Thousands of Louisiana residents who don’t have health care coverage will start getting no-cost insurance on Friday when the state’s new Medicaid expansion program takes effect.

But several of the broad impacts — on populations that range from convicts serving time in prison to poor mothers who typically would lose coverage shortly after their children are born — have drawn less attention as Louisiana gears up to become the 31st state in the country and first Deep South state to embrace one of the key provisions of the federal Affordable Care Act.

The decision to expand Medicaid through the federal Affordable Care Act has been nationally lauded and heavily promoted within the state’s borders.

“This is going to be a new day,” Department of Health Secretary Dr. Rebekah Gee said.

For months, Gov. John Bel Edwards’ administration has touted expansion, which is an option for states through the ACA, and the potential benefits to health care in the state.

One of the key points that has been stressed has been the impact on the state budget — an estimated $184 million was saved over the next year alone, as Louisiana faces yet another budget shortfall. Alternately, expansion has been pitched as a way for one of the nation’s poorest and sickest states to look out for its people.

But state health officials say many more areas will be touched.


With nearly 70,000 people behind bars in jails or prisons across the state, Louisiana’s incarceration rate dwarfs most states in the country — a rate of about 816 people per 100,000 residents, compared to the national average of 392, according to the National Institute of Corrections.

In an odd twist, that actually provides more opportunities to provide health care coverage through expansion.

“We have more opportunity to change and improve mental health services for this population than any other state in the nation,” Gee said.

The state Department of Health has been regularly meeting with the Department of Corrections in recent weeks in anticipation of the expansion date. “Both of us are excited about the opportunity to work together,” Gee said.

The new partnership will mean that inmates who are released with known mental health issues and meet the new Medicaid requirements will get access to needed medication or other treatments.

Gee said she’s hopeful that means that, in the long run, Medicaid expansion can have a positive impact on public safety. If people whose issues stem from mental illness and a lack of access to medication or other treatment are counseled to seek Medicaid-backed treatment, perhaps they will be less likely to re-offend, she said.

“We are looking for the best ideas and where they are having the best results,” Gee said.

The biggest impact, Gee said, could be on mental health.

Based on state health estimates, at least 7 percent of the people joining Medicaid have a mental health disorder and 14 percent have an addictive disorder.

Affecting those populations could have a profound effect on not just coverage but future public safety, Gee said.


Maybe it’s the fattening, frequently-fried food. Maybe it’s the perpetuation of an often alcohol-soaked culture. But health officials agree that the culture adds a difficult layer to curbing Louisiana’s abnormally high cancer and health disparity rates.

“I’m not being a Pollyanna and saying it will cure all things,” Gee said of expansion. “If people wanted to eat less, they’d be eating less.”

Louisiana has historically ranked among the states with the highest rates of cancer and heart disease.

Under the state’s old subsidized charity system model, patients could wait weeks — sometimes months to see a doctor. Several legislators and other officials frequently recount stories of people who died of cancer while on appointment waiting lists because they didn’t have access to regular or adequate specialty care.

In the past, patients have often waited to seek treatment through the old charity hospital system, with no primary physician to guide the way. Health care leaders agree that better treatment will lead to fewer deaths — and hopefully fewer cases — from the ailments that plague Louisiana and other southern states.

“I expect screenings to skyrocket,” said Dr. Peter DeBlieux, chief medical officer at University Medical Center in New Orleans.


Both Baton Rouge and New Orleans — Louisiana’s most populous cities — annually rank among the cities with the highest rates of HIV or AIDS cases.

The proponents of Medicaid expansion claim that expanded health care coverage can help curb that trend.

State health officials say that the new coverage could be monumental for patients with HIV or AIDS, and give them new access treatment, as well as drugs like PrEP, which helps reduces the likelihood that someone will contract HIV from an infected individual.

A recent report from the U.S. Department of Health and Human Services found that the uninsured share of hospitalizations for people with HIV in four Medicaid expansion states dropped 60 percent. In non-expansion states, the decrease was 8 percent.

Follow Elizabeth Crisp on Twitter, @elizabethcrisp.