Walking across the Baton Rouge Community College campus on a recent Tuesday, Jaylin Davis didn’t know he was about to stumble upon some incredibly good news: He’s likely to get no-cost health care coverage starting in July — thanks to Louisiana’s decision to expand Medicaid.
Davis had only recently learned that when he turned 19 this spring he aged out of the Louisiana Children’s Health Insurance Program and lost his LaCHIP health insurance.
“They just sent me a letter in the mail,” he told a reporter observing a recent Medicaid enrollment drive on the BRCC campus.
At that time, Davis, a BRCC student and local Wal-Mart stocker, said he had no idea that the state is expanding Medicaid to cover thousands of people like himself. He hadn’t heard the political bickering nor the national praise that’s been heaped on Gov. John Bel Edwards for expanding the health care program through the federal Affordable Care Act.
As he made his way across campus, still wearing his dark blue Wal-Mart vest, a group promoting the sign-up effort encouraged him to meet with one of the certified enrollees inside to see if he would qualify. Thirty minutes later, he had a slip in hand and was told to keep an eye out for his new Medicaid card.
This wouldn’t have been a typical Medicaid enrollment story — here or elsewhere — just a few years ago. But similar outreach efforts are going on throughout the state on college campuses, in churches, community centers, libraries and even some grocery stores.
Welcome to the new world of Medicaid expansion: Louisiana style.
Working poor joining Medicaid
Shortly after Edwards took office in January, he signed an executive order to expand Medicaid to cover thousands more Louisiana residents. Edwards, a Democrat, specifically said at the time that he wanted Medicaid cards in the hands of most new enrollees by July 1.
In Louisiana, Medicaid has almost exclusively benefited pregnant women, the disabled and children. There has been no way for able-bodied, single adults to get into the program. But the ACA encouraged states to raise the income level that qualifies to let more people — many of them the working poor — onto their Medicaid rolls. The incentive: For the first six months of expansion here, the federal government will pick up 100 percent of the costs for the newly covered. The match rate gradually drops back to 90 percent in 2020.
Adults whose income falls below 138 percent of the federal poverty level, which is about $33,500 a year for a family of four or $16,200 for a single adult, are among the newly-eligible population.
The goal is to have 375,000 people signed up by next July 1. Officials estimate that as many as 580,000 people in Louisiana are eligible, and the state has one of the highest rates of uninsured people.
As of Friday, the state had already hit 225,900, a feat that has been praised by people from across the country.
It hasn’t been an easy task, though. Cash-strapped and walking a fine line to not draw opposition from a tepid Republican-controlled state Legislature, the Edwards administration has relied on a creative blend of enrollment efforts. Much of the effort has relied on existing infrastructure or help from outside entities.
Inventive enrollment ideas
“They say that necessity is the mother of invention,” state Health Secretary Dr. Rebekah Gee often recites when describing how the state is going about signing up thousands of people for health insurance.
Louisiana became the first state in the country to link Medicaid enrollment to the Supplemental Nutrition Assistance Program, or food stamps, after having won the approval of the federal Centers for Medicaid and Medicare Services.
The state sent more than 105,000 “canary yellow” forms to people already benefitting from the federally-funded food stamps program to notify them that they now also qualify for Medicaid. If they confirm four simple income-related questions by phone, fax, mail or email, SNAP recipients will be enrolled in Medicaid.
Louisiana also was able to auto-enroll people benefitting from an existing program in the state’s Take Charge Plus program that primarily provided reproductive health care services, including birth control and sexually transmitted infection testing; as well as the Greater New Orleans Community Health Connection, a post-Katrina system of health clinics.
People who benefitted from those programs received letters earlier this month notifying them that they will have full Medicaid coverage beginning July 1 with no action necessary.
“When you think about how we were able to enroll so many people in such a short period already, it’s pretty remarkable,” Gee said. “Sometimes having a low-resource environment isn’t always bad.”
Other states that have expanded Medicaid have hired hundreds of new workers to lead enrollment efforts and execute flashy campaigns.
“I think we’re recognized already across the country for how innovative we’ve been,” Edwards said.
At Baton Rouge Community College, signs are tacked up through hallways: “Good news Louisiana. Medicaid is expanding in Louisiana, meaning more residents than ever will be eligible for no-cost health coverage. To make sure as many people as possible receive health care coverage, we want everyone to be aware of this change.”
For two afternoons in June, certified Medicaid enrollees from Southeast Community Health Systems — including the woman who helped Davis, the student and Wal-Mart worker, with his application process — camped out at computers in the campus Career Center.
“It just took about 30 minutes,” Davis said.
Grover Harrison, a community health outreach coordinator for AmeriHealth Caritas, one of the state’s five approved Medicaid managed care providers, said similar events have been held across the state in recent weeks to good turnout.
“It’s been a real mix of people qualifying,” he said.
The managed care providers are pitching in to take up part of the responsibility of promoting expansion on the ground.
That Tuesday, the “Caritas on the Move” crew was set up in a highly-trekked spot on the BRCC campus quad with a miniature Plinko game, giving away red, white and blue T-shirts, bags, cups and other items as prizes for the game’s “winners.” Several students stopped by to figure out what was going on under the white tent.
Over the course of talking to Davis and other students, the AmeriHealth Caritas outreach workers casually explained that the state’s expanding Medicaid so more people will soon be eligible for no-cost health insurance. If people were interested, they were directed inside, to the independent certified enrollees.
Typically within a few minutes, they could find out whether they qualify for the expanded program.
“You’ve got to meet them where they are,” said Yolanda Criss, a community health educator with AmeriHealth Caritas.
Criss rattled through a list of the various barriers that can prevent people from signing up without this type of engagement: transportation, child care, job obligations, basic education or language barriers.
“This is working,” she said of the community-based outreach efforts.
Hospitals are also getting on board, helping to sign people up for Medicaid when they seek treatment — often emergency room care — and they have no insurance because they cannot afford it.
“People are in tears,” said Dr. Peter DeBlieux, chief medical officer at University Medical Center in New Orleans. “People are understanding that and how it changes their lives and their access to health care.”
Dr. Jennifer Avegno, an emergency department physician at UMC, said ER patients are frequently people who have nowhere else to turn.
“They have no means to have insurance,” she said.
She said she’s hopeful that Medicaid expansion will mean the expansion of primary care and give patients other options for health care.
“It’s going to capture a segment of the population who truly had nowhere else to go,” she said.
Sonya Nelson, chief executive officer of Amerigroup RealSolutions, another one of the state’s five managed care providers, said that the aggressive ramp up extends beyond just signing people up.
“ID cards and new member packets are already on the street,” she said. “When the governor said he wanted ID cards in hand before day one, we took it very seriously.”
Edwards said he has already witnessed the real-world impact.
A woman at his church in Amite told him how she couldn’t afford a badly-needed surgery.
“She works three jobs,” he recalled recently. “She still couldn’t access the care she needed.”
But Edwards said the woman qualified for Medicaid expansion. He said she has already signed up and her surgery has been scheduled after her benefits kick in this week. (The Advocate’s attempts to reach the woman, via the governor’s office, were not successful.)
“At the end of the day, we are going to have that story replicated across the state of Louisiana,” Edwards said. “Having people sign up does not at all surprise me. It gratifies me.”
Follow Elizabeth Crisp on Twitter, @elizabethcrisp.