Rep. Karen Lupton Urges CareSource and Peach State Health Plan to Return to Agreed-Upon Medicaid Reimbursement Rates

ATLANTA - State Representative Karen Lupton (D-Chamblee) urges CareSource and Peach State Health Plan to rescind recent decisions to reduce Medicaid reimbursement rates and return to their previously agreed-upon reimbursement rates until the next reenrollment period. These private care management organizations (CMOs) recently notified providers of reimbursement reductions to 80 percent of the Medicaid fee schedule, effective in May.

"Healthcare providers in my district and across the state have contacted me regarding the reimbursement changes that CareSource and Peach State are implementing," said Rep. Lupton. "I am alarmed that two out of three Care Management Organizations can slash their reimbursement rates mid-year, well outside the period of enrollment. Changing the parameters of reimbursements well after providers and members have signed contracts puts me in mind of someone selling a car to a person but then showing up six months later and repossessing the brakes. Although many providers are asking me to urge the Department of Community Health to force the CMOs to stick to their original reimbursement schedule, I do know that DCH's role does not include the management of reimbursement rates within CMOs"

The Department of Community Health is the single state agency for Medicaid. The Georgia Families managed care program was established in 2006 and contracts with private Care Management Organizations to deliver healthcare services to enrolled members of the Medicaid program and PeachCare for Kids® in the State of Georgia. DCH employs a care management approach to organize its system of care, enhance access, achieve budget predictability, explore possible cost containment opportunities and focus on systemwide performance improvements.

"Given the lack of good healthcare options for so many in this state, as well as the provider shortages Georgia is enduring, I would think that every good effort would be made on the part of the DCH and CMOs to keep reimbursement rates at a level that will not threaten the solvency of providers or the wellbeing of Medicaid members," added Rep. Lupton. "I am distressed that so many people are being affected by these changes in my district. I would urge CareSource and Peach State to return to their agreed-upon reimbursement rates until the next reenrollment period, at the very least."

Representative Karen Lupton represents the citizens of District 83, which includes a portion of DeKalb County. She was first elected to the House of Representatives in 2022 and currently serves on the Education, Energy, Utilities & Telecommunications and Human Relations & Aging committees.

###