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Gov. John Bel Edwards, at left, shakes hands in January 2016 with his health care transition team co-chairs, Gary Wiltz, CEO of Teche Action Clinic, and Ronnie Goux, president of the Louisiana Nursing Home Association, at the State Capitol after Edwards signed his first executive order to provide for Medicaid expansion in the state of Louisiana. Goux, through his various companies and families, donated about $142,000 to Edwards' campaign. 

In the 2015 campaign, when he ran for governor, candidate John Bel Edwards promised to pursue a policy to give older people a better path to receive care at their homes instead of being forced into nursing homes.

More than two years later, having won the election, Edwards has taken no action. Though the governor maintains his commitment hasn't wavered, his support seems to have grown tepid as he often casts doubt on whether the policy is the right course to pursue.

This year, his words have come back to haunt him.

“My commitment is to do everything possible to make sure individuals get to stay in their homes longer, as they want to. Long-term managed care, with a comprehensive model, including nursing homes, is absolutely my goal,” Edwards said in a recorded interview in 2015 with AARP of Louisiana, noting that several states had already implemented the policy change.

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Edwards, at the time, acknowledged that he had some concerns about maintaining quality of care. But he was resolute that there was a way to make it work for Louisiana’s most vulnerable population, even if nursing home owners — who have openly opposed the measure for years — were uncomfortable. “I have to believe that if 18 states have done this, there have got to be one or two out there where nursing homes are satisfied with the results, and even if they are not, we can look at those 18 models and make any necessary changes here in Louisiana so that we can move forward with long-term managed care for our seniors to allow them to stay at their homes as long as possible, where they want to be and where I would certainly want them to be as well,” he said.

This past week Edwards’ words were quoted in committee hearings by two Republican legislators, Metairie state Sen. Conrad Appel and Prairieville state Rep. Tony Bacala, who were attempting to pass bills to implement the same “long-term managed care” proposals that the governor once said he supported. "Long-term managed care" oversees the elderly Medicaid population with private insurance companies, which could steer more people toward home- and community-based programs rather than to nursing homes.

“Wow, that was a firm promise to the seniors of our state,” Appel subsequently tweeted about Edwards. “What happened to honoring promises!”

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The legislators used Edwards' remarks in the closing of their bills, both of which did not advance in the face of opposition from the powerful nursing home industry. Edwards' administration could implement the plan by directing the Louisiana Department of Health to do so, without the need for any legislation. 

Similarly, AARP of Louisiana, the organization Edwards made the commitment to during the election, is publicly accusing Edwards of "going back on his word," while reminding him that it’s not too late to make good on his commitment. 

“Seniors have clearly demonstrated they want to live at home, and the governor needs to remember that he already has a solution in front of him and can keep a campaign promise with the stroke of a pen,” said Andrew Muhl, a lobbyist for AARP of Louisiana. “He can change the lives of thousands of seniors languishing on state waiting lists who are hoping for care.”

Over the past years Edwards has expressed waning confidence in the proposal. Asked about his inaction, he's previously cited concerns that managed care would reduce quality for seniors and has raised questions about upfront costs and problems in other states. 

This week, when asked about the accusation that he had gone back on his word, his spokesman reaffirmed the governor's commitment to the plan but cited costs as the major deterrent. 

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"Both the governor and the Louisiana Department of Health are continuing to have constructive conversations on what direction the state should take with limited financial resources at our disposal," said Edwards' deputy chief of staff, Richard Carbo. "His comments that this remains his goal haven't changed, but the reality of the costs makes it slower than some would like." 

Bacala and Appel say the initial implementation costs are unclear because the administration has yet to produce a report that examines what it would take to make the change. They also noted that most projections show the change generating money for the state within a couple of years. 

"Imagine if we'd implemented it last year or the year before," Bacala said. "Would be nice to have that money coming into the state by now, wouldn't it?"

Carbo firmly pushed back against the mounting criticism by the advocacy organization that has long been friendly to Edwards.

"Unfortunately, the staff at AARP have taken a completely unproductive approach and have resorted to attacks rather than constructive dialogue," Carbo said. "More importantly, the last time we checked, the governor did not sit on any legislative committees, so any lack of support for this effort rests with the bill authors. Both Representative Bacala and Senator Appel are placing blame on others for the things the state cannot afford to do, but are absolutely unwilling to work collaboratively to ensure we can fund priorities we all identify." 

Edwards' predecessor Bobby Jindal initially planned to implement managed care for nursing homes, going so far as to craft a request for proposals that was never issued. After two years of work, the plan was abandoned in 2015, one day after the then-leader of the nursing home association emailed the then-Louisiana Department of Health secretary to tell her the association opposed the plan. Jindal received well over $1 million in campaign contributions from nursing home leaders to support his gubernatorial and presidential campaigns.

Edwards has received more than $700,000 from the nursing home industry in campaign donations.

AARP has been heavily advocating for managed long-term care in Louisiana as a way they say will even the scales for elderly Medicaid population, who prefer to live at home but will more likely end up in a nursing home. The elderly Medicaid budget is split between home and community-based services and nursing homes, but nursing homes receive the lion's share of the dollars.

Providing home- and community-based support, in lieu of nursing homes, is less expensive to the state. However, the state's policies and resources favor nursing homes, and there is a waiting list of 28,000 people who want home- and community-based services.

The idea of managed care is that if insurance companies were hired to manage the elderly Medicaid population, more people would be served in their home with medical help and daily assistance because it’s a less expensive service for the state.

Mark Berger, executive director of the Louisiana Nursing Home Association, which represents more than 250 facilities in the state, said he disagrees the state would save money with managed care because Louisiana's nursing homes are already running on low costs. He notes that Louisiana nursing homes have the fourth-lowest state reimbursements in the nation.

Berger said there are many examples of states fumbling long-term managed care, adding that sometimes even home- and community-based providers complain about reductions in quality of care and an increase in claims being denied. 

Managed care, however, is not a new a concept to Louisiana. In fact, nursing homes are an outlier in the way Medicaid patients are served, because they are one of the only populations not already under managed care. Louisiana's traditional Medicaid and expanded Medicaid populations are managed by insurance companies.

And even Edwards has repeatedly affirmed that he believes managed care is working for the rest of the state. That's exactly why Muhl said he isn't buying the governor's concerns that managed care won't work here.

“We are already managing the care of the majority of the Medicaid population with improved savings and quality care. Why not manage the care of our seniors too?” Muhl said.

Follow Rebekah Allen on Twitter, @rebekahallen.