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Medicaid reform missed in chaos of special session

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So much for Medicaid reform in Louisiana, at least insofar as the Louisiana Legislature’s special session went.

With the state spending nearly half its budget on the program, and rivaling elementary and secondary education for the largest single category of expenditures in the $3.7 billion range, such a huge amount of taxpayer dollars leaves a lot of latitude for efficiency. In particular, House of Representatives Republicans promoted these measures as counterweights to several hundred million bucks worth of permanent tax increases advocated by Gov. John Bel Edwards.

GOP legislators settled on three initiatives. They wanted to cut down on fraudulent eligibility, which makes up an unknown proportion of the Medicaid population. Numbers from other states paint a scary picture: in Oregon, as many as 45 percent of recent Medicaid enrollees actually don’t qualify. And because Louisiana based much of Medicaid expansion population enrollment on participation in other welfare programs that also have a nontrivial proportion of improper enrollments, that potentially magnifies the problem.

Republicans also wanted to introduce a work or community engagement requirement. This would have able-bodied non-elderly adults without dependents obtain part-time or more employment or volunteer or attend school in order to receive Medicaid. In Louisiana, such a requirement would affect roughly 10 percent of the existing Medicaid population.

And, the Republican lawmakers desired increased patient responsibility for Medicaid services rendered. Federal law allows co-payments, which 17 states have implemented, charged to the non-indigent for roughly the price of a pack of cigarettes (nearly 30 percent of Medicaid-enrolled adults smoke) for outpatient services, while a hospital stay would cost a maximum $75. This could raise an estimated $172 million annually.

But within a week, most of this agenda lay in tatters. Democrats made known they would block any patient responsibility items, so that bill never even had a committee discussion. A bill with work-related requirements became watered down to little more than a study. Only a bill mandating that the state make some attempt to verify Medicaid eligibility through cross-referenced tax returns made it out of the House intact.

And, even if the bill had survived in the Senate, the past record of the Edwards Administration’s Department of Health suggests half-hearted implementation would have followed. For two years, LDH has made a bigger deal of trying to put more people on Medicaid rolls than in backing initiatives to reduce dependency, while spinning a web of obfuscation and deceit.

The latest example comes from the most recent LDH report on Medicaid, which trumpeted $26 million fewer in state money spent for the budget year to date as a result of expansion. But that was because of lower-than-expected enrollment and delaying a reversal of fee cuts to providers. Meanwhile, uncompensated care costs, which expansion claimed it would lower, came in $110 million over budget.

Out of control, inefficient Medicaid spending, exacerbated by Edwards, remains the greatest threat to funding adequately other parts of state government. He and Democrats seem all too willing to subvert any efforts to control it.

Jeff Sadow is an associate professor of political science at Louisiana State University Shreveport where he teaches Louisiana Government. He is author of a blog about Louisiana politics at http://www.between-lines.com, where links to information in this column may be found. When the Louisiana Legislature is in session, he writes about legislation in it at http://www.laleglog.com. Follow him on Twitter @jeffsadow. Write to him at voteearlyvoteoften@yahoo.com. His views do not necessarily express those of his employer or this newspaper.

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