In Louisiana, Working to Expand Medicaid - Without Losing Other Programs

Officials are using innovative methods like automatically enrolling beneficiaries based on their eligibility for foods stamps, and adding a large group that takes part in an existing New Orleans-area health project but currently lacks prescription drug coverage.

When Louisiana Governor John Bel Edwards took office in January, he vowed to make Medicaid expansion a priority—with the hope of extending health coverage to about 375,000 adults.

Governor Edwards and his Health and Hospital Secretary, Rebekah Gee, MD, MPH, MS, unveiled the “Healthy Louisiana,” initiative May 2, 2016, which calls for using expedited measures to get people enrolled in Medicaid. The administration says it will save $180 million once federal dollars flow to the program.

Edwards and Gee are taking a statewide tour to promote the policy change, and officials say a large share of the enrollment will be on eligibility for the Supplemental Nutrition Assistance Program (SNAP), cutting down on time and paperwork. Another element would automatically enroll participants in a New Orleans-area initiative that is a successor to a post-Katrina healthcare program; the addition of Medicaid will give this group access to prescription drugs.

But faced with a budget gap of $600 million for the fiscal year that starts July 1, 2016, the new administration is struggling to keep other healthcare programs intact while it expands eligibility for uninsured adults.

The Associated Press reported that on Sunday, Louisiana’s Health and Hospitals Secretary, Rebekah Gee, MD, MPH, MS, told legislators that “critical services, life-saving services,” were not funded in a budget plan being considered by the Senate Finance Committee.

Gee warned that proposed cuts to 4 Medicaid programs that are discretionary under federal rules threaten the state’s ability to keep the elderly and disabled out of nursing homes, which has been an ongoing issue in Louisiana.

Meanwhile, leaders of the Louisiana State University medical schools in New Orleans and Shreveport warn of canceled training programs like undergraduate nursing if they are forced to take a $50 million cut.

There’s also disagreement between the hospitals and Gee on whether a healthcare budget already passed in the Louisiana House of Representatives pays enough to continue current services, due to a dispute over the estimated savings that will come when more federal dollars flow to the state.

Louisiana once had a unique, separate system of charity care hospitals that served generations of poor residents. But former Governor Bobby Jindal dismantled that system, asking private hospitals to partner with the public ones to bring better management and savings. However, Jindal also refused to expand Medicaid, which critics said essentially forced subsidization of the public hospitals.

So, hospital executives have been waiting for Medicaid expansion—and they feel strongly the new administration’s budget estimates are too rosy. One lobbyist told the AP that contracts for safety net care allowed for “zero profit.” But one key lawmaker called that claim “ridiculous.”

In the meantime, Gee’s department is gearing up for an enrollment period for Medicaid expansion that will start June 1, 2016. Besides the use of SNAP criteria to automatically enroll some residents, the state will send 100,000 letters to people outside that program it believes meet the income criteria.

Louisiana’s approach is expected to not only add thousands to the Medicaid rolls very quickly, but it also holds down the number of staff needed to serve all the applicants. The DHH has asked for 90 workers in 60 locations, mostly hospitals and Federally Qualified Health Centers. According to The Times-Picayune, the state will avoid use of paper records—staff will scan eligibility documents, further expediting the process.