A state Senate committee Monday asked Gov. Bobby Jindal’s health department to stop wasting time and come up with a proposal to expand Medicaid by the end of the year.
Jindal and Republican legislators repeatedly have rejected efforts to increase the Medicaid rolls, the government program paying for health care coverage for the poor, to include people who make too much money to qualify for the program but not enough to buy adequate coverage on the private market. They have argued adding 307,000 to 531,000 new people to the million or so poor people already enrolled would eventually become too expensive for Louisiana taxpayers.
Medicaid spending accounts for about $8 billion in annual state and federal dollars, roughly a third of Louisiana’s operating budget.
GOP lawmakers are now showing more willingness to expand Medicaid as Gov.-elect John Bel Edwards prepares for his Jan. 11 inauguration. As a Democratic state representative, Edwards tried several times to adopt expansion, and he has made it a priority of his new administration.
Edwards can order the program expanded, and the federal government will pay for nearly all coverage, but legislators still will have to vote on additional state funding that goes along with administrative and other costs.
Acknowledging the complexities of the issues involved, state Sen. Francis Thompson, D-Delhi, halted a long presentation on ramifications of various options to ask the staff of the state Department of Health and Hospitals to just come up with a single proposal for the committee to review.
“At least it would be a base to start from,” Thompson said at the Senate Finance Committee hearing.
Picking up two thick folders, Thompson added, “We’ve looked at 40-something (alternatives) in pieces and parts.”
DHH Secretary Kathy Kliebert said it would be difficult because the plan depends a lot on what the incoming administration wants. DHH officials were scheduled to meet Monday afternoon for the first time with a transition team focused on health care issues.
“It really depends on the priorities,” Kliebert said.
For instance, she said, one question is how fast does the new administration want to roll out the new program? DHH would have to sign up and vet up to 500,000 new applicants.
Twenty-two states and the District of Columbia have elected to expand Medicaid rolls without any special considerations.
Eight other states have asked for “waivers” to federal law — such allowing for co-pays or contracting private insurers — to adjust the Medicaid expansion to fit their particular populations and political realities. Each idea carries different costs and issues.
Creating a single plan would be difficult without knowing which path the Edwards administration wants to go down, she said.
“That’s the purpose of these meetings,” Thompson said. “I feel like we’ve somewhat wasted valuable time.”
Senate Finance Committee Chairman Jack Donahue, a Mandeville Republican, told Kliebert to get a feel for the incoming administration’s views and to come up with a base proposal. “That’s the intention we would like you to leave here with,” he said.
The committee also asked the Legislative Fiscal Office and its staff to study the different models being used by various states seeking waivers.
Donahue, who had opposed earlier legislative expansion efforts, said after the hearing that Medicaid could be good for the state. “I’d like to see how much it costs the state. I don’t think we’ve ever had a really good estimate of what it costs,” he said.
But it won’t help a $530 million deficit that, if not fixed, could keep doctors, hospitals and other health care providers from getting paid after the end of April.
DHH officials had come up with $190.5 million in fixes to cover its shortfall in this year’s budget, but the Jindal administration took that money to patch over other holes in the state spending plan. Unless the state can find that money, then it won’t be able to match the $339.5 million federal dollars and would lose that money as well.
“At the end of the day, the state can’t print money,” said Jeff Reynolds, the DHH undersecretary. “Then the payments to the providers stop.”
Medicaid is a program in which government pays for the medical care of poor people. About one-fourth of Louisiana’s residents are members, and Medicaid is the largest single expenditure in the state’s budget even though most of the costs are picked up by the federal government.
Medicaid expansion is a key component of the federal Affordable Care Act, a signature program of President Barack Obama.
Expanding the rolls of the program would allow signing up people who make too much money to qualify but too little to purchase adequate coverage on the private market. Medicaid expansion covers adults making up to 138 percent of the federal poverty level — about $33,465 for a family of four.
All four of the major candidates for governor said they would consider Medicaid expansion in some form.
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