In Jeff Sadow’s recent article “Medicaid expansion a budget disaster,” he used a highly inflated estimate to criticize the cost of Medicaid expansion.

In an attempt to bring attention to home and community-based services by linking the issue with Medicaid expansion, Sadow criticized the 2014 medical assistance constitutional amendment as exacerbating the budget crisis. This amendment protects the proceeds of the special tax that is levied on nursing facilities and certain other providers and directs that those fees be utilized to provide the intended services. The amendment was passed by Louisiana’s Legislature with overwhelming bipartisan support and approved by the voters of Louisiana by a wide margin. This amendment is unrelated to Medicaid expansion.

In addition, Sadow continued to share his false statements and skewed statistics regarding nursing facilities in Louisiana. His statistics regarding per capita costs on nursing facility services is significantly different than the Kaiser Foundation’s findings ( and a Wall Street Journal article utilizing federal data to measure per capita health care spending by state and by service. Nursing facility per capita spending in Louisiana is $68 below the national average while spending in the category that contains home and community-based waivers is $34 higher than the national average. Additionally, Medicaid spending per recipient may be a better measure of efficiency as opposed to per capita spending. According to the Kaiser Foundation, Medicaid per recipient spending on Louisiana’s aged population was 44th in the nation and 35 percent below the national average. And Sadow is misinformed about occupancy rates. Although the overall occupancy rates of Louisiana nursing facilities are low, they are not the lowest, and they have been improving over the past 10 years because of initiatives recommended by the nursing facility profession, including bed buy-back and private room conversion. And taxpayers and families of care recipients need to know that fraud and waste remain a serious problem in the personal care services business.

Medicaid expansion will have a broad impact on Louisiana in a positive way. The state economy will have federal Medicaid dollars flowing through it. Because Louisiana is one of the poorest, sickest states in the nation, providing health care to the uninsured working poor will drastically reduce state costs for uncompensated care. Also, the expansion will significantly reduce the number of uninsured working adults, which will help ensure a healthier workforce of low-wage workers. Improved health decreases absenteeism, which in turn increases productivity.

Louisiana’s nursing facilities strive to provide quality care in an efficient way. We will continue to collaborate with other health care providers and the Edwards administration to search for meaningful solutions to issues that surround our profession, including the health and well-being of Louisiana’s elderly. I believe expansion could improve the health of wage earners who can’t afford insurance, some of whom work in nursing facilities.

Joseph Donchess

executive director, Louisiana Nursing Home Association

Baton Rouge