Medicaid Matters to Georgia's Children

Medicaid Matters

Medicaid impacts Children’s more than any other hospital in Georgia. More than 397,663 patient episodes of care at Children’s in 2012 were covered by Medicaid or PeachCare. This represents about 55 percent of total patients.

Doctors and staff at Children’s treat about four out of every 10 pediatric Medicaid cases in Georgia, making Children’s the largest Medicaid provider in the state. Medicaid funding affects everyone, including those not on Medicaid. 

Without Medicaid dollars, Children’s would have to reduce the scale of its current services. Additionally, we would be forced to decrease the amount of research that has led to groundbreaking technologies and treatment plans.

  • What is Medicaid?

      Medicaid is the U.S. public health insurance program for low-income women, children, seniors and people with disabilities. Medicaid covers more than 66 million Americans, roughly half of whom are children. At Children's, more than half of our patients rely on Medicaid for health insurance.

  • How is Medicaid funded?

      Financing for Medicaid is a shared responsibility between the state and the federal government via a formula called the Federal Medical Assistance Percentage (FMAP). The formula is based on the wealth of a state, which is measured by the state's per capita income. 

      The logic here is that a wealthier state should pay more of the cost of its Medicaid program than a poor state. In Georgia, the federal government pays about $0.66 of every Medicaid dollar spent. No state has to pay more than half of its Medicaid costs. On average, the federal government pays 64 percent of a state's Medical bill.

  • How does Medicaid affect Children's?

      Medicaid is the single largest source of revenue for Children's. Medicaid affects Children's in two ways:

      Payment

      Medicaid reimburses Children's at less than the amount it costs to treat a child. After an encounter with a patient, Children's must submit a list of services rendered to the state for payment.

      Ideally, hospitals like to be paid within the month, but that is not always possible because of many factors, including the patient's eligibility status and whether the service rendered is reimbursable by Medicaid. The gap between treatment cost and what is reimbursed cannot be made up in volume.

       

      Volume

      Georgia has the eighth largest pediatric population in the nation, and Children's is the largest provider of pediatric clinical care services in the nation.

      We are capable of treating a wide range of medical conditions, which makes us the first choice for many families in and around the Atlanta area, and the first choice for Georgia families with children who have complex medical issues. 

      As the population increases, so will demand for our services. In Georgia, Children's is the only freestanding pediatric hospital system.

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