Earlier this year, Georgia announced the winners of its latest Medicaid managed care contracts, a multi-billion-dollar shift that will impact over a million low-income children, pregnant women, and children in foster care across the state. Among the chosen insurers is UnitedHealthcare, which starting next summer, is poised to become the sole provider of Medicaid services for children in Georgia’s foster care system.
But here in Northeast Georgia, the announcement raises more questions than answers, especially when you consider the fractured relationship between UnitedHealthcare and Northeast Georgia Health System (NGHS).
For the past two years, United has been unable to reach a commercial agreement with NGHS. The dispute has been so contentious that NGHS still maintains a public-facing microsite that reads plainly: “United has let you down.” It outlines grievances ranging from claim denials to underpayment issues, painting a bleak picture of an insurer that has left many families caught in the middle.
And now, with United set to take over care for Georgia’s most vulnerable populations, failure to reach an agreement with NGHS will leave at-risk groups, especially foster children, without access to the care they desperately need. While most Medicaid recipients in Georgia will have the option to choose from four insurers, children in foster care will not. As a result, if United fails to reach a deal with NGHS, foster families in NE Georgia could be left with no access to care at their local hospital.
The good news is United appears to have secured Letters of Intent to participate in their Medicaid network from many hospitals across Georgia. The bad news? There is no indication NGHS is among them. Which makes you wonder: did they try and fail, or not even bother? It’s hard to say which is more concerning. Either way, there is little reason for optimism a deal is near.
This is especially troubling given what we know about the unique health needs of children in foster care. A 2023 ProPublica investigation found that United has routinely denied or restricted access to mental health services for children, particularly those with autism. That’s a chilling revelation, considering children in foster care experience far higher rates of autism and trauma than their peers.
A foster parent in Gainesville might take in a child with trauma-related behavioral needs or complex medical issues. But if NGHS is out of network, that child can’t see a doctor locally. Instead, families could be forced to drive to Atlanta just to find care!
The risks are too great to ignore. We’re talking about real kids with real medical needs unable to access care at the only hospital they know.
Our local delegation, Republicans and Democrats alike, must start asking tough questions about what happens next. Because if this goes sideways, and if United continues its pattern of failed negotiations and denied care, it won’t be United or NGHS that pays the price.
It’ll be the children.
