Redesign Background & More

Medicaid and CHIP Redesign - Background

The Redesign Initiative is focused on solution planning, innovation and strategic options for managing the care and financing of Georgia's Medicaid and CHIP populations.

Key Features of the Redesign Initiative:

Navigant Consulting Inc. will:

  1. Conduct a comprehensive environmental scan of the Medicaid and
    CHIP programs on both a national and Georgia-specific basis that
    will include:   
    • Nationwide data that reflects trends in other states
    • Identification of "best practices" in Medicaid and CHIP program design for managed care and fee-for-service (FFS) programs
    • A review of Georgia's current Medicaid and PeachCare for Kids® managed care and FFS models
    • 30 statewide stakeholder meetings to understand the stakeholder perspective of the Medicaid and PeachCare for Kids programs' strengths, weaknesses and opportunities in Georgia
  2. Identify options for innovative redesign of the current Medicaid and PeachCare for Kids managed care and fee-for-service programs. The Redesign options will address:
    • The most appropriate approaches for providing services to the varied Medicaid populations and CHIP members
    • Plans for sustained access to quality health care services in all geographic areas of Georgia
    • An analysis of service gaps or potential weaknesses in the current Medicaid and PeachCare for Kids programs, and how to address such gaps or weaknesses
    • Opportunities to enhance administrative efficiencies for DCH, providers and contractors in the oversight and delivery of health care services to Medicaid and CHIP members
    • Overall Medicaid and CHIP expenditures, and opportunities for budget predictability and cost management
  3. Assist with the procurement of vendors or providers for DCH's recommended redesigned solution and implementation
Medicaid and CHIP Redesign – Process

The Georgia Department of Community Health’s (DCH) comprehensive assessment and recommended redesign of Georgia's Medicaid Program and Children's Health Insurance Program (CHIP/PeachCare for Kids®) is underway.

The Medicaid and CHIP Redesign Initiative includes four (4) phases:

Assessment Phase - Completed
  • This phase covered the August through December 2011 period.
  • Navigant has completed the environmental scan of the Medicaid and CHIP programs on both a national and Georgia-specific basis; Navigant has also completed 30 statewide stakeholder meetings and has reviewed more than 400 online surveys.
Recommendation/Decision Phase – Nearing Completion
  • This phase covers the January 2012 through summer 2012 period.
  • Navigant has submitted its Redesign Strategy Report to DCH detailing options for a proposed redesign of Georgia's Medicaid and PeachCare for Kids programs.
  • The Strategy Report includes the environmental scans and stakeholder meeting results, as well as options for the state's consideration:
    • Options for a "best-in-class" service model for Georgia, which will include the impact of the solution on level of care, access, projected cost savings and state expenditures during a five (5) year period
    • Navigant's assessment regarding federal and state regulatory and operational requirements for the proposed solution
    • Consideration of potential Medicaid expansion
    • Contractual accountability of contracted vendors to provide the desired network access, and program and health outcome objectives
  • The Redesign decision will be announced in summer 2012 pending finalization of the following: Strategy Report review and analysis including feedback from stakeholders; preparation of additional data and financial modeling; and incorporation of task force and workgroup input.
Procurement Phase - Underway
  • This phase covers the April 2012 through April 2013 period.
  • DCH and Navigant will finalize all procurement documents for the Medicaid and CHIP Redesign procurement (e.g., scope, RFP(s), contract, evaluation tools, etc.)
  • During the third quarter of 2012, DCH expects to issue an electronic RFP(s) for the Redesign procurement
Implementation Phase - Slated to Commence Early 2013, 2014
  • The phase covers the early 2013 through late 2014 period, and beyond as necessary.
  • DCH anticipates making contract awards to vendors selected for the redesigned Medicaid and PeachCare for Kids programs
  • During the implementation phase, Navigant will assist DCH with:
    • Internal resource management
    • Planning with DCH's Fiscal Agent (Hewlett-Packard, HP) and subsequent testing
    • Network access assessment
    • Member enrollment activities
    • Vendor onsite readiness reviews
    • Risk identification and management
    • Establishment of policies, procedures and tools for the administrative oversight and monitoring of vendors' contractual performance and deliverables
  • While implementation is expected to begin in early 2013, DCH plans to roll-out ("go-live") the redesigned Medicaid and PeachCare for Kids programs starting in the first half of 2014.

Check this website often for updates and additional information.