Georgia lawmakers push for state health insurance plan transparency

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A House committee Tuesday approved a bill that would require more public disclosure about Georgia health plans serving Medicaid patients and state employees and teachers.

Members of the House Health and Human Services Committee did not voice any objections to the measure, which now goes to the Rules Committee in that chamber.


The legislation was sponsored by Rep. Lee Hawkins, a Gainesville Republican and a dentist. He said that as lawmakers, “we’ve always wanted to see’’ the insurance information required in the bill.

“We’ve got to know where the problems are,’’ Hawkins told the committee. “We’ve had a hard time understanding exactly what’s wrong.’’

The information would be collected by health insurers and then transmitted to the state Department of Community Health (DCH), which oversees Medicaid and the State Health Benefit Plan. The latter benefits plan covers more than 600,000 state employees, teachers, other school personnel, retirees and dependents.

Jesse Weathington, CEO of the Georgia Association of Health Plans, an industry group, sat next to Hawkins during his presentation to the committee. Hawkins said Weathington agreed to the bill’s provisions.

The proposed legislation, though, comes amid calls for greater financial and performance transparency about how the state Medicaid insurers provide care.

Under a separate bill, the managed care plans serving much of the Medicaid population are facing potential requirements to refund payments to the state if they don’t spend enough on medical care and quality improvements for patients.

Georgia Health News and Kaiser Health News reported in September that Georgia is one of only a few states that doesn’t mandate a minimum level of medical spending for its Medicaid insurers.

The House health panel is expected to take up the Ralston legislation, House Bill 1013, on Wednesday.

Last September, a report from the Georgetown University Center for Children and Families found that Georgia failed to post important information about Medicaid management and performance on the DCH website. For example, the state did not post quality metrics or enrollment data that are delineated by race and ethnicity, which the Georgetown report said is “vital to ensuring that Medicaid equitably delivers care.”

DCH’s performance dashboard shows how each Medicaid insurer performs on national quality metrics through using a star-rating system. The latest data come from measurement year 2019.  The dashboard does not break up the data by race or ethnicity.

Prior to the new dashboard, some key data were difficult to find on the DCH website, Georgia Health News reported.

The new bill would require DCH to post “demographic and population-based reporting on common disease states.”

Hawkins’ legislation would also require the state to post the per-member, per-month “cost figures” for the Medicaid, PeachCare and fee-for-service plans that provide health insurance to hundreds of thousands of Georgians, most of them children.

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