Georgia Medicaid insurer reverses 20% therapy rate cut, but not for all providers

ATLANTA, Ga. (Atlanta News First) - A Georgia Medicaid managed care company is reversing a planned 20% reimbursement rate cut for special needs therapy providers, but the rollback does not apply to every clinic affected by the original notice.

CareSource, one of three companies in Georgia managing Medicaid coverage, notified some providers this week that it is formally rescinding the rate reduction that had been set to take effect May 11, 2026.

“This correspondence serves as formal notice of rescission of the previously issued reimbursement adjustment,” the company said in a letter to its providers. “As a result, the agreement shall remain under their current reimbursement agreement terms.”

Cut would have affected thousands of patients

The original rate cut would have reduced annual Medicaid payouts by 20%. A clinic that previously received $65,000 in Medicaid reimbursements in a year, for example, would have received $52,000 — with no reduction in patient workload, as costs of business rise. Clinics that refused the new terms risked being dropped from the CareSource network altogether.

An analysis found the cut could have affected at least 71% of the state’s pediatric Medicaid therapy network. In 40 of Georgia’s 159 counties, there are already no CareSource therapy providers.

Clinics across the state said they were preparing to close, downsize, or stop accepting Medicaid patients in response. Aileen Deogracias, owner of Therapy Works, a physical, occupational, and speech therapy clinic for children in Gwinnett County, announced she was closing her doors.

The Georgia Department of Community Health (DCH) said the rescission is limited in scope.

“DCH is aware that CareSource has issued rescission letters to certain providers to maintain the 100% reimbursement rate,” the agency said. “The letters are being issued in areas where a shortage of providers is identified based on ongoing analysis of network adequacy that Care Management Organizations are contractually required to maintain. This rescission is targeted and does not apply to all providers in the CareSource network.”

Tender Ones Therapy, known as TOTS, a clinic serving children including three-year-old Joanna — who has a rare neurological disorder that causes episodes of paralysis — had not received a rescission letter. TOTS was terminated from its CareSource contract after refusing the rate cut, leaving CareSource families still searching for new providers.

“Therapy is not a luxury,” said Raquel Lopez, Joanna’s mother.

Therapists accused CareSource of mismanaging funds after state lawmakers recently approved increasing payment rates for these providers. The issue also drew criticism at a recent state health committee meeting.

Watch Uncovered by ANF Investigates every Sunday at 7 p.m. on Atlanta News First.

“I’ve got no tolerance for anyone whose hurting some of our state’s most vulnerable kids,” said state Rep. Scott Hilton, R-Peachtree Corners.

“Every effort we make should be focused on taking care and improving services, not decreasing them, to improving services for the frailest of the frail and the most vulnerable in society,” said state Rep. Jesse Petrea, R-Savannah. “Our efforts must be making things better for the disabled before we think about doing anything else.”

“As always, CareSource is working with our provider partners so that our members across Georgia can access the high-quality care and support they need,” the company said. “We understand the importance of these services and are having targeted conversations with providers to ensure continued access in their respective communities.”

If there’s something you would like Atlanta News First Investigates to dig into, fill out this submission form.

Download our Atlanta News First app for your latest news and information.

Atlanta News First podcasts are available now on: Spotify | Apple Podcasts | Amazon Music | YouTube