State House Republicans have submitted proposed changes they want made to deals with private companies that manage care for 1.5 million Louisiana Medicaid recipients, as the lawmakers remain at odds with Democratic Gov. John Bel Edwards over the multibillion-dollar contracts.
The governor is proposing 23-month, $15.4 billion extensions for the five managed-care companies, contracts that are state government's largest. House Republicans on the joint legislative budget committee that must approve the extensions are pressing for adjustments.
Appropriations Chairman Cameron Henry sent a letter late Wednesday detailing "suggested changes," asking questions about management terms and seeking more scrutiny by the legislative auditor. The letter comes ahead of a vote on the extensions planned Friday.
Edwards doesn't want to tweak the contracts beyond changes already proposed by the Department of Health. House Republicans, led by Henry, blocked the extensions two weeks ago, and the letter appears to suggest the votes may not be there again for approval Friday.
"I don't think it's best to move forward until we have these responses," Henry said.
The managed-care contracts, enacted by former Gov. Bobby Jindal's administration, expire at the end of January.
Health department officials said refusal to extend the contracts would damage care for Medicaid patients, forcing Louisiana to return to a previous model of care they said would cost the state more money and offer fewer services.
"The consequences of not extending the contracts is so severe that I have to believe that at the end of the day the House is going to do the right thing — as they often do, but they do it after some foot dragging," Edwards said.
The House letter, sent to Medicaid Director Jen Steele, pushes for tightened management of mental health services, seeks opportunity for public comment and calls for explicit terms to handle data breaches. Henry said suggestions came from multiple House members.
Most changes sought would give Legislative Auditor Daryl Purpera's office more explicit authority in the contracts to review managed-care records, as auditors work with the health department to root out Medicaid misspending.
Henry pointed to Health Secretary Rebekah Gee's comments to lawmakers that she has too few staff to monitor the contracts properly.
"Having the auditor have a great presence in oversight is a good thing since the department has stated many times on record that Dr. Gee says she does not have the staff to do this," Henry said. "We want to make sure we're spending all the state dollars wisely."
Purpera said his office gave Henry the list of areas where it would be helpful to have clearer access to information. The auditor's office has documented areas where it says the agency isn't properly monitoring the managed-care organizations.
"We began a much greater role of providing oversight to the Medicaid program. In that year-and-a-half there's been some growing pains," Purpera said. "This is a list of things we think if you put in the contract ... it makes everyone knows what's expected."
The Edwards administration has been trying to sway lawmakers that changes already made to the deals will improve accountability and performance.
Republican and Democratic senators on the budget committee voted unanimously for the extensions two weeks ago. The Senate currently controls the committee and added the contracts to Friday's agenda.
In his letter, Henry gave the health department and the managed-care companies until Dec. 11 to answer the questions and comment on the proposed changes — an indication Friday's vote may not change, keeping the extensions stalled.
Henry said it's possible answers to the letter could be ready by Friday, but he added: "I think most members feel that giving them until December is a more appropriate response."