It’s not clear just how willing candidates for governor are to take on a powerful State Capitol lobbying force, the nursing home industry, which has balked at the managed-care model that Gov. Bobby Jindal has imposed on other providers in the Medicaid program.
Unfortunately, as so often with Jindal’s administration, the facts are in dispute about whether managed care has saved the state money and boosted health care outcomes for Medicaid recipients. What is certain is that the providers don’t like it.
Gubernatorial candidate Scott Angelle on Thursday backed off the original Jindal plan to extend managed care to nursing homes. “Certainly, it’s saving money, but it’s not just about money,” Angelle said of managed care. While just about everyone can agree with the sentiment, it’s not a dreadfully courageous stand.
“I want to see some of the outcomes of the program” before making a commitment to expand it to include long-term care for the elderly and developmentally disabled, Angelle said, deeming this “a vulnerable population.” Just about everybody can agree with that, too, but is this a case of tending to the interest of the taxpayer or tending to the interest of provider groups?
Angelle’s backing away from a Jindal program — he was a key aide to the sitting governor — came as he and two other candidates participated in a forum on issues facing the elderly. Lt. Gov. Jay Dardenne and state Rep. John Bel Edwards also spoke, but U.S. Sen. David Vitter did not participate, citing a scheduling conflict in Washington. Edwards is a Democrat. The remainder are Republicans.
Jindal already has turned over to private insurance companies management of medical and behavioral health components of the state’s $8 billion-plus Medicaid program. The companies are charged with managing the care of Medicaid recipients.
Many middle-class families don’t think of themselves as Medicaid recipients, but their elderly relatives often are. Long-term care for the elderly and developmentally disabled was supposed to be the final part of the Jindal initiative where private companies manage the care of Medicaid recipients. But the administration said Wednesday it will leave the move to the next governor, who takes office in January.
A question about the candidates’ positions on the issue was first up at the forum sponsored by AARP Louisiana, the Councils on Aging and the Louisiana Aging Network Association.
“If we have managed care, it needs to be across the continuum of services,” Dardenne said. “It’s the last of three areas and it needs to be applied to everybody consistently.”
That makes sense, and Edwards somewhat more broadly agreed. “We also need to transition to nursing homes when necessary,” he said. “It is my goal that we sit at the table and work this out.”
We can’t help but agree with Angelle as well, though, that this managed care initiative should also stress improved care as well as curbing costs. And one of the problems with Jindal’s administration is its yawning credibility gap with legislators and the public. The ultimate fate of managed care for nursing homes and other providers will depend on whether projected cost savings, as well as service improvements, can be trusted in the existing Medicaid contracts.
That may take, after Jindal’s phony figures of recent years, a raft of auditors and the blessing of the pope. But even then, the new governor will have to be willing to take on influential State Capitol lobbyists to make things happen.