Family Cost Participation in Georgia

1. Family Cost Participation in Georgia Part C/Babies Can’t Wait Program

2. Why FCP in Georgia? Precedent Initial Planning Stakeholder Involvement

3. GA Part C Demographics • Part C serving 4,457 children (6/30/03) and over 7,000 per year • Moderate eligibility criteria • 62.6% Medicaid eligible • 39.1% Private Insurance • 4.8% PeachCare (S-CHIP)

4. Georgia Demographics • Median Income of families with children (2000) = $44,800 ($50,000 nationally) • Percentage of Children Living in Poverty: 21% in 1990; 18% in 2000 • Percentage of Children in Extreme Poverty (below 50% Poverty level) = 8% (7% nationally) Source: GA Kids Count 2003

5. Why does FCP Work for Georgia? • Consistent policies & procedures • Same criteria is applied to all families • Scheduled updates & revisions

6. Ongoing Monitoring Demographics: FCP scale is reviewed and updated annually to include most current Federal Poverty Guidelines and other necessary changes

7. Modifications are Based on Ongoing Monitoring Local monitoring & site reviews Complaints Identification of new fund sources

8. Revisions that Occurred in Response to Ongoing Monitoring Revised Policies: FCP & Medicaid-eligibility - Provisions applied family cost participation to non-covered services for all families

9. Revisions that Occurred in Response to Ongoing Monitoring Revised Policies: “Spend Down” & Adjusted Income - Revisions to refine, clarify, and define allowable and disallowed “spend downs”

10. Revisions that Occurred in Response to Ongoing Monitoring Revised Criteria: For families with multiple children enrolled in Part C - Provisions to reduce FCP percentage by 5% for each child after the first enrolled child

11. Revisions that Occurred in Response to Ongoing Monitoring New Funding Sources & Coordination: • Private Insurance provisions • Expansion of FCP to Title V

12. Things we Considered but did not do in GA • Out of pocket maximum costs per year for each family • Separate scales for families who access insurance and those who deny access

13. Why does FCP Work for GA? Consistent Policies: • Determination of “inability to pay” Ongoing Monitoring: • Widespread acceptance & expectations

14. Family Cost Participation -What’s Next in GA? Changes in Political and Economic Context: • Look at FCP fee scale, levels Infrastructure Changes: • Data system enhancements

15. What Does It Take to Get the Job Done? Consider this as you study FCP in your state… • Stakeholders • Data • Other options • Authority needed

16. Any Questions??? Georgia’s FCP forms are available for your reference. Contact me at skmoss@dhr.state.ga.us or 404-657-2721