Louisiana House Republicans again Friday spurned contract extensions sought by Gov. John Bel Edwards for Medicaid managed-care companies that coordinate health services for 1.5 million people, continuing a stalemate over deals that are the most expensive in state government.
Friday's vote was the second time this month House GOP lawmakers on the joint legislative budget committee have refused to support the 23-month, $15.4 billion extensions the Edwards administration is proposing for the five managed-care organizations.
The current contracts, negotiated by former Gov. Bobby Jindal's administration, end Jan. 31. Lawmakers who voted against the extensions haven't suggested a backup plan for continuing to provide Medicaid health services covering nearly one-third of Louisiana's residents, including 800,000 children, if the deals expire.
Edwards, a Democrat, said lawmakers were "leveraging the health and well-being of Louisiana citizens for messy political battles."
"The people of Louisiana deserve better. The partisan spectacle led by a vocal minority in the House fell far below what we should expect of public servants who have pledged to uphold the best interests of their constituents," the governor said in a statement.
Led by Appropriations Chairman Cameron Henry, House Republicans question whether the health department is doing enough to monitor and squeeze savings out of contracts that annually account for roughly one-quarter of the state's operating budget.
They point to audits suggesting the agency isn't properly supervising the managed-care companies and to comments from Health Secretary Rebekah Gee that she has too few staff for the oversight.
"The intention is to get the most benefit we can and the best deal for taxpayers," Henry said.
The House vote was 17-7 against the extensions. Two Republicans voted to approve the extensions, while all other GOP House members — including Speaker Taylor Barras — opposed them. Senators on the committee previously supported the deals unanimously, but they didn't vote Friday because the House decision meant the contracts couldn't pass.
Gee said the administration improved contracts it inherited, adding stronger accountability and performance-based payments.
"We have gotten a much better deal for the state's citizens," she said.
Edwards said his administration is working on a contingency plan if the contracts expire.
"We will spend the next several days putting together a plan to ensure that we have contracts in place and we can continue the managed-care program," said Edwards' chief lawyer Matthew Block.
It's unclear how the health department could have contractors to run the managed-care program without a new competitive bid process — or approval of the extensions from lawmakers. Block didn't explain what the administration was considering.
Friday's hearing was the third on the extensions proposed. Each time, the Edwards administration has refused to change the contracts.
This week, Henry sent a letter suggesting changes, most of them to give Legislative Auditor Daryl Purpera's office more explicit authority to review managed-care records.
The health department responded with a letter that said many issues raised by House Republicans already were addressed in the contracts and the auditor already has authority to access the information he's seeking.
Henry replied that it shouldn't be a problem then to add the auditor language into the contracts: "Give us the comfort level."
Block and Gee urged lawmakers to change their votes in Friday's hearing, to no avail.
"If we've answered every question this committee has had, what's the basis for not approving them?" Gee said. "What's the justification? It's disruptive. It's fly-by-the-seat of your pants. You can't run a Medicaid program like that."