Initial Medicaid Implementation Louisiana began the state’s Medicaid program in July of 1966. The state began the program with generous benefits which later were reduced for Medicare beneficiaries and limits were placed on inpatient stays and drugs. While the state reduced benefits, it maintained usual and customary fees for providers. In essence, the state’s cuts were felt more by the beneficiary rather than the provider. At the onset of the Medicaid program the state was one of a handful of states that did not take up the medically needy benefit option.
Key Medicaid Political Issues: One significant area that distinguishes the Medicaid program in Louisiana from other most other states is the extent to which Medicaid was instrumental in response to natural disasters, specifically Medicaid has helped with the response to the 2005 Hurricane Katrina. As part of the Affordable Care Act, Louisiana received additional federal matching money following the natural disaster and the state received an 1115 waiver to help additional federal aid rebuild the health care infrastructure. Aside from the disaster response the Medicaid program has played a significant role in a state with high poverty and poor health. The state had relatively generous Medicaid benefits and eligibility levels through the 1970s, 1980s and early 1990s, continually expanding coverage along with federal mandates. Over the course of the late 1990s the Medicaid program experienced a period of retrenchment and benefits and eligibility levels were reduced to often meet federal minimums. At the same time, the state experienced a period of fiscal constraint and the state’s health rankings put the state near or at the bottom.
Medicaid Expansion Implementation: Louisiana did not participate in Medicaid expansion while Governor Jindal ran the state. In 2015 Louisiana elected Democratic Governor Bel Edwards who campaigned on expanding Medicaid. The legislature had approved a plan that allowed the governor to elect to expand Medicaid without further action from the legislature. At the time, there were questions of whether the legislature ceded budgetary authority improperly but it was ultimately determined that the legislature’s intentions were to allow the expansion of Medicaid and the legislature has since adopted funding for the program. The state has reported data on the impact of Medicaid expansion on the health of state residents through monthly reports on the uptake of certain procedures and diagnoses of various diseases. The Medicaid expansion is primarily financed through a fee assessed to hospitals. Prior to the expansion of Medicaid several hospitals in the state closed and many experienced significant uncompensated care costs. Shortly after the announcement of the community engagement or work requirement policy by the Trump administration, Governor Edwards indicated that he was exploring instituting these requirements for the state. Since then there has been no movement toward adding work requirements to the Medicaid expansion despite several legislative attempts in the 2018 session.
General facts about Louisiana Medicaid:
Medicaid program name: Medicaid
CHIP Program name: LaCHIP
Separate or combined CHIP: Combination
Medicaid Enrollment: 1.45 million (2018)
Total Medicaid Spending: $8.64 billion (FY 2016 estimate)
Share of total population covered by Medicaid: 25%
Share of Children covered by Medicaid: 50% (estimate)
Share of Medicaid that is Children and Adults: 72%
Share of Spending on Elderly and people with disabilities: 68%
Share of Nursing Facility Residents covered by Medicaid: 75% (estimate)
Expansion state: Yes
Number of people in expansion: 324,000
Work Requirement: No