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Grady Board Asked to Have Indigent Patients Pay for Shortfalls

In a December 1st Medicaid Watch Report on State Medicaid and Health Cuts and Expansions, by Thomas P. McCormack, Grady is referred to as “Georgia's Safety Net.”

Concerns are expressed because of the $250 Million short fall which the indigent care of primarily Fulton & DeKalb Counties.Both Fulton and DeKalb Counties were asked for an additional $20 million. Fulton gave and additional $15 million and the DeKalb County and the State may offer an additional $5 million each.

Where is the $200 million promised by business leaders if Grady were to be privatized?

Promises to provide funding to continue Grady Memorial Hospital's indigent care services have not been kept. Who will pay the difference between what is needed and what is available?Grady's Chief Financial Officer thinks that the patients that used to benefit from free services, because they are indigent, should pay for the services themselves!According to a memorandum from the Grady Coalition, “Mike Ayers plans to ask for Board approval on January 5 to begin to require Fulton and DeKalb patients who earn between 126 and 200% of the federal poverty income to pay 40% of the cost of their care (up to 25% of annual income).

This means, for example, that a single person earning $13,001 per year before taxes, could be charged as much as $3250 a year, and a single person with a $26,000 income could be charged as much as $6500. At present, Fulton and DeKalb patients with incomes below 250% of the federal poverty guidelines receive free care.”

The memorandum continued... “Coalition has met and unanimously agreed to stand against the Grady Health System administration's proposal to cut thousands of low-income patients off the rolls of those receiving free care.

The Grady Coalition believes that implementing this proposal will jeopardize the health of thousands of patients. Many patients will not seek care due to the charges, resulting in suffering and death.

NCH Recommendation Re: Healthcare

National Coalition for the Homeless Recommends
Homeless Access to Recovery through Treatment Act

Background: The Homeless Access to Recovery through Treatment (HART) Act (H.R. 4129) is designed to increase access to mental health services and substance abuse programs to persons who are experiencing homelessness.

The HART Act would improve the state planning and implementation of the already existing programs to include preferences to those who are without housing and insure patient discharge from these programs systems into stable and appropriate housing. The bill would not make substantial changes to the programs, themselves. It would simply strengthen and expand federally funded programs that are currently working well, such as PATH and GBHI/THP, to be more inclusive of the needs of those without housing (including youth).

Status: Representatives Hilda Solis (D-CA), Julia Carson (D-IN), Jim Ramstad (R-MN) introduced the Homeless Access to Recovery through Treatment Act (H.R. 4129) in late 2007. The bill’s sponsors and advocates are seeking co-sponsors to establish a base of support for inclusion of the HART Act provisions within the larger Substance Abuse and Mental Health Services Administration (SAMHSA) reauthorization measure currently under development.

NCH, Recommendations: Ensure homeless people with addictions and mental illness receive the necessary treatment and assistance to help them recover and end their homeless conditions.

Recommendations to U.S. Representatives: Cosponsor the Homeless Access to Recovery through Treatment Act (HART Act, H.R. 4129).

Recommendations to U.S. Senators: Introduce or cosponsor a companion bill to the Homeless Access to Recovery through Treatment Act (HART Act, H.R. 4129).
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NCH lists reasons that persons who are experiencing homelessness should be guaranteed access to recovery through treatment:

• Addiction and mental illness – frequently co-occurring – often lead to and prolong homelessness and tend to be exacerbated by the experience.

• Among surveyed homeless people, 39 percent have some form of mental health problem, and SAMHSA estimates that between 20 percent and 25 percent meet criteria for serious mental illness. In addition, 38 percent of surveyed homeless people have an alcohol problem, and 26 percent report problems with other drugs.

• In 2004, more than 175,300 admissions (13 percent) to substance abuse treatment facilities were homeless at the time of admission.

• A person experiencing homelessness is more than twice as likely to have had five or more previous treatment episodes as their housed counterparts.

• Untreated addictions and mental illnesses present serious barriers to employment and permanent housing, perpetuating an ever-worsening cycle of poor physical health, hospitalization, social dysfunction, incarceration, poverty, and homelessness. These are tragic outcomes for homeless persons and their families; burdens on healthcare, social service, and corrections systems; and costs to taxpayers.

• Homelessness presents serious barriers to treatment for behavioral health conditions. People experiencing homelessness are impoverished, uninsured or underinsured, and often alone. Lack of documentation, lack of transportation, and difficulty adhering to treatment regimens prevent many homeless individuals from succeeding in mainstream behavioral health care, including in the public behavioral health care safety net systems established for persons without insurance. Due to monetary constraints and limited understanding of homelessness, many mainstream behavioral health service providers are unable to offer the full range of care necessary to address the complex needs of people experiencing homelessness. People experiencing homelessness present complex challenges for which most mainstream providers are ill equipped or untrained.

• A helpful, but ultimately inadequate, work-around to these mainstream system failures has been two federal behavioral health care programs targeted to persons experiencing homelessness – Projects for Assistance in Transition from Homelessness (PATH) and Grants for the Benefit of Homeless Individuals/Treatment for Homeless Persons (GBHI/THP).


For further information on the public policy recommendations of the National Coalition for the Homeless, contact the NCH public policy staff at:

info@nationalhomeless.org or 202.462.4822

OR: visit www.nationalhomeless.org.

OUR POLICY RE: HEALTHCARE:

Livable Wages, Safety Net Issues. OUR POLICY GOAL: To initiate and perpetuate universal access to a living wage and living-income support.

We believe that if a person works 40 hours per week, then he/she should be able to access basic housing. Existing federal guidelines have been used to determine what a living wage should be. The first guideline dictates that no more than 30% of a person's gross income should be spent on housing. The second is Fair Market Rents (FMR's), established by HUD, nationwide, for both rural and metropolitan areas. FMR's are based on the gross rent estimates, which include shelter rent and the cost of utilities, except for phone service. , Though the average livable wages for cities across the U.S. is calculated $12.75, federal minimum wage remains at $5.25.

Those with disabilities, or who are unable to work for other reasons, lack the resources to obtain or maintain decent housing. 40% of those without housing are working. Many who manage to maintain housing with low paying jobs, do so out of their food or health care budgets and budgets for other basic needs. This may explain why 42 million Americans are without health insurance and why one in four children, in Georgia, go to bed hungry. It explains why over 7 million Americans experienced homelessness last year and why millions are continually at risk of becoming homeless. The Task Force continually strives to educate and advocate for livable wages for all and for access to basic needs, including decent housing and quality health care for all [including those who cannot work].

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BELOW ARE A FEW ARTICLES RE: HEALTHCARE FROM OUR ARCHIVES THAT RELATE TO DIFFERENT ASPECTS OF HEALTHCARE AS IT RELATES TO POVERTY AND HOMELESSNESS...

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SOAR INTO ACTION! A Message From The National Healthcare for the Homeless Council

NHCHC ACTION PLAN FOR “SOAR”
[SSI/SSDI Outreach, Access, and Recovery program]

Schedule visits to educate Members about the SOAR Initiative: Despite the hard work of Senators and Representatives during this period to pass a range of appropriations bills through Committee, it is widely expected that unresolved differences between Congress and the Administration may force the government to operate under continuing resolutions until the new Congress passes appropriations bills early next year. This political strategy reduces the opportunity to gain targeted funding for the SOAR Initiative this year; however, it does provide a unique opportunity to build support for the program and educate Members about the relationships among poverty, disability, and homelessness.

August 11 marks the beginning of Summer Recess for the 110th Congress, when Members return to their home districts and often reach out to constituents to identify issues important to them. This is an opportune time educate your Members about the barriers your clients face when trying to obtain disability benefits and the promise of the SOAR Initiative in overcoming those obstacles. Although the 110th Congress is unlikely to make changes in funding, it nonetheless is imperative to educate your Member(s) about SSI and SOAR now to establish a stronger knowledge-base and contacts for future advocacy in the next Congressional session.

SOAR into Action!

• Invite your Member(s) of Congress to tour your clinic to facilitate a conversation about homelessness and the SOAR Initiative. Find out who represents you at www.house.gov or www.senate.gov or call the Capitol Switchboard at 202-224-3121. Call your Member at their local office and ask to speak to their scheduler or policy staffer. Explain the type of work you do and ask to schedule a meeting at your clinic.

• When you speak with your elected official or their representatives about SOAR, be

sure to emphasize the talking points listed below:

• Explain the obstacles that people experiencing homelessness face when trying to access SSI/SSDI benefits, such as lack of proper identification, not having a fixed address, incomplete medical records, transportation barriers that prevent individuals from keeping appointments, etc.

• Since its implementation, over the past 5 years in 34 states the SOAR Initiative has dramatically improved access to SSA disability benefits for homeless applicants.

• SSA data shows the average approval rate for initial applications from all applicants is only 37% and smaller studies indicate the approval rate for initial applications from homeless clients is only 10-15%.

• Preliminary 2008 data from 18 participating states suggest that SOAR is a model worthy of replication. A total of 66% of initial applications submitted through the SOAR program were approved and approval times were reduced, on average, to 88 days

Background on SOAR legislation: SOAR-ing through the Barriers: Improving Access to SSI/SSDI Benefits People without a regular place to stay face substantial barriers to participation in federal disability assistance programs that could help to end their homelessness. Such obstacles, well

known to providers at HCH projects, include the lack of acceptable identification, the absence of a fixed address, and incomplete medical records. Over the past three years, a promising federal initiative under the acronym SOAR (the SSI/SSDI Outreach, Access, and Recovery program) has substantially improved access to disability benefits for people experiencing homelessness. The effectiveness of this national program warrants its continuation and expansion. The National Council encourages Mobilizer readers to support the SOAR initiative.

Federal Disability Assistance – Out of Reach -The Social Security Administration (SSA) oversees two entitlement programs designed to provide financial support to individuals with disabilities. Supplemental Security Income (SSI) is a needs-based program that provides a modest maximum income of $637 a month (in 2008) to individuals with disabilities who lack stable employment histories, while Social Security Disability Income (SSDI) is related to earnings history and the amount an individual has paid into the Social Security system. Most recipients of SSI or SSDI qualify for government health insurance under Medicaid and/or Medicare. In 39 states and the District of Columbia, recipients of SSI also meet eligibility criteria for Medicaid. Persons who qualify for SSI or SSDI are also more likely than others to obtain available subsidized housing, including supportive housing.

Unfortunately, accessing these entitlements is especially challenging for people experiencing

homelessness; final determination of eligibility often occurs years after the initial application.

According to the Social Security Advisory Board Annual Report 2006, only 37% of all SSI/SSDI

applications nationwide are initially approved. For homeless applicants, a mere 10-15% are

determined disabled upon the initial application.1 Strikingly, more than 60% of initial denials are

overturned following a substantial appeals process averaging two to three years. This lengthy

delay only further compromises the health and stability of applicants.

1 Dennis D, Perret Y, Seaman A, Wells S. (2006). Expediting Access to SSA Disability Benefits: Promising Practices for People Who Are Homeless. Delmar, NY: Policy Research Associates, Inc.

SSI/SSDI Outreach, Access, and Recovery - Recognizing the importance of financial assistance to the overall health and well being of people with disabilities, the federal government implemented the interagency SOAR program to reduce the delay between application and receipt of benefits for eligible homeless applicants. A partnership between the Departments of Health and Human Services and Housing and Urban Development, the SOAR initiative is a multifaceted approach to improve the quality of initial applications while streamlining the state and local processes through which disability is determined. Strategic components include a “train the trainer” model to equip service providers

with the tools necessary to complete effective and well-documented applications, strategic planning among states and communities to expedite the claims of homeless applicants, and technical assistance and outcomes evaluation for states and localities.

SOAR-ing Results - Following implementation in 34 states over the past three years, the SOAR initiative has dramatically improved access to SSA disability benefits for homeless applicants. Preliminary 2008 data from 18 participating states suggest that SOAR is a model worthy of replication. In a complete inversion of national data, a surprising 66% of applications submitted through the SOAR program were initially approved, and approval times were reduced, on average, to just 88 days. A SOAR pilot project in New York cut the average approval time to 59 days. In Nashville, Tennessee—home to the National Council—a remarkable 98% of all SSA disability applicants in their SOAR project were approved upon initial application.

Many involved in the SOAR process believe the results are simply too promising to be ignored. Advocates are urging Congress to appropriate $5 million to expand the program to all 50 states and to develop advanced training materials to help applicants and their service providers to more effectively navigate the SSI/SSDI application process. The National Council calls upon Congress to enable all states to “do what works” by funding an expansion of the SOAR initiative.

2008 Georgia Health Disparities Report "Community Conversations"

The Office of Health Improvement will host a series of Community Conversations in various cities throughout Georgia. These “Conversations” will share information and obtain feedback about the Health Disparities Report 2008: A County-Level Look at Health Outcomes for Minorities in Georgia that was released on April 18, 2008.

Developed and presented by the Georgia Department of Community Health’s Office of Health Improvement and its Minority Health Advisory Council (MHAC), this inaugural report gives an account of the health status of Georgia’s minority populations by county, and aims to identify inequality in health care and outcomes, and to encourage action towards health equality for all Georgians.

Who are we talking to?
- Local Government Leaders - Health Care Providers/Professionals
- Business Leaders - Community Organizations
- Chamber Officials - Concerned Citizens

What are the objectives for the Conversations?
1. Does your county understand the issue of health disparities and how it affects the community?
2. What do people think about their county scores and how they fared?
3 Are there reasons for success or failures in their various communities?
4. In what ways can communities address the reduction and elimination of health disparities? Are they interested in forming local health equity coalitions?
5. How can we engage non-healthcare advocates on the issue?

Community Conversations Locations and Dates (First-Round):
Augusta: May 28th, 1PM to 3PM, Richmond County Health Department
Columbus: May 29th, 1PM to 3PM, Columbus State University
Cordele: June 3rd, 1PM to 3PM, City of Cordele Community Club House
Albany: June 4th, 10AM to 12PM, Phoebe Northwest
Fort Valley: June 11th, 1PM to 3PM, Fort Valley State University, Pettigrew Cntr
Athens: June 12th, 10AM – 12PM, ACC Health Dept./N. Harris Street
Valdosta: June 19th, 10AM – 12 PM, Valdosta Tech
Gainesville: June 24th, 1PM to 3PM, DHR , Thompson Bridge Office
Brunswick: July 18th, 10AM – 12PM, Southeast GA Health Systems

Additional Community Conversations will be held throughout the summer in Griffin, Dublin, Atlanta, and Lyons.Locations and dates will be announced.

To obtain a copy of the report, please visit our website at www.dch.georgia.gov or you may e-mail us at gahealthequity@dch.ga.gov to request a copy.

Privatization of Grady Hospital Commences Despite Unmet Conditions

By Jonathan Springston, Senior Staff Writer, Atlanta Progressive News (5/19/08)

(APN) ATLANTA – The Fulton-DeKalb Hospital Authority (FDHA) officially transferred operations of the Grady Health System to the new 501(c)(3), the Grady Memorial Hospital Corporation (GMHC), on Monday, May 19, 2008.

The lease will commence on May 20, 2008, and all Grady employees will transfer under the control of the GMHC with their current jobs and salaries and the GMHC will be responsible for the operations of the health system.

However, the FDHA inexplicably moved forward without a specification from the State of Georgia regarding the amount of trauma funding Grady will receive, despite an April 7, 2008, letter, in which FDHA Chairwoman Pam Stephenson said such specification would be a precondition to the transfer.

In the April 7 letter to the GMHC, Stephenson wrote, "I hereby execute the lease on behalf of the [FDHA] subject to the condition that clarification…be received by the [FDHA] regarding the amount and level of funds available to Grady Memorial Hospital for fiscal years 2008 and 2009."
"Such clarification satisfactory to the [FDHA] shall be required prior to the acceptance of a commencement certificate under the lease by the [FDHA]," she concluded.

But Stephenson, who also serves as Grady CEO and GMHC Vice Chair, told Atlanta Progressive News on Monday that the FDHA "decided to move forward" without knowing how much of the $58 million Grady would receive.

The $58 million was appropriated for the 2008 fiscal year, so the money has to be divided no later than June 30, Stephenson told APN.

She appeared confident Grady would know how much it is going to get and receive that amount on or before June 30, but offered no explanation for why the lease was moving forward despite her previous statements.

This is not the first time the conditions surrounding the privatization of Grady Hospital have shifted or simply disappeared.

As previously reported by Atlanta Progressive News, it was stipulated in the original FDHA resolution leading to the formation of the GMHC that numerous state legislators and officials would need to sign letters promising Grady funding. That condition vanished when the FDHA and other parties voted on the lease.

Grady still faces a number of issues in the near future, namely figuring out how to obtain more funding for its Level I trauma center, the only such hospital in north Georgia.

The Georgia General Assembly failed to pass legislation this Session that would have pumped millions of annual dollars into all of Georgia’s trauma hospitals, including Grady.

Lawmakers did succeed in amending the fiscal year 2008 budget to include a one-time payment of $58 million to be shared by all of Georgia’s trauma hospitals.

The Trauma Care Network Commission, a State committee charged with determining how much of this $58 million each trauma hospital in Georgia is to receive, canceled its May 15, 2008, meeting for unknown reasons, APN learned Monday.

That Commission was supposed to determine how the money was to be divided at that meeting.
As a result, the lease will take effect without Grady knowing how much of the $58 million it will receive.

Over the coming months, both Boards will continue to work with lawmakers to obtain continued trauma funding, Stephenson said.

APN SEEKS GMHC’S TAX-EXEMPT APPLICATION

APN delivered a written request Monday to Grady legal counsel and registered agent, Timothy Jefferson, requesting to inspect the GMHC's application to the IRS seeking recognition of tax-exempt status.

Federal law requires a tax-exempt organization to provide any member of the public access to their IRS recognition application for inspection on that same business day, unless extenuating circumstances exist, in which cases the organization must provide it on the next business day.
APN previously requested the application months ago and was told at that time it did not exist. Now that the application was approved, APN has made several phonecalls to the GMHC to identify the person who had access to the document.

APN requested an appointment to view the documents under federal law; however, Jefferson insisted he would treat the request as an Open Records Act request under Georgia law, because he said the document did not exist in physical form and he needed time to print it out.
APN expects to be able to view this document later this week and will report on its findings.
If not, APN is prepared to take further steps. APN let the GMHC know that a corporation which does not comply with the law can be exposed to extensive fines from the IRS.

PRIVATIZED GRADY APPEARS TO MOVE FORWARD

"Tomorrow begins a new chapter in Grady’s history," A.D. "Pete" Correll, Chairman of the GMHC, said in a press release.

"The [GMHC] has a singular focus - to preserve Grady’s historic mission as a safety-net hospital for this region by getting Grady the funding it needs," he added. "The first infusion is already on its way. And in the weeks and months ahead, we will be calling on the broader community to do its part to rally around this critical resource we all depend on."

Correll appeared Monday during the regular meeting of the FDHA as a “special guest” and said the Robert W. Woodruff Foundation would deposit $50 million in the form of Coca-Cola stock into the Community Foundation for Greater Atlanta on May 20, 2008.

The $50 million is the first of several installments of $200 million promised by the Woodruff Foundation to be doled out over four years for capital improvements.

The GMHC has also pledged to raise an additional $100 million over four years for capital improvements.

"It’s been a long journey…but we’ve reached the goal line," Correll said Monday. "We have given this hospital a chance. We have given this hospital a future."

GRADY CEO SEARCH

Stephenson has served as Interim CEO at Grady since January 2008 after officials fired Otis Story for unknown reasons.

Story filed a lawsuit against the FDHA two weeks ago in Fulton County Superior Court in which he asserts Stephenson had him fired so she could take his job, The Atlanta Journal-Constitution newspaper (AJC) reported May 12, 2008.

The AJC obtained a dismissal letter from Stephenson to Story that claims Story did not provide good leadership and made decisions without getting approval from the FDHA.
Story is seeking $1.8 million in severance pay, a $60,000 signing bonus, and unspecified punitive damages, according to the AJC.

Meanwhile, critics contend Stephenson has a conflict of interest by serving in three posts at Grady: CEO, FDHA Chair, and GMHC Vice Chair.

A Search Committee has spoken to about 30 candidates for the permanent CEO position and hopes to hire one by the end of June, Correll said last week.

Stephenson has said publicly that while she is interested in staying on as CEO, she will not make a formal announcement on whether she has applied for the post.

Correll is scheduled to speak with reporters May 20 in his downtown office about the transfer. The GMHC will hold its first meeting as the Grady Health System operator on June 2, 2008.

About the author:
Jonathan Springston is a Senior Staff Writer for Atlanta Progressive News. He may be reached at jonathan@atlantaprogressivenews.com