Here is some consolation for poor folk denied regular health care because of Gov. Bobby Jindal’s refusal to accept the federal dollars that would pay for an expansion of Medicaid: You may not be missing much.
The way Jindal’s Health Department runs Medicaid, its coverage is inadequate anyway if you get chronically sick.
Here is some encouragement for rich folk who might consider supporting Jindal as a GOP presidential candidate: He is your kinda guy.
His administration is not only limiting government handouts to the great unwashed but has figured out how to do an end run around those free-spending liberals in Washington.
Medicaid is an obvious place to save money. In Louisiana, 1.4 million people are on it, and a further 240,000 would qualify under the looser criteria proposed under “Obamacare.” The state’s share of the tab currently comes to about $8 billion a year, state Treasurer John Kennedy recently noted.
Given that Louisiana seems to run out of money halfway through every fiscal year, the Jindal administration needs to swing the ax wide. It stands to reason that a lot of that Medicaid money must be wasted. Kennedy is consistently at loggerheads with Jindal’s bean counters, but they clearly agree with his assessment that “Medicaid, as we know it, is dysfunctional.”
Still, it does keep lots of people alive, a happy state of affairs that would ideally survive any cost-cutting measures. In Louisiana, the limits imposed on the services Medicaid will cover may leave the sickest of the impecunious sick out in the cold.
All states cap the number of doctor visits Medicaid will pay for, although Louisiana, at 12 a year, is among the least generous. Patients must pay for any treatment provided over the limit unless their state health department grants a waiver, which, in Louisiana, evidently makes getting blood out of a stone seem a cinch. Indeed, it is much harder than it appears to be from a reading of our state Medicaid plan.
All states submit a plan to the Centers for Medicare and Medicaid Services. Once the plan has been approved, the feds determine how much each state must contribute to the cost of Medicaid coverage; Louisiana pays about 38 percent.
According to the Louisiana plan, “When the service cap has been reached, any additional services must meet medical necessity criteria” in order to be “retroactively authorized on a case-by-case basis.” Only when an “extension” has been “filed and denied as not medically necessary” is the cost of the visit “billed to the recipient.”
If Medicaid recipients were capable of paying bills, they wouldn’t be Medicaid recipients in the first place, but the wording on the state plan is most reassuring, since it suggests that only frivolous claims will be denied. There is indeed no reason for taxpayers to pick up the tab if Medicaid recipients are wasting a doctor’s time.
However, “medical necessity” is not defined in the state plan, and the Health Department has chosen to adopt excessively stringent criteria. The Health Department’s Medicaid Physician Provider Manual decrees that visits over and above the annual limit of 12 are covered only for “emergencies, life-threatening conditions and life-sustaining treatments” such as chemotherapy.
So many desperately ill patients are deemed ineligible under this rule that the Louisiana Medical Society’s lawyer suggests the Health Department is exceeding “the authority to limit services which was approved by CMS.” In a letter to a geriatric specialist alarmed by the denial of coverage to patients with multiple ailments, Gregory Waddell notes that the rule enshrined in the Provider Manual does not square with the Health Department’s own definition of medical necessity for Medicaid in the rules set out in its Administrative Code.
There it means “services that are in accordance with generally accepted” standards of care and are deemed “reasonably necessary” to alleviate conditions that “cause suffering or pain.”
The state Health Department does not deny adopting conflicting definitions of medical necessity, but spokeswoman Olivia Watkins says the provider manual is now being updated to “ensure consistency with our promulgated rules.” The contractor handling Medicaid payments is being advised on “what exceptions are allowable” so that “the discrepancy some providers may have encountered” can be fixed.
That doesn’t quite amount to a promise to quit stiffing the poor, but maybe it’s a start.
James Gill’s email address is email@example.com.