Photos: Candidates for Louisiana governor participate in debate forum Thursday _lowres

Advocate staff photo by MATTHEW HINTON--Sen. David Vitter, R-La., right, and State Rep. John Bel Edwards, D-Baton Rouge, prepare before the gubernatorial candidates debate at WDSU in New Orleans, La. Thursday, Oct. 1, 2015.

Democrat John Bel Edwards and Republican David Vitter differ on whether Gov. Bobby Jindal’s privatization of Medicaid should expand into care for the elderly and developmentally disabled.

Edwards favors the idea, which AARP Louisiana and others say could free up money for more home and community based services where there are long waiting lists.

Vitter won’t commit to the move, saying more research is needed to see if Jindal’s privatized managed care is working in health care areas where it’s in effect today.

The candidates shared their views in separate filmed AARP interviews, which the organization released Wednesday.

The Jindal administration has already contracted with private managers to handle the medical and behavioral health components of the state’s $8 billion Medicaid program. The long-term care portion would be the third and final installment of J indal’s privatization of the government insurance program for the poor.

Under privatized “managed care,” the idea is to provide needed services to people at the right time and in the most appropriate and generally less expensive setting. It is private companies obligation to see that happens.

The state’s powerful nursing home industry wants to be exempted, fearing loss of patients and the dollars that go with them. Advocates for the elderly and developmentally disabled want them included, hoping that dollars would be shifted to more home and community based services.

Amid the continuing disagreement, the Jindal administration punted — leaving the decision up to the new governor who takes office in January — either Edwards or Vitter.

“My commitment is to do everything possible so an individual can stay in their home longer if they want to,” said Edwards, a state representative from Amite. “Long-term managed care with a comprehensive model including nursing homes is absolutely my goal.”

Edwards said 18 states have adopted long-term managed care programs and 16 of them include nursing homes.

“My biggest problem is making sure when you put an insurance company between the state and the provider — and that takes 15 to 20 percent off the top — that you still have enough money for the people who need the services so that we don’t have a reduction in the amount of care that is actually available to our seniors,” Edwards said.

Out of the models in use in other states there has to be “one or two out there where nursing homes are satisfied with the result,” he said. “Even if they are not we can look at those 18 models and make necessary changes so we can move forward . ”

Vitter, one of Louisiana’s U.S. senators, said he will commit to “looking at” the long-term care expansion. “But I cannot commit as we speak to necessarily doing that,” he said.

“Managed care is a relatively new experiment, if you will, in terms of Medicaid in Louisiana and Bayou Health,” Vitter said, referring to Jindal’s privatized program. “It’s a work in progress, certainly all the kinks have not been worked out by a long shot.”

He noted audits and studies that have pointed out issues in Bayou Health. “It’s not clear if it’s saving money or improving outcomes.”

“What I would do first is take a deep dive with significant audits and significant investigation of Bayou Health to come up with a reliable metric , where we are able to see what it’s doing in terms of patient care and quality and cost and then based on that would go into the future with any expansion of Medicaid managed care.”

The 475,000 member Louisiana AARP has been on record favoring the expansion of the current Medicaid managed care program to include support and services for the elderly, developmentally disabled and disabled. The group said the whole spectrum of care should be included from home and community-based services to nursing homes and other institutions. Its polls show that 90 percent of those age 45 and above prefer staying in their homes as long as possible.

“We think a managed care approach inclusive of all providers is the best way to allocate resources long term,” AARP Louisiana’s director of advocacy Andrew Muhl said

“We hope the next governor will move forward to implement this program. It will make a real impact on the quality of life of the most vulnerable,” Muhl said. “Failing to move forward will mean the current waiting list (for home and community-based services) will continue to grow longer and services are more threatened.”

The AARP does not endorse candidates.

“From our standpoint our purpose for doing this is to educate the electorate so they are better informed on the issues that are important to the 50-plus population,” Muhl said.

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