Louisiana enrolling thousands of people into expanded Medicaid program_lowres

Gov. John Bel Edwards, right, speaks to the Buteaux family at University Medical Center in New Orleans to announce the state's expansion of the Medicaid program.

Where there’s smoke, there’s fire; and, smoke has been clouding the realities of our state’s Medicaid expansion program for the last two years. There has been a great deal of misleading reports, anecdotal evidence and conjecture surrounding this subject. I believe that Louisianans deserve the facts. 

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On Day One, both Democrats and Republicans agreed that if Medicaid expansion was implemented, it must serve Louisiana’s most vulnerable citizens. Since then, this pact has not only been disregarded but completely reversed. 

To date, we have more than a thousand cases of individuals earning $100,000 per year while on Medicaid, and approximately one-third of the expansion population is reportedly made up of unemployed, able-bodied individuals. As we’ve shot past initial enrollment projections by hundreds of thousands of people, some of the most in need among us remain on lengthy waiting lists hoping and praying for care. 

Late last year, the state legislative auditor reported on inappropriate payouts from Medicaid expansion. A random sample of 19,226 single-person households, which the auditor pre-identified as having average quarterly income above the Medicaid eligibility income limit, revealed that from mid-2016 to 2018, 82 percent didn’t qualify to receive about half of their paid benefits. More shocking is the revelation that a subsample of 100 individuals reporting income higher than what would have made them eligible showed 93 percent received about two-thirds of their benefits inappropriately.

Some progress was made at the end of last month when, after intense pressure, the state finally purged more than 30,000 individuals from Medicaid due to ineligibility. While tamping out this fraud was a step in the right direction, Louisianans need to know that this doesn’t come close to solving the problem. 

While recipient fraud is at an all-time high, provider fraud is rampant as well. Hundreds of cases are currently under review. Early indications project millions of dollars will be identified and reported of classic provider fraud. Most agree this is unacceptable. 

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Now, the Louisiana Department of Health is back asking for more — $1 billion more to be exact. Is it really unreasonable that my colleagues and I on the House Appropriations Committee are concerned about adding another billion dollars to a program that has a proven track record of fraud and abuse? Is it truly a wise idea to give more tax dollars to a program that has misspent at least 100 million dollars?

Make no mistake; we have only scratched the surface of the problems with Medicaid expansion, and we are committed to ensuring every dollar spent is accounted for and dedicated to the program’s original purpose — taking care of those most vulnerable and in-need in Louisiana.

Rick Edmonds

state representative

Baton Rouge

Editor's note: An earlier version of this letter was corrected to address an erroneous suggestion that the legislative auditor's random sample was drawn from all Medicaid enrollees rather than a subset of enrollees identified as having incomes that exceeded the program's eligibility limits.