3010 Georgia SHIP Overview | ACCESS-TO-SERVICES-5200-MANUAL

Georgia Division of Aging Services
Access to Services Manual

Chapter:

3000 Georgia State Health Insurance Assistance (SHIP) Program

Effective Date:

Section Title:

Georgia SHIP Overview

Reviewed or Updated in:

Section Number:

3010

Previous Update:

Georgia SHIP is a trusted source for information and assistance regarding Medicare and other related health insurance. Georgia SHIP helps with financial assistance programs, long-term care insurance decisions, healthcare fraud and consumer protection issues. Georgia SHIP includes the State Health Insurance Assistance Program (SHIP) and SMP. Georgia SHIP is a program of the Department of Human Services Division of Aging Services.

Georgia SHIP is a statewide coalition of private and public partners that seeks to provide education and assistance to individuals who need help making challenging health insurance decisions. Georgia SHIP includes the SHIP (State Health Insurance Assistance Program), which seeks to answer complex questions related to Medicare, prescription assistance programs, long-term care insurance and supplemental insurance. This includes helping beneficiaries enroll in the new Medicare Prescription Drug benefit. Georgia SHIP also includes SMP formerly the Senior Medicare Patrol. SMP provides education to beneficiaries and their families on Medicare fraud, error and abuse and reports such occurrences to law enforcement agencies.

Georgia SHIP has multiple partnerships throughout the state. These partnerships include state universities, pharmaceutical companies, hospitals, physicians, drug stores, medical and pharmacy associations, financial institutions, FDIC, Office of the Insurance Commissioner, Secretary of State, Department of Community Health, fraud investigators, and a number of volunteer organizations.

Georgia is the eleventh most populated state for Medicare beneficiaries. The number of Medicare beneficiaries is growing at an almost exponential rate with the Georgia Medicare population expected to better than double over the next 20 years.

State Fiscal Year	Medicare Population	Population Increase
2003	904,111	Base year for this report
2005	932,747	28,636 (4%)
2007	973,614	40,867 (4%)
2008	1,024,180	50,566 (5%)
2009	Estimated: 1,123,763	99,583 (9%)

As the table above indicates we are well on our way to reaching the estimated population increase.

Georgia SHIP services are available across Georgia through 12 local Area Agencies on Aging. Georgia SHIP has 15 trained local counselors, over 250 trained volunteers and 4 state staff who provide one-on-one counseling and educational sessions to groups of interested individuals. The Georgia SHIP toll free number, 1-800-669-8387, automatically routes callers to local offices. Every effort is made to respond to callers within 48 hours.

State Health Insurance Assistance Program (SHIP)

SHIP is a program funded by the Centers for Medicare & Medicaid Services (CMS) to provide counseling and assistance to people with Medicare and their families. SHIP funding is only available to states. SHIP provides free counseling and assistance via telephone and face-to-face interactive sessions, public education presentations and programs and media activities. While Georgia SHIP has a wide latitude in providing services we must offer locally accessible services to all eligible persons requesting assistance, develop an intra-state agency referral system, and communicate timely and accurate health care information.

Services Offered by Georgia SHIP SHIP Project:

Information, counseling & assistance on a wide range of Medicare, Medicaid and Medigap matters
- Enrollment in Medicare prescription drug programs
- Medicare Advantage options
- Long-term care insurance
- Claims and billing resolution
- Information and referral on public benefit programs for those with limited income and assets
- Other health insurance benefit information as requested.

SMP – Formerly Senior Medicare Patrol is a project funded through the Administration on Aging via a demonstration grant that is available to states, public and private non-profits, and federally recognized tribes. SMP projects provide trained advocates, preferably retired professionals, engaged in fighting fraud, error and abuse in Medicare. The focus of the SMP is to engage older Americans in taking responsibility for their health care and to educate them on how to recognize and report Medicare fraud, error and abuse. The program helps seniors make informed decisions about their health care as well as ensuring that the seniors we serve safeguard their personal information.

Services Offered by Georgia SHIP SMP Project:

Media and private organization outreach activities
Community events and other efforts to educate beneficiaries on erroneous, abusive and fraudulent activities associated with Medicare
Individual counseling regarding Medicare billing
Refer complaints of fraud cases to the proper authorities
Track complaints and concerns for reporting requirements.

The Georgia SHIP SMP project has one of the best records in the nation for reporting Medicare fraud, error and abuse. Georgia was ranked 17 out of 54, which includes every state in the nation plus the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands.

History of Georgia SHIP

1992	The Division of Aging Services (DAS) received a Health Information, Counseling and Assistance Grant from the Health Care Financing Administration (now known as the Centers for Medicare and Medicaid Services or CMS). In the early years the program was named HICARE (Health Insurance Counseling, Assistance and Referral for the Elderly) and operated in only 6 regional Planning and Service areas (PSAs).
1998	HICARE expanded to statewide coverage From the beginning, coordinators and volunteers conducted community education to prevent Medicare and Medicaid fraud, waste, and abuse.
1999	U.S. Administration on Aging provided a grant that expanded program efforts in this area and launched the Senior Medicare Patrol (SMP). On July 1, HICARE was again expanded and renamed GeorgiaCares.
2002	With additional state funds and in collaboration with many partners including pharmaceutical companies, pharmacies, hospitals, Schools of Pharmacy, and other organizations, GeorgiaCares set out to enroll every eligible Medicare beneficiary in Georgia in all available low-cost prescription assistance programs. Through the years, GeorgiaCares has educated thousands of Georgians about Medicare and related health insurance issues. Most importantly, GeorgiaCares has provided the state’s Medicare beneficiaries with increased opportunities to save millions of dollars in health care costs
2005	GeorgiaCares expanded under a Lifelong Planning initiative to educate Georgians in the use of personal planning tools and private funding options to meet future long-term care needs.
2007	January 1, 2007, the Senior Medicare Patrol was renamed nationally to SMP.
2009	The LifeLong Planning program and the state funded prescription assistance service was discontinued from the Division of Aging Services due to an economic recession in SFY 2009.

Georgia SHIP Programmatic Goals

Educate Medicare beneficiaries, their families and caregivers about health insurance coverage, benefits, consumer rights and healthcare fraud.
Provide in-depth information and assistance to consumers in order to increase their understanding of Medicare and other health insurance issues; help Medicare beneficiaries resolve problems related to their health insurance coverage; inform them about the eligibility criteria for various health insurance programs and help them enroll when applicable.
Provide consumer education in understanding Long-Term Care insurance and the Georgia Long-Term Care Partnership program.
Protect Consumers from health care fraud, error and abuse by educating them on prevention and how to report potential claims.
Empower consumers to make informed decisions concerning health insurance options, exercising their appeal and grievance rights.
Demonstrate the effectiveness of recruiting and training volunteers to teach, educate, and assist Medicare beneficiaries.

Georgia SHIP Funding Sources

This program is funded through grants from the Centers for Medicare and Medicaid Services (CMS), the U.S. Administration on Aging (AoA), and state funds appropriated by the Georgia General Assembly.

In addition to administering the program, the DHS Division of Aging Services operates the statewide Georgia SHIP hotline and contracts with all 12 Area Agencies on Aging (AAA) for the provision of Georgia SHIP services locally.

The AAA operates the Georgia SHIP program directly or subcontracts with a service provider for program service delivery.