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GA Georgia Better Health Care (GBHC)

Georgia Better Health Care (GBHC) matches Medicaid recipients to a primary care physician or provider. Through GBHC, the Department of Community Health (DCH) contracts with primary care physicians and providers to deliver and coordinate Medicaid recipient health care services.

About 4,200 physicians contract with DCH to serve as primary care case managers. Data as of April 2002 (the most recent available), shows that more than 707,000 recipients were enrolled in GBHC in all 159 Georgia counties. Another 222,852 children enrolled in GBHC receive coverage through the PeachCare for Kids program.

The key goals of the program are to:

·               Improve access to medical care, particularly primary care services

·               Enhance continuity of care by creating a "medical home"

·               Reduce unnecessary use of medical services

Recipients may select their GBHC primary care case manager. If they do not choose a primary care provider, they will be assigned a physician based on historical usage (the recipient or a family member has been to the same doctor before) or based on geographic convenience (whichever available enrolled primary care provider is most easily accessible geographically).

Primary care physicians receive a monthly case management fee of $3 per member for coordinating members' health care services, regardless of whether they see the member that month. When services are provided, the regular Medicaid fee-for-service reimbursement applies.

GBHC improves patients' access to primary care and helps reduce hospitalization for serious illnesses. It also reduces the number of unnecessary visits to emergency rooms (for non-emergency care) and to specialists for care that could be provided through a primary care physician.

Approximately 70 percent of Georgia Medicaid recipients are enrolled in GBHC. Membership is mandatory for most Medicaid recipients. Exceptions include:

·               People residing in nursing facilities, personal care homes, mental health hospitals and other residential facilities

·               Recipients with short-term Medicaid enrollment, such as pregnant women covered under Right From The Start.

·               Recipients covered by both Medicare and Medicaid are eligible, but not required, to become members of GBHC.

GBHC was approved by the Health Care Financing Administration (HCFA) through a waiver under authority of section 1915(b) of the Social Security Act. In October 1993, the Department of Medical Assistance began offering GBHC to recipients in the pilot counties of Baker, Columbia, Dougherty, Lee, Murray, Richmond and Whitfield. Today it is operational in all counties.

NOTE: Information about Georgia Better Health Care (GBHC) was drawn from the Georgia Department of Community Health website available at:
http://www.communityhealth.state.ga.us/

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Medicaid Overview

Medicaid Financial Eligibility

Georgia Benefit Information System (GABIS) Overview

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