Oh Caresource part 2

Since a lot of you responded, thought I would add some feedback....

Yes DPH is going to take a hit and reimburse the difference to the Medicaid rate. Will have to file SSPR forms to receive the difference. I hate that the state still has to take funding hit to support these corporations. 

I don't think DCH has much control over contract rates the CMOs do, something we learned when Peachstate went 80% a few years ago, and it's a loophole I'm sure Caresource figured out. However I still believe a response is needed. 

Yes this will affect everyone eventually, individuals and clinics ...

TriAlliance sent out their email if you didn't received it and I hope it's ok to forward here because Kelly Ball did state several good points in her email....especially stating don't just copy and paste the letter you see, make it personal.   It's really a joint effort with all of us to complain, reason I try to spread these messages. Also support TriAlliance if you can thru your state association. 

It doesn't hurt to email DCH to complain, so if it helps, I recommend it.  mgdc.complaints@dch.ga.gov

Supposedly, there is a meeting DCH is supposed to be having with Caresource to address this. 

Here's Trialliance (Kelly Ball's) email: 

Oh Caresource - part 1

If you haven't received your certified letter yet, Caresource is reducing everyone's rate starting in May to 80% of the Medicaid rate. I started getting calls on Friday about it, and unless someone else has a solution, there's not much we can do except leave the network. I had seen a lot of new contracts coming being offered at 80% but I thought they would only go forward with new contacts at that rate. 

I've heard rumors that it's because they can't continue to keep up with the ABA rates that were just raised last summer by DCH, or that they expect to take over the Peachstate caseload who's rate is lower for most newer contracts, but no confirmations on any rumors so far. With the new CMOs eventually coming into the picture, I thought they would understand the competition isn't offering a lower rate. So much for being a non-profit...

If you haven't received the letter it looks like this: 

Notice it says 45 days yet most are receiving them this week. 

So as your patients to change to another CMO when they can or email them stating you disagree and leave the network. You can find the redetermination date for each patient on GAMMIS on the eligibility page when you search right under the name, or the parents can call GA Families  (1-888-423-6765) to ask when they can switch. 

Why yes there's something wrong with eligibility this month on GAMMIS

UPDATE:

Some parents are also getting emails from DCH saying they're working on it...

Parents should email Emily Yona: emily.yona@dch.ga.gov

When my assistant Ruby and I were checking eligibility yesterday, we saw the issue online with eligibility for a lot of kids. She kept texting me, something is wrong. I kept agreeing. 

Here was what made us clue in: 

When  you would check a patient that had Katie Beckett or SSI and was active last month, this month their redetermination date was from last year long ago, something that would have triggered eligibility for January instead of now...

Some of the CMO kids are eligible with the CMO via their website, but not on GAMMIS

I don't know what the issue is, hoping it will be fixed, but from everything I'm seeing online, parents are stressed too with not being able to reach anyone at Medicaid today or DFCS. 

So it's up to you on whether you see the patients, but due note, if you do, you're taking a chance they do not have coverage. However, I would definitely recheck these after the 3^rd or 4^th day of this month, as often the eligibility changes/gets updated again then. Just stating on observation .