About 27% of professional license applications administered by the Professional Licensing Board Division take a year or more to process, according to the secretary of state. The rest can take up to six months. Some boards are relying on paper applications, mail service and manual processes to handle applications.

Why It Matters

Hyden noted that other states manage to issue licenses within 30 days, in part because their boards are better staffed and meet more often — monthly, instead of quarterly, as with some Georgia boards.

Georgia is enjoying record economic growth. Over the last four years, the state has attracted over 1,700 economic development projects, $65 billion in investment and 165,000 jobs, according to the Georgia Chamber of Commerce.

But the state’s workforce can’t supply enough workers to meet the growing number of job opportunities. There is only one job seeker for every three job postings, the Chamber said.

Among jobs in highest demand in Georgia are registered nurses, pharmacists, accountants, construction contractors and truck drivers – all of which require state licenses. Many workers now in these fields are nearing retirement.

According to the Georgia Health Care Workforce Commission, 20% of health care workers are over age 55 and looking to retire in the next 10 years. About 4% of the health care workforce leaves annually and is not being replaced by new graduates. 

Most of the state is medically underserved, with 65 of Georgia’s 159 counties without a pediatrician, 82 counties without an obstetrician and 90 without a psychiatrist.

To draw more people into skilled professions, “we need to think creatively … and improve licensing,” said Daniela Perry, vice president of the Chamber.

What’s Next

One area ripe for reform is how the state handles licensing of professionals who come to Georgia from other states and countries.

Since 2019, 22 U.S. states have adopted universal license recognition laws that establish a streamlined process to recognize professional licenses issued by another state. If the applicant holds a license in good standing and has no pending disciplinary actions or a disqualifying criminal record in one state, they can practice in another.

This year Georgia passed HB 155, which allows licensing boards to grant licenses to some out-of-state professionals if the license they hold is “substantially similar” in qualifications and scope to what Georgia requires.

The Georgia law is more restrictive than those in other states, which only call for “similar” qualifications and don’t require residency, said Austen Bannan, an employment expert with Americans for Prosperity. Other states allow years of professional experience to stand in for some training requirements. Georgia doesn’t, mandating seasoned skilled tradespeople pursue hundreds or thousands of hours of additional training. 

“The idea is not to force people to relearn their skill set,” Bannan said.

Georgia is also missing out on the skills of many foreign-trained professionals due to its stringent licensing requirements, said Darlene Lynch, who chairs the Business & Immigration for Georgia Partnership, which works to enhance economic development by tapping into the skills of immigrants. 

Georgia’s foreign-born population has grown by 90% over the last 20 years, and 10% of Georgians — more than a million people — are now foreign born, she said, adding that half are naturalized citizens, and a third have college or graduate degrees. 

Though 1 in 5 doctors in Georgia is foreign-born, Lynch said, “Too often we’re watching doctors driving Ubers, dentists working behind a CVS counter, a welder working at a poultry plant — they’re not going back to the field where they have the most experience.”

She urged the committee to adopt the licensing practices of other states, which recognize the medical credentials of foreign-born physicians and other health care professionals, and develop expedited pathways for other skilled immigrants to become licensed. 

“We have a pool of talent that other states don’t have to draw upon,” Lynch said. 

Sen. Larry Walker III, R-Perry, chair of the occupational licensing committee, said many of the issues raised at the meeting this week have come up at the GA WORKS Commission, an effort led by Secretary of State Brad Raffensperger this year to slash bureaucratic barriers in occupational licensing. That includes a total revamp of the application process, which is projected to be fully digitized by spring 2024. 

 “We’ve got to get into the modern world with this licensing issue if we’re going to continue to grow our economy,” Walker said.

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Header photo: Some foreign-trained doctors and other health professionals wait for years for approval to practice in Georgia, due to the state’s demanding occupational licensure requirements. (Credit: baona)

What’s Happening

Georgia has about 11,000 children in foster care, committee chair Sen. Kay Kirkpatrick told State Affairs  in a post-hearing interview Tuesday. Many are in the system due to abuse, neglect, family drug addiction, violence and other hardships.

Georgia’s foster care system is stretched so thin that children in foster care in Georgia spend about two years in the system — nearly three months longer than the national average of 21.7 months, according to The Council of State Governments Southern Office. 

Often there aren’t enough families to take in children so many end up in hotels or offices as a result, Candice Broce, head of Georgia Family and Children Services, recently told the committee.

Broce was back before the committee Tuesday with good news. The foster care system reached a milestone on Sept. 8, when no foster children were reported staying in hotels or offices, she said. Since then, the agency has only used hoteling in a few emergency cases, she noted.

Still, Tuesday’s testimonies showed Georgia is spending more money troubleshooting and intervening rather than preventing children from having to go into the foster care system.

About $538 million in state and federal money is spent on Georgia’s foster care system. The bulk of that — $498.5 million — goes to intervention and late intervention programs, according to Voices for Georgia’s Children, a nonprofit child policy and advocacy group.

“In Georgia, we allocate around 20% of Title IV funding towards prevention while the majority of resources are funneled into the foster care and adoption industry,” said Sarah Winograd of Together With Families, an advocacy group for families in the child welfare system. 

 “While the majority of the resources are funneled into the foster care and adoption industry,” Winograd told the committee. “It’s an industry. Consider the numbers: a staggering $32,000 per year to keep one child separated from their family and in foster care.” 

It costs her organization “a mere $500 to $1,500 per child in assistance and resources at Together with Families to prevent foster care and help families improve their own lives,”she said.

Why It Matters

The committee heard suggestions to help Georgia focus more on prevention rather than intervention. Among the suggestions: 

• Issue state identification cards to foster children. Often kids are removed from their homes during chaotic situations leaving birth certificates and other import documents unavailable to them. Children would be issued a state ID within 90 days of entering the foster care system, displaying information such as the child’s Medicaid number. It would enable older children in the system to get jobs and perform other vital daily tasks.  The cost would run about $5 a child. “That should be something that’s not too difficult to achieve,” Kirkpatrick said. 
• Use the Safe Babies approach in Georgia courts. Between 2011 and 2018, Georgia saw a 44% increase in infants and toddlers entering foster care, more than any other Southern state. As a result, it needs a more collaborative, family-based approach to dealing with the youngest children in foster care, such as the Safe Babies approach used in Iowa. Iowa’s infant courts are adorned with quilts, diapers, toys and books, to help alleviate the trauma experienced by toddlers and infants in the court system. In a recent visit, Georgia officials saw how one Iowa judge, his court staff and attorneys dealt with a mother who became distraught during the hearing. The judge stopped the hearing, allowing attorneys and other staff to embrace the woman. The DFCS case manager and defense attorney told the woman they were there to help her figure out ways to keep her baby. “That’s super important. It’s been successful in other states,” Kirkpatrick said.
• Use opioid settlement money to finance foster care needs. Kirkpatrick called it a good idea but “it might not be that easy to accomplish. It’s not really under the legislature’s control.” 

What’s Next?

Kirkpatrick, a Republican and retired orthopedic surgeon who practiced in metro Atlanta for over 30 years, called Tuesday’s hearing extremely productive.

“I thought it was another great meeting,” she said. “We work pretty hard to get input from all the different groups. We won’t make our decisions about which things to tackle until we finish [all of] our meetings. We have one more where we’ll be getting some testimony.”

The senate committee’s next meeting is in Columbus on Oct. 26. It will focus on adoption.

“After that, we’ll get together and figure out what our legislative priorities are going to be,” Kirkpatrick said.

Want to know how many foster children have been placed in foster homes outside of your county?  Go to seetheneed.org to find out. See The Need was created by Alpharetta-based FaithBridge Foster Care to raise awareness about foster care in America. 

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Header image: The Senate Study Committee on Foster Care and Adoption held their second meeting at the Capitol to hear testimony from citizens, nonprofits and state agency representatives. (Credit: Georgia Senate)

Meanwhile, some  larger assisted living providers want much wider access to Medicaid funds to meet the ever-increasing demand for affordable housing and supportive care that aging residents need.  

Among them is Wesley Woods Senior Living, which provides apartment homes and care to about 1,800 older adults in Georgia, ranging from seniors with extremely low incomes to the affluent. CEO Terry Barcroft told the aging committee that she has 172 beds categorized as assisted living or personal care homes, where staff provide daily living support services to residents. 

Many of their units are occupied by seniors on fixed incomes who depend on subsidized housing assistance, she said, and can’t afford to pay for supportive services. Wesley Woods provides more than $1 million in charitable care to make sure such people can stay in their homes,” said Barcroft.

But there are many more seniors in Georgia who need assisted living care but who don’t qualify for Medicaid waivers. The passage of HB 582 would create more accessible options within long-term care programs for thousands of people “who don’t need 24-hour skilled nursing but do need 24-hour watchful, protective oversight,” Barcroft said.

Why It Matters

The state’s senior population is rapidly growing. Georgians aged 60 or older currently represent more than 15% of the total state population of 11 million, said Debra Stokes, executive director of the Georgia Council on Aging. Numbering 1.7 million in 2020, the senior population will expand by more than 500,000 people by 2030, when they’ll outnumber the under-20 population. By 2040, older Georgians will number 2.8 million, with the greatest rate of growth among those 80 and older.

Meanwhile, the number of Georgians age 65 or older living with Alzheimer’s disease and dementia is also expected to climb to 190,000 people in 2025 from 150,000 in 2020, a 27% increase, said Nancy Pitra, government relations director for the Alzheimer’s Association of Georgia.  At the same time Georgia’s Medicaid costs to care for seniors with Alzheimer’s, $1.2 billion in 2020, are expected to increase 26% by 2025, she said. 

People with moderate to severe dementia need constant oversight, Pitra noted, and allowing them to access Medicaid-funded services in assisted living facilities would mean living and receiving care in more affordable, less isolated, home-like environments.

This swelling of the aging population will elevate the demand for affordable housing that is already tough to come by in Georgia. It will also exacerbate the existing shortage of skilled nurses, nursing assistants, memory care providers and other caregivers that serve seniors. 

Finding new ways to finance the cost of long-term care for seniors is crucial, said MaryLea Boatwright Quinn, assistant deputy commissioner of the Division of Aging Services in the Department of Human Services. She leads the agency’s home- and community-based services program for vulnerable adults, which has a budget of $114 million, and allocates state and federal funds to aging-related agencies in Georgia.  

Home- and community-based services positively impact seniors’ health and reduce health care costs by reducing hospitalizations and getting people to be more compliant with disease management, said Quinn, a licensed medical social worker.

“We’re trying to help people … stay in their home of choice and avoid institutionalization as long as possible,” she said. 

What’s Next

One of the newer models relying on Medicaid, and Medicare, to provide long-term, community-based care for seniors is PACE, or Programs of All-Inclusive Care for the Elderly, which provides, often at an adult day health center, comprehensive medical and wraparound services to medically frail elderly people through an interdisciplinary team of caregivers. 

Most patients enrolled in PACE programs live at home. Costs for their care are capped at a flat per diem rate, instead of being paid per service, and providers are required to deliver all the medical, social, transportation, food, physical therapy, memory care and other services that seniors in the program require. 

The FY 2024 state appropriations bill mandated that the Department of Community Health conduct a needs assessment on the establishment of one or more PACE programs.

Brian Dowd, deputy commissioner of the department, told lawmakers that his team has been studying some of the PACE programs operating in 32 states for several months, and determined that the model could be viable in several Georgia counties they looked at, including Fulton, Dekalb, Cobb, Bibb, Chatham, Richmond, Gwinnett and Muscogee. 

Because “they’re essentially on the hook for everything” that patients need, Dowd said, providers are also incentivized to use case management and other efficiencies to keep costs down.

Adopting PACE wouldn’t rely on a Medicaid waiver, which typically lasts five years, he said. It would more likely involve amending the state Medicaid plan. Dowd said the Department of Community Health is examining the need for legislation to authorize PACE programs in Georgia, and also developing cost projections for the program.

Kathleen Benton, CEO of Savannah Hospice, told lawmakers that she had spent two years researching PACE programs, and hopes the state will fund a pilot program.

She estimated the per person cost of a PACE program in Georgia would be $4,700 per month. “That’s much different than the $6,100 spent on nursing homes right now,” she said, adding that with PACE, patients and providers are more satisfied, attrition for both groups is low, and the supportive family members of patients aren’t overwhelmed with trying to provide or coordinate all of their care.

“We’re in a perfect storm in Georgia,” she said. “Beyond the aging population, we have a labor shortage,” and no good solutions on the horizon to solve it, Benton said. “We must look for inherent caregivers in the home. We have to support them and provide them respite.” 

Rep. John LaHood, R-Valdosta, who manages several assisted living and senior care centers in Georgia, told State Affairs he sees pros and cons in the PACE model.

“In one way it makes it more predictable for the state to put a price tag on one person and say, ‘Alright, they’ve been taken care of at this price, no matter what they need,’ ” he said. “I think my concern would be that a PACE provider might be incentivized to be so efficient, to mitigate the risks of overspending, that they might avoid necessary care and getting that person engaged with the necessary providers. We would need some accountability, some kind of backstop for that.”

While all lawmakers and others who spoke at the committee meeting agreed that providing more independent living situations, medical care and social supports for seniors is important to pursue, not everyone was sure that using Medicaid funding to do it would work.

Some were not clear if repealing the state prohibition on funding assisted living and large personal care homes with Medicaid monies is permitted by the federal Medicaid agency. Others pointed out that 45 states are already using Medicaid funds for assisted living and a variety of home- and community-based services, with no regulatory backlash. 

Catie Ramp, CEO of the Georgia Senior Living Association, a nonprofit trade association representing private pay senior living facilities, said her association is concerned about the potential negative consequences of allowing more Medicaid spending in the senior living market. 

She said Medicaid’s low reimbursement rates might lead providers to “minimize quality of care and care options” in order to avoid passing on costs to residents. Otherwise, their labor costs will rise significantly, she said.

Barcroft said that labor shortages since the pandemic have led Wesley Woods to raise its base pay to $15 an hour, costs which “can only be passed on to residents and their families,” she said, adding that she hoped the state would continue to promote medical career pathways “to help students understand what CNAs [certified nursing assistants] and med techs do,” and draw more people into the field.

Read this related story:

https://stateaffairs.com/georgia/healthcare/caresource-georgia-medicaid-wow

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Header photo: A nurse assists a resident at Fellowship Home at Brookside, an assisted living center in Valdosta. (Credit: The Fellowship Family)