Copays, work referrals, other measures eyed for Louisiana Medicaid expansion _lowres

Advocate staff photo by TRAVIS SPRADLING -- Gov. John Bel Edwards speaks Tuesday at the State Capitol at a press conference with legislators, community leaders, and key stakeholders, just after issuing his first executive order, No. JBE 16-01, to provide for Medicaid expansion in the state of Louisiana. Dept. of Health and Hospitals Secretary Dr. Rebekah E. Gee, MD, is at right.

After making Medicaid expansion central to his campaign in the fall, Gov. John Bel Edwards’ plan for growing the health care program is beginning to take shape — even as some state lawmakers remain wary of embracing a key component of the federal Affordable Care Act.

Edwards, during his State of the State address Monday, revealed new details about how he sees the program moving forward, including that he is embracing some conservative ideas, such as co-payments.

“We can improve our Medicaid program and require personal responsibility for health by charging copays, providing premium assistance, requiring work referrals and promoting healthy behaviors,” Edwards said in his speech that kicked off the start of a three-month legislative session. “We save money, promote individual responsibility and achieve better health outcomes.”

The copay line didn’t appear in an early written version of Edwards’ speech that was distributed to reporters.

But it appears to signal movement toward more common ground between Democratic Edwards and the Republican-controlled Legislature on an issue that could become a hallmark of Edwards’ first year in office.

Former Gov. Bobby Jindal, a staunch opponent of President Barack Obama’s signature health care law, adamantly opposed expanding Medicaid, but Edwards signed an executive order pushing expansion shortly after taking office in January, joining 30 other states in embracing the expansion plan.

House Health and Welfare Committee Chairman Frank Hoffman, R-West Monroe, said he has met with Edwards and his staff to discuss expansion details and potential legislation for this session. He said he thinks the state could look to others that have tailored expansion plans to their needs or come up with a Louisiana-specific plan.

Hoffman is among legislators eyeing additional cost-sharing measures that would require new recipients to have a personal stake in their health care coverage. He has filed a bill that would implement monthly premiums, but he cautioned that the current version of his proposal is a work in progress and could change.

“We want it to work, and we want the people participating in it to be healthier because of it,” Hoffman said. “This, I think, makes them more involved in it. It makes it more effective.”

In just three months, Louisiana will begin signing up people soon to be eligible for Medicaid coverage. The state plans a push to sign up people using contract employees who the state will pay using private funds from health care providers.

Dr. Rebekah Gee, secretary of the Department of Health and Hospitals, said no state funds will be used and the state is on target for its July 1 expansion rollout. “We have a great team, and we are very confident that we’re doing every thing we can to make this as successful as possible,” she said.

More than 300,000 additional Louisiana residents, mainly the working poor, will be added to the Medicaid rolls under the expansion, based on the Kaiser Family Foundation’s latest estimates. Adults who make up to 138 percent of the federal poverty level — about $33,460 for a family of four — would become eligible.

Some legislators already have filed bills that would block expansion or throw up significant hurdles. One bill would bar any additions to the Medicaid program after this month without legislative approval. Another would require that the state scale back the number of Medicaid recipients every year.

During a recent special legislative session, several legislators changed their votes on a bill linked to the state’s Medicaid providers because they feared votes in favor would signal endorsement of Medicaid expansion.

But several others seem in line with Edwards’ plan.

“By and large, what we’re hearing is support from the Legislature,” Gee said, noting that Edwards’ reform efforts will apply to the whole program, not just Medicaid expansion. “We’re hearing that the legislators see the fiscal picture, the economic benefits and the health benefits of expansion — even our conservative legislators are supportive.”

Gee said several of the proposals may not require waivers from the federal government and can be implemented on the state level or with an agreement from the federal government outside of the waiver process.

Gee said Edwards is supportive “in concept” of bills that seek to require come co-payments.

“This is to help make sure that they have a sense of responsibility and pride in the health benefits that they receive,” Gee said.

She said measures that would penalize people for the use of more costly emergency room visits for nonemergency health issues also are supported by the administration.

Further, establishing wellness incentives would help curb costs and improve health in the long run, Gee said.

“We’re moving toward those goals,” she said.

Some states have sought work requirements for Medicaid eligibility, but the federal government has rejected those plans. Work referral programs, like Edwards mentioned in his speech, have emerged as a next-best alternative. In states that have adopted work referral provisions, unemployed Medicaid recipients are directed to career centers or other services to help them find work.

Gee said efforts to implement such a program is already in the works for the current Medicaid system.

Follow Elizabeth Crisp on Twitter @elizabethcrisp. For more coverage of Louisiana state government and politics, follow our Politics blog at http://blogs.theadvocate.com/politicsblog .