0%

0%

0%

0%

Orthotics/Prosthetics

0%

0%

0%

0%

Other Coinsurance and Deductibles *

0%

0%

0% <0.1%

37

PERCENTAGE OF TOTAL EXPENDITURES FOR EACH CATEGORY OF SERVICE

Category of Service
PASARR Perinatal Case Management Physician Physician's Assistant Podiatry Pregnancy-Related Services Pregnant Substance Abuse Day Treatment Prescribed Drugs Protective Services, Adult Protective Services, Child Psychology Qualified Medicare Beneficiaries Rural Health Clinic Swing Bed Services Therapeutic Residential Intervention Therapy Services (Physical, Occup, Speech)

FY93
0% 14% <0.1%
0% 0% <0.1% 9%
0%
<0.1% <0.1%
100%

FY94
0% 14% <0.1%
0% 0% <0.1% 9%
0% 1 %
0% <0.1 %
0% <0.1%
100%

FY95
0% 0% 15% <0.1% 0% 0% <0.1% 9% 0% 1% 1% <0.1% 0% <0.1% 1% 0% 100%

FY96
<0.1% 0%
15% <0.1%
0% <0.1% <0.1%
10% 0% 1% 1%
<0.1% 0%
<0.1% 1%
<0.1% 100%

Source: Benefit expenditures (by date of payment) are reported in the FY95 Annual Statistical Report on Medical Care (HCFA 2082) and estimated from the FY 95 Medicaid Expenditures by Recipient County of Residence. "Total Expenditures" include copayments and deductibles for persons eligible for Medicare and Medicaid, but not Medicare premiums. Indigent Care Trust Fund is not included.

38

PROVIDERS WITH PAID CLAIMS BY CATEGORY OF SERVICE

Category of Service

FY93

FY94

FY95

FY96

Adults with AIDS Case Management

1

8

15

16

Ambulance

213

221

228

215

Ambulatory Surgical

22

34

42

51

At Risk of Incarceration

8

2

1

Certified Registered Nurse Anesthetists

544

624

670

Childbirth Education Program

2

8

7

Children at Risk

83

13

7

10

Children's Intervention Services

107

154

593

Community Care

252

295

372

351

Dental, Adult

874

896

810

784

Dental, Child

1,036

1,150

1,014

970

Dental Oral Surgery

1

30

52

50

Diagnostic, Screening & Preventive Services

33

44

37

35

Dialysis

181

197

250

275

Durable Medical Equipment

467

1,620

1,908

1,945

Early Intervention Case Management

41

64

57

54

Family Planning

23

29

31

46

Federally Qualified Health Centers

14

19

Georgia Better Health Care

218

442

1,088

HEALTH CHECK (EPSDT)

353

523

688

877

Home Health

82

83

85

91

Hospice

26

30

35

42

Hospital, Inpatient

414

375

452

453

Hospital, Outpatient Independent Care Services

679

574

525

710

8

22

32

48

!

Laboratory/Radiology Mental Health Case Management

96

94

86

99

17

20

42

23

l'

Mental Health Clinic

33

31

185

72

Mental Retardation Waiver Program

108

128

24!?

169

Model Waiver Services

26

28

23

25

Non-Emergency Transportation

580

895

1,128

761

Nurse Midwife

92

109

124

144

Nurse Practitioner

108

176

180

179

Nursing Home Intermediate Care-MR

12

12

12

12

Nursing Facility Services

334

339

341

342

39

PROVIDERS WITH PAID CLAIMS BY CATEGORY OF SERVICE

Category of Service
Optometry Orthotics/Prosthetics Perinatal Case Management Physician Physician's Assistant Podiatry Pregnancy-Related Services Pregnant Substance Abuse Day Treatment Prescribed Drugs Psychology Rural Health Clinics Swing Bed Services Therapeutic Residential Intervention Therapy Services (Physical, Occup, Speech)

FY93
503 124
46 12,390
153 72 5.
1,964 399 32 6

FY94
545 127
66 13,073
126 164 103
10 1,957
496 35 8 1
116

FY95
548 139
88 14,148
203 188 104
10 1,974
624 46 9 14
263.

FY96
559 175
98 14,981
274 189 100
5 2,006
623 37 11 17
258

TOTAL

18,686

20,131

22,284

29,600

NOTE: The number of providers with paid claims can be considerably less than the number of providers "enrolled". For example, the number of providers enrolled for inpatient hospital during FY 95 was 589; for nursing facility services, 351; for pharmacy, 2,244; and for physicians, 31,262. The total number of providers enrolled at the end of FY95 was 52, 164. Out-of-state providers are included for all years. If a provider has more than one location, the provider is only counted once. Source: Provider Participation Summary.

40

ANALYSIS OF RECIPIENTS AND EXPENDITURES BY RECIPIENT'S COUNTY FY96

County

Benefits Paid

Estimated 1996
Population

Unduplicated Recipients

% Population Recei'ling Medicaid

%of Total
State Recipients

Expenditures per
Recipient

Appling

$10,165,126

16,359

4,031

24.64%

0.36%

$2,521.74

Atkinson

4,422,895

6,749

2,049

30.36%

0.18%

2,158.56

Bacon

8,506,005

10,438

2,745

26.30%

0.24%

3,098.73

Baker

1,943,033

3,766

1,161

30.83%

0.10%

1,673.59

Baldwin

59,294,459

41,854

6,930

16.56%

0.61%

8,556.20

Banks

3,004,347

11,616

1,568

13.50%

0.14%

1,916.04

Barrow

16,041,608

35,699

5,671

15.89%

0.50%

2,828.71

Bartow

21,125,127

63,732

8,923

14.00%

0.79%

2,367.49

Ben Hill

12,481,843

17,258

4,388

25.43%

0.39%

2,844.54

Berrien

8,812,397

15,466

3,434

22.20%

0.30%

2,566.22

Bibb

90,665,524

155,066

34,904

22.51%

3.07%

2,597.57

Bleckley

5,109,430

10,958

2,112

19.27%

0.19%

2,419.24

Brantley

6,780,254

12,698

3,065

24.14%

0.27%

2,212.15

Brooks

10,067,374

15,837

4,283

27.04%

0.38%

2,350.54

Bryan

6,180,678

21,190

3,470

16.38%

0.31%

1,781.18

Bulloch

21,005,227

48,642

9,127

18.76%

0.80%

2,301.44

Burke

14,901,600

21,742

7,101

32.66%

0.63%

2,098.52

Butts

9,519,960

16,025

3,069

19.15%

0.27%

3,101.97

Calhoun

4,346,046

4,851

1,872

38.59%

0.16%

2,321.61

Camden

8,347,373

40,714

5,472

13.44%

0.48%

1,525.47

Candler

10,794,061

8,637

2,977

34.47%

0.26%

3,625.82

Carroll

32,945,224

77,977

12,670

16.25%

1.12%

2,600.25

Catoosa

13,905,669

48,008

6,603

13.75%

0.58%

2,105.96

Charlton

5,595,872

9,296

2,189

23.55%

0.19%

2,556.36

Chatham

110,887,901

226,160

44,292

19.58%

3.90%

2,503.57

\

Chattahoochee

1,082,675

15,871

786

4.95%

0.07%

1,377.45

Chattooga

10,728,149

22,884

3,974

17.37%

0.35%

2,699.58

Cherokee

22,200,833

114,751

8,030

7.00%

0.71%

2,764.74

Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson

36,622,385 3,004,771
71,643,080 5,594,885
97,971,105 19,929,634 22,321,221 16,212,078
9,220,454 21,467,757
4,684,517 16,596,418
4,365,730 3,696,988

90,207 3,473
198,551 6,438
525,453 32,697 38,072 83,674 13,950 72,021 10,166 20,716 14.158 12,237

13,783 1,402
32,286 2,204
38,354 8,851 10,925 7,566 3,627 9,045 1,843 7,552 2,189 1,632

15.28% 40.37% 16.26% 34.23%
7.30% 27.07% 28.70%
9.04% 26.00% 12.56% 18.13% 36.45% 15.46% 13.34%

1.21% 0.12% 2.84% 0.19% 3.38% 0.78% 0.96% 0.67% 0.32% 0.80% 0.16% 0.67% 0.19% 0.14%

2,657.07 2,143.20 2,219.01 2,538.51 2,554.39 2,251.68 2,043.13 2,142.75 2,542.17 2,373.44 2,541.79 2,197.62 1,994.39 2,265.31

41

ANALYSIS OF RECIPIENTS AND EXPENDITURES BY RECIPIENT'S COUNTY FY96

County Decatur DeKalb 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 Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones

Benefits Paid
$25,139,414 234,661,409
11,670,378 6,992,541
55,434,533 27,024,805
9,309,802 746,766
10,330,999 10,819,014 18,759,064
6,215,078 8,815,463 9,014,327 46,764,590 13,532,899 10,877,431 350, 190,599 9,370,137 3,009,117 32,202,313 14,187,454 10,440,123 7,956,388 69,461,832 11,829,137 42,198,639 9,423,691 12,431,787 5,774,168 9,773,116 4,865,920 17,430,219 32,345,315 6,456,323 17,165,408 3,648,417 6,169,204 15,382,464 6,659,760 6,839,855 7,061,238

Estimated 1996
Population* 26,390 582,095 17,956 10,314 97,511 82,297 12,198
2,325 32,118 19,173 20,954
9,438 17,480 78,879 83,935 62,335 17,701 700,689 15,916
2,456 65,565 38,442 21,312 12,781 457,058 30,146 108,238
9,100 23,378 20,479 20,848
9,573 84,553 99,647
8,725 33,921
9,168 12,366 17,872
8,658 8,436 22,077

Unduplicated Recipients 8,212 91,327 4,184 2,974 28,804 9,665 4,370 554 4,519 4,306 7,117 2,865 3,456 2,889 15,240 4,386 3,656
148,140 3,493 516
11,855 6,523 5,691 3,189
26,802 3,761
16,154 2,738 4,573 2,345 3,633 1,920 6,785
13,395 2,237 6,061 1,757 2,730 5,935 2,629 2,448 2,721

%Population Receiving Medicaid
31.12% 15.69% 23.30% 28.83% 29.54% 11.74% 35.83% 23.83% 14.07% 22.46% 33.96% 30.36% 19.77%
3.66% 18.16%
7.04% 20.65% 21.14% 21.95% 21.01% 18.08% 16.97% 26.70% 24.95%
5.86% 12.48% 14.92% 30.09% 19.56% 11.45% 17.43% 20.06%
8.02% 13.44% 25.64% 17.87% 19.16% 22.08% 33.21% 30.36% 29.02% 12.33%

o/oofTotal State
Recipients 0.70% 7.73% 0.35% 0.25% 2.44% 0.82% 0.37% 0.05% 0.38% 0.36% 0.60% 0.24% 0.29% 0.24% 1.29% 0.37% 0.31% 12.54% 0.30% 0.04% 1.00% 0.55% 0.48% 0.27% 2.27% 0.32% 1.37% 0.23% 0.39% 0.20% 0.31% 0.16% 0.57% 1.13% 0.19% 0.51% 0.15% 0.23% 0.50% 0.22% 0.21% 0.23%

Expenditures per
Recipient $3,061.30
2,569.46 2,789.29 2,351.22 1,924.54 2,796.15 2,130.39 1,347.95 2,286.13 2,512.54 2,635.81 2,169.31 2,550.77 3,120.22 3,068.54 3,085.48 2,975.23 2,363.92 2,682.55 5,831.62 2,716.35 2,174.99 1,834.50 2,494.95 2,591.67 3,145.21 2,612.27 3,441.82 2,718.52 2,462.33 2,690.10 2,534.33 2,568.93 2,414.73 2,886.15 2,832.11 2,076.50 2,259.78 2,591.82 2,533.19 2,794.06 2,595.09
42

ANALYSIS OF RECIPIENTS AND EXPENDITURES BY RECIPIENT'S COUNTY FV96

County

Benefits Paid

Estimated 1996
Population*

Unduplicated Recipients

%Population Receiving Medicaid

%ofTotal State
Recipients

Expenditures per
Recipient

Lamar

$6,895,598

13,797

2,720

19.71%

0.23%

$2,535.15

Lanier

4,655,896

6,312

1,738

27.53%

0.15%

2,678.88

Laurens

25,873,713

42,852

9,698

22.63%

0.82%

2,667.94

Lee

3,839,530

19,922

2,515

12.62%

0.21%

1,526.65

Liberty

16,574,289

58,749

8,527

14.51%

0.72%

1,943.74

Lincoln

3,005,844

8,055

1,571

19.50%

0.13%

1,913.33

Long

2,282,401

7,885

1,582

20.06%

0.13%

1,442.73

Lowides

42,873,253

82,952

17,122

20.64%

1.45%

2,503.99

Lumpkin

6,915,547

16,822

2,417

14.37%

0.20"/4

2,861.21

Macon

11,800,902

13,249

3,869

29.20%

0.33%

3,050.12

Madison

11,056,738

23,396

3,989

17.05%

0.34%

2,771.81

Marion

3,984,364

6,370

1,591

24.98%

0.13%

2,504.31

llllc:Dutfie

12,378,757

21,627

5,221

24.14%

0.44%

2,370.96

llllclntosh

4,536,769

9,456

2,259

23.89%

0.19%

2,ro3.31

M3rill'oether

12,774,540

23,041

5,185

22.50%

0.44%

2,463.75

MIier

5,069,974

6,161

1,790

29.05%

0.15%

2,832.39

Mtchell

14,365,618

20,859

6,937

33.26%

0.59%

2,070.87

l'vtmroe

10,056,219

18,950

3,009

16.30%

0.26%

3,255.49

fVbntgomery

3,139,105

7,635

1,574

20.62%

0.13%

1,994.35

1\/brgan

6,075,034

14,006

2,581

18.43%

0.22%

2,353.75

l'v\.Jrray

11,452,505

30,032

5,071

16.89%

0.43%

2,258.43

l'v\.Jscogee

81,545,462

184,594

36,070

19.54%

3.05%

2,200.76

Nev.ton Oconee

22,437,550 4,707,710

50,644 21,190

9,168 1,964

18.10% 9.27%

0.78% 0.17%

2,447.38 2,397.00

r

Oglethorpe

4,651,978

10,911

1,958

17.95%

0.17%

2,375.88

l

Paulding

13,645,400

59,920

5,635

9.40%

0.48%

2,421.54

:

Peach

10,051,422

22,906

5,198

22.69%

0.44%

1,933.71

1

Pickens

8,753,714

16,881

2,785

16.50%

0.24%

3,143.16

Pierce

7,938,196

14,821

3,321

22.41%

0.28%

2,390.30

Pike

3,911,987

11,441

1,622

14.18%

0.14%

2,411.83

Polk

18,415,101

34,771

6,959

20.01%

0.59%

2,646.23

Pulaski

5,468,361

8,245

1,970

23.89%

0.17%

2,775.82

Putnam

6,800,505

15,991

2,657

16.62%

0.22%

2,582.05

Quitman

1,011,178

2,420

783

32.36%

0.07%

1,291.42

Rabun Randolph

6,356,901 5,414,320

12,738 8,002

2,004 2,806

15.73% 34.68%

0.17% 0.24%

3,172.11 1,929.55

Richmond

143,040,814

195,500

48,100

24.61%

4.07%

2,973.27

Rockdale

15,803,597

64,448

5,891

9.14%

0.50%

2,682.67

Schley

1,402,770

3,783

818

21.62%

0.07%

1,714.88

Screven

8,161,368

14,336

3,734

26.05%

0.32%

2,185.69

Seminole

6,777,307

9,007

2,893

31.80%

0.24%

2,342.66

Spalding

26,625,779

57,306

11,343

19.79%

0.96%

2,347.33

43

ANALYSIS OF RECIPIENTS AND EXPENDITURES BY RECIPIENT'S COUNTY. FY96

County

Benefits Paid

Estimated 1996
Population

Unduplicated Recipients

%Population Receiving Medicaid

o/oofTotal State
Recipients

Expenditures per
Recipient

Stephens

$12,704,766

25,CXX)

4,696

18.78%

0.40%

2,705.44

Ste\l\0rt

4,759,020

5,438

1,670

30.71%

0.14%

2,849.71

Sumter

20,133,447

31,245

9,554

30.58%

0.81%

2,107.33

Talbot

2,491,404

6,741

1,511

22.42%

0.13%

1,648.84

Taliaferro

970,119

1,883

511

27.14%

0.04%

1,898.47

Tattnall

14,163,380

18,588

5,247

28.23%

0.44%

2,699.33

Taylor

6,022,209

8,048

2,549

31.67%

0.22%

2,362.58

Telfair

10,191,256

11,623

3,253

27.99%

0.28%

3,132.88

Terrell

6,967,834

11,(X)7

3,840

34.89%

0.33%

1,814.54

Thomas

29,652,764

41.419

10,741

25.93%

0.91%

2,760.71

Tift

18,217,222

35,932

9,001

25.05%

0.76%

2,023.91

Toombs

19,675,760

25,276

7,048

27.88%

0.60"/4

2,791.68

Towis

3,651,449

7,559

996

13.18%

0.00%

3,666.11

Treutlen

4,683,226

5,943

1,790

30.12%

0.15%

2,616.33

Troup

27,214,672

57,882

11,215

19.38%

0.95%

2.426.63

Turner

5,110,390

8,916

2.821

31.64%

0.24%

1,811.55

Twggs

5,676,022

10,000

2,177

21.64%

0.18%

2,607.27

Union

6,264,349

14,427

2,055

14.24%

0.17%

3,048.35

Upson

13.476,696

26,961

5,157

19.13%

0.44%

2,613.28

Walker

26,183,879

60,654

9,985

16.46%

0.85%

2,622.32

Walton

17,995,739

46,694

7,773

16.65%

0.66%

2,315.16

Ware

26.471,556

35,589

9.410

26.44%

0.80%

2,813.13

Warren

5,124.423

6,057

1,854

30.61%

0.16%

2,763.98

.,,

Washington

14,148,928

19,953

5,001

25.06%

0.42%

2,829.22

Wayne

13,705,867

24,818

5,366

21.62%

0.45%

2,554.21

Webster

890,120

2.260

465

20.58%

0.04%

1,914.24

Wheeler

4,116,104

4,830

1,402

29.03%

0.12%

2,935.88

Vvhite

5,951,295

15,330

1,951

12.73%

0.17%

3,050.38

Whitfield

30,299,867

78,033

13,246

16.97%

1.12%

2,287.47

Wlcox

7,527.475

7,100

2,101

29.59%

0.18%

3,582.81

\Mikes

5,372,101

10,615

2,496

23.51%

0.21%

2,152.28

\Mlkinson Worth

4,359,784 10.:ni.192

10,627 21,643

2,117 5,703

19.92% 26.35%

0.18% 0.48%

2.059.42 1,806.00

Statewde

$3,089,570,328 7,200,882

,.181,092

16.40% 103.98%

$2,615.86

Estimaled population for 1996 based on 1990 census figures from 1he Gowrnor's Office of Planning and Budget
-s1a1ewde 101als reflect unduplica1ed recipiems and expendi1ures as lis1ed elsewiere in 1his report The sum of''% Total Stale Recipiems" exceeds 100%since a recipient may reside in more 1han one county during a year. Expenditures do not indude Indigent Care Trust Fund amount of $391,707,oc:13 or Medicare preniums.

44

Number of Medicaid Eligibles by County - Fiscal Year 1996

Number of Medicaid Eligibles

36,000 to 161,000

!I 9,000 to 36,000

lllll 4,000 to 9,000

[liJ

Oto 4,000

r
\ \
l
l
\

45

SOURCE: Georgia OMA MMIS

Number of Medicaid Eligibles Compared to Population by County - Fiscal Year 1996
Number of Medicaid Eligibles 1 Dot = 3,000 Population
Based on 07/01/95 Estimates 457,000 to 701,000 II 57,000 to 457,000 fill 19,000 to 57,000
CJ 1,000 to 19,000
SOURCE: Georgia OMA MMIS and University of Georgia
46

Percent of County Population Eligible for Medicaid Services - Fiscal Year 1996
Percent Eligible 28% to 39% II 21% to 28% f!'i:l 14% to 21% 00 4% to 14%

\

l
I
\
I
I

1

SOURCE: Georgia OMA MMIS

l

I

47

l

- .... ---------- ---- - - - - - - - - - - - - - - - - - - - - - ~

I

Number of Medicaid Recipients by County - Fiscal Year 1996

Number of Medicaid Recipients

24,000 to 136,000

lm 3,000 to 24,000

l'.dl 2,000 to 3,000

0

0 to 2,000

SOURCE: Georgia DMA MMIS
48

.........
Percent of Medicaid Eligibles Receiving Medicaid Services - Fiscal year 1996
Percent Receiving Services 87% to 93% Ill 85% to 87% ~ 83% to 85% [ill 75% to 83%
r
1
1
1
I
1
\
\
I
I
I
(
\'
SOURCE: Georgia OMA MMIS
49