Free Essay. An Analysis of PeachCare for Kids Healthcare Program in Atlanta

The US government has been actively involved in the nation's healthcare delivery at the federal, local, and state level. Government involvement started in 1965 when it instituted Medicare and Medicaid to make sure that most people have access to insurance. The aim of such strategies is to improve the quality of patient care in the region. Since then, each of the different government levels has increased its involvement through the use of various relevant programs and policies. For example, some of the standard programs at the federal level include Medicaid, Medicare, and State Children's Health Insurance Program, among others. One of the cities that have followed suit to enhance healthcare delivery is Atlanta, Georgia, with its various programs such as the PeachCare for Kids Program. An analysis of this program helps in understanding the program's planning, implementation, and evaluation as well as its relevancy to Saint Leo University's core values of excellence and integrity.

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A Brief Overview of the Program

One of the leading healthcare programs in Atlanta is PeachCare for Kids Program. It is a statewide program that covers not only Atlanta but also the entire state of Georgia. The plan was created after the 1997's Congress legislation. It enabled states to develop SCHIP-State Children's Health Insurance programs in order to intensify affordable health insurance access (GeorgiaGov, 2019). The program began its operation a year after the Congress' legislation with aims of providing comprehensive coverage to uninsured children. Some of the healthcare benefits offered by the program include specialist care, dental care, preventive, vision care, as well as primary care.

The program is built on Medicaid, which is the primary source of children's healthcare coverage in the country. The Medicaid program is voluntary for different states, but all of them participate. However, before joining, specific guidelines or parameters created by CMS-Center for Medicare and Medicaid Services must be met by all the participating countries before getting the federal funding. The children program provides limited coverage, cost-sharing protections, and pediatrician endorsed services. Therefore, the CHIP program, which is PeachCare for Kids, follows these foundations set by Medicaid. The PeachCare for Kids program also uses some guidelines set by the ACA- Affordable Care Act. The rules helped in launching marketplaces for families to buy their health insurance covers and even receive some financial assistance.

The Planning that Went into the PeachCare for Kids Program

Different models are used for planning of public health programs' such as the Peachcare for Kids Program. These approaches were set and promoted by the CDC in the 1980s for a systematic plan. They include MAPP, CHIP, and PACE-EH (Issel & Wells, 2017). Amongst these, the most widely used in the planning process is MAPP-Mobilizing for Action through Planning and Partnership. The strategic planning tool was developed for public health leaders to help with the ranking of public health issues. Besides, it also helps with the pinpointing of resources that can be used for dealing with the problems identified. The first phase of this planning process, which the PeachCare for Kids program must have followed, is the organization and engagement of partners. This first process involves the building of commitment and actively engaging participants as partners. The second process that goes into the programs is the visioning process, whereby shared community values and vision is developed. These statements help with providing purpose, direction, and focus on the program's operation to ensure that a collective shared vision is achieved in the future. Having a shared community vision also makes sure that the community moves towards a shared goal and is considered the second MAPP phase (NACCHO, 2019). The third phase that the PeachCare for Kids program had to go through was data collection and analysis. This strategy involves the collection of wide-ranging data about the community that is being affected or where the program will be provided to understand the community's health status and some of the

The third phase involves four different assessments. They include the community strengths and themes tests, forces of change, community health status evaluation, and the local public health system. Their work is to obtain vital information that can be used in improving the health of the community. Each of these assessments must be collected for any program because lack of any can lead to an incomplete comprehension of some of the factors affecting the community and public health system. After this, an application like the PeachCare for Kids program must make sure that strategic issues in the society are identified and prioritized. These issues are identified through the data collection processes. A determination of the effects of the problems on the shared vision is done. The fifth process involves coming up with strategies, goals, and a plan for action from the identified strategic issues. In the process, things like timeframes, strategy statements, and performance measures are developed (NACCHO, 2019). The last method that any program must go through is the action taking and sustaining of the work. In this process, the planning, implementation, and evaluation processes are linked since each depends on the other interactively and continuously.

How the PeachCare for Kids Program is Implemented

Like all the other programs, the PeachCare for Kids program was implemented in the context of existing healthcare programs. The plan begins coverage where Medicaid stops. Starting with the program's administration, DMA-Division of Medical Assistance and The Department of Community Health are the ones responsible for the program (PeachCare for Kids, 2004). Agreements between government and private medical agencies and providers have been established to facilitate the administration of the program. The DMA does reimbursement of services provided. The same institution is also tasked with the roles of providing polices, rules, and procedures that guide the program. Some of these rules and procedures involve eligibility determination, application receipts, and verification, as well as premium collection and enrolling of those who are eligible. The state of Georgia funds the program in conjunction with the federal government under the guidelines of the law. The administration makes sure that the costs are subsidized to up to a 72% level and the State of Georgia bears the remaining cost.

A study of the PeachCare for Kids program to determine eligibility and availability shows that it is available for those children who are 18 years and below. The children should fall in families with a monthly income of $2,571 and an annual income of $30,850 for a family size of one(GeorgiaGov, 2019). For a family size of 2, their monthly and yearly salaries should be at $3,481 and $41,768 respectively and for a family size of 3; the monthly and annual revenues should be $4,390 and $52,685 respectively (GeorgiaGov, 2019). The eligibility based on income has been provided through the Federal Poverty Guidelines, which updates them every year. The revenues have to be verified during the time of application, and annually during the time of renewal. Apart from income, another eligibility requirement is that the program is only for US citizens or for immigrants' category who are legally eligible. The officials require enrollees to produce their original documents for the verification of the children before they are enrolled. However, parents' verification of status is not necessary since it is a children's program.

The healthcare benefit associated with this program includes mental care, vision care, dental care, primary services, hospitalization, prevention services, prescription medication, emergency room services, and specialists. For each of the child enrolled in the program, he or she is enrolled in a CMO-Care Management Organization with a primary care provider who helps in coordinating the child's care. The CMOs tasked with these roles include CareSource, WellCare, Peach State Health Plan, and Amerigroup Community Care.

A study of the program's cost reveals that apiece of the monthly cost of this coverage is about $11-36 with a maximum of $72 when two or more children are involved(GeorgiaGov, 2019). Children aged six years and older require premiums, which are payable on the first day of every month preceding the month of coverage. This move means that premiums covering this month are due the first day of next month. The program's customers are also required to have some co-payments. The money is paid to healthcare providers on the days of the services. However, children under six years are exempt from these co-payments together with American Indians, foster children, and Alaskan Natives.

A Study of the Evaluation of the PeachCare for Kids Program

Different evaluations have been done to determine the success of the program in entire Georgia and at the countrywide level. In 2003, an assessment was done at the countrywide level, immediately after the CHIP programs were implemented. It was found out that the CHIP program, which is inclusive of the PeachCare for Kids program provided numerous benefits to their users (Hakim & Rosenbach, 2003). It was also found out that many states using the program faced challenges in coming up and upholding provider networks in all the delivery systems used.

Another recent evaluation found out that 76% of children were under poverty in the assessment in the entire state of Georgia, including Atlanta (GeorgiaGov, 2019). There were also a considerable percentage of infants, preschoolers, toddlers, and children with disabilities who needed this program. Other children that needed the program were those in foster care and those facing family dysfunction, neglect and chronic health and emotional issues. Evaluations have also revealed that most of the ones under the program were female, and most of those who benefitted from the program were from the Atlanta region (PSHP Georgia, 2015). Other areas which had a high enrollment to the program include the Central Region and the Southwest Region. Regions, such as the East Regions and the Southeast and North Regions' membership was low. Other factors considered in the 2015 evaluation were race and ethnicity where it was found out that most of the enrollees were African American, followed by Whites and Asians (PSHP Georgia, 2015). Most of the members were from African Americans, the group that also had a higher female enrollment compared to others.

As for the disease burden, most of the enrollees fell in the primary risk category meaning that there were no significant health factors among enrollees. The disease disparities among the enrollees were also there and asthma, which is in the primary risk category, was found to be affecting African American males. Other conditions such as HIV/AIDS were also found to be higher among African Americans while female whites were found to have higher risks of cancer. From the evaluation done in 2015, evaluators found some of the causes of healthcare disparities with cultural competency being one of the problems followed by insufficient access of providers. To deal with these issues, the State of Georgia continues to maintain and even monitor the provider network to enhance access to care to all the program members.