The bill's sponsor called it a win-win: give the state's elderly and most vulnerable population more care options outside of nursing homes, while improving the state's financial position by at least $100 million.
But the measure was killed overwhelmingly in a House Health and Welfare committee, packed with nursing-home industry leaders, for the second year in a row. The bill was opposed by the powerful Louisiana Nursing Home Association, who testified that nursing homes unfairly receive a bad rap for their quality of care and warned that the bill would result in limited care for the state's oldest and most vulnerable population.
The nursing-home industry is among the top sources of campaign cash for legislators and other Louisiana politicians. Owners of nursing homes and their affiliates have poured roughly $6 million into state campaigns during the past decade or so, a tsunami of checks that has helped the industry maintain its powerful hold on lawmakers and state executives.
A team of government experts and industry stakeholders spent more than two years painstakingly crafting a plan that would have reduced Louisiana’s expensive and unpopular reliance on nursing homes to house the state’s most helpless residents.
On Wednesday, state Rep. Tony Bacala, R-Prairieville, urged the committee to pass his bill that would have expanded the state's private managed-care model for Medicaid services to the elderly and physically disabled. The rest of the Medicaid program went to this model under former Gov. Bobby Jindal, but the nursing home and long-term care population was left out of the transition.
Managed care, a model used by many other states, means that private insurance companies would be hired to oversee the state's Medicaid services and make determinations about how and where patients should be cared for. Experts assume that insurers would gradually shift more people out of more expensive nursing homes to receive less expensive home care.
Bacala and other groups representing the elderly and disabled pointed out that an AARP survey found that 90 percent of people in Louisiana would prefer to be cared for at home with home- and community-based support programs, but more than 30,000 Louisianians are sitting on a waiting list. Meanwhile, on Wednesday morning a new annual report from the United Health Foundation came out ranking Louisiana 47th in the nation for senior care, and 49th for nursing-home quality.
Year after year, Louisiana lawmakers gather in Baton Rouge and grouse about the unpalatable choices they face: Cut state services, raise taxes or do some of both.
"People will die waiting for those (home-based) services," said Jeanne Abadie, with The Advocacy Center, a New Orleans based group that advocates for the elderly and disabled.
The Advocate recently published a three-day series that showed that Louisiana's fealty to nursing homes is unusual. Most other states have moved toward supporting home- and community-based services instead of nursing homes: In Louisiana, 77 percent of the state's Medicaid money for the elderly and physically disabled goes to nursing homes, with home care getting the rest. In most states, that ratio is closer to 60-40.
Home-based services are both preferred by patients and cost the state less money. But in Louisiana, nursing homes have been well protected by unique laws that prevent them from being cut during difficult financial years and require that their budgets are increased at least every 2 years.
"The growth in the elderly population is going to be astronomical in the next few years. If you can't afford to pay for health services today, how will we pay for it when we're faced with that?" said Hugh Eley, who retired from the Louisiana Department of Health after 20 years as an administrator. "This is an opportunity to work with the system we have, and bring in some additional revenue."
The Legislative Fiscal Office projected the move could generate upwards of $100 million a year. The Advocate reported the move would generate about $200 million by the second year, according to the Louisiana Association of Health Plans, mostly because of a 5.5 percent tax imposed on managed-care companies.
In Jindal's last two years in office, he assembled a 30-person task force that studied how the state could privatize oversight of long-term care. But the plan, which cost $2.5 million to design and create, was abandoned even though a request for proposals had been completed. The Jindal administration dumped the plan a day after receiving an email from nursing home industry leaders saying they opposed the measure.
Bacala's House Bill 152 would have directed the administration to release that solicitation and start the process.
But Mark Berger, executive director of the Louisiana Nursing Home Association, said managed care has failed other states, and would not necessarily generate additional savings for Louisiana. He also said managed care often results in an increase in denied claims, because for-profit insurance companies are incentivized to reap a profit.
Berger also took issue with The Advocate's reporting, which noted nursing homes have received special financial protections in the state budget. Over the past eight years, nursing home rates have increased by more than 54 percent, while almost every other health care service paid for by Medicaid has been cut or stayed flat.
"If that's true, then why are nursing home rates consistently so low compared to the rest of the nation?" he asked rhetorically. Louisiana nursing homes have the fourth-lowest rate Medicaid reimbursement rate in the country.
"Our reimbursement increases are based on the actual cost increases," Berger said. "Our rates have gone up because our costs have gone up."
Lafayette nursing home owner Joe McPherson, who used to chair the Health and Welfare committee as a state senator, said most people in nursing homes are unable to be cared for in home- and community-based services because they are too dependent.
"If you can identify people in nursing homes who can live cheaper and better in their community then we'll help them out," McPherson said. "They don't exist."
But the United Health Foundation report found that 14.2 percent of Louisiana nursing home residents are considered "low-care" and don't require physical assistance for daily living. Additionally, a U.S. Department of Justice investigation released in December found that many Louisiana nursing homes are failing to do their part to identify patients who want to transition back to their homes.
Bacala's bill had support from the AARP and groups representing the elderly and disabled, such as The Advocacy Center in New Orleans and The Arc. Bacala pointed out that the opponents of the bill were the nursing homes, a group with a strong financial interest, but the supporters were nonprofits.
Characterizing the issue as both a health and financial emergency, a Baton Rouge state repre…
"It's interesting that seeing this bill fail was important to the members of the Nursing Home Association, whose members are owners of nursing homes, and the AARP said it's important to their members that this pass. They represent the seniors in your community," Bacala said urging the committee to vote in favor of the bill.
The measure was killed 10-3. The supporters of the bill were Reps. Helena Moreno; D-New Orleans, Julie Stokes; R-Kenner, and Jerome Richard, no party-Thibodaux. Those against the bill were Reps. Bernard LeBas, D-Ville Platte; J. Rogers Pope, R-Denham Springs; Joseph Stagni, R-Kenner; Bob Hensgens, R-Abbeville; Frank Hoffman, R-West Monroe; Larry Bagley, R-Stonewall; Charles Chaney, R-Rayville; Dodie Horton, R-Haughton; Katrina Jackson, D-Monroe; Robert Johnson, D-Marksville. Reps. Marcus Hunter, D-Monroe; Dustin Miller, D-Opelousas; and Kenny Cox, D-Natchitoches, were not present for the vote.
"We are disappointed to see the committee vote against the needs of their constituents and against overwhelmingly favorable public opinion that supports alternatives to nursing home care," said Andrew Muhl, a lobbyist for AARP lobbyist, adding that the issue will not go away. "We will continue to seek an answer from the governor and our Legislature on why they think Louisiana should continue a system that does not work for the 30,000 people currently waiting for services."
Bacala agreed that the ball is now in Gov. John Bel Edwards' court. Ahead of his gubernatorial election, Edwards said he supported managed care for the nursing home and long-term care population, but recently told The Advocate he now has serious reservations.
"It's still an option for the executive branch to enact on their own," Bacala said.
Richard Carbo, a spokesman for Edwards, said the administration is actively reviewing options to improve long term care services for the elderly, but stressed that managed care "is not an easy task, despite how it has been portrayed by some, nor is it a silver bullet that will solve all of our problems." It would also require upfront investment in state resources, he said.
"LDH works continuously with both nursing home providers and home and community based providers to address issues and work on solutions to improve efficiency and quality," Carbo said. "We are going to continue to work with advocates and providers to find ways to improve the system."
Profits over Patients: The Advocate takes a deep dive into Louisiana's powerful nursing home…