Medicaid expansion: State costs and the remaining gap


Gov. John Bel Edwards travels to New Orleans Wednesday to officially kick off enrollment for the state’s new Medicaid expansion program.

Will Laird of New Orleans could write a book on getting sick and having to shoulder all the expenses.

“You start relegating, can I live with this and dose it with over-the-counter medications?” he said.

He is a local musician who also works at restaurant, but his job does not provide health coverage. A couple of years ago he was forced to go to the hospital.

“Yeah, I got a $100,000 bill from the hospital. I make nowhere near that,” said Laird.

The expansion program is designed to help the working poor.

“To a mother who makes $14,000 a year, she is exactly the person who would fall into the gap in the past and now will be eligible for Medicaid,” said Secretary of the Louisiana Department of Health and Hospitals Dr. Rebekah Gee.

She and others said Medicaid expansion is not welfare.

“You’re really looking at an impact for people who are working, living, a part of our economy, contributing, paying taxes through payroll, through things they buy,” said Executive Director of 504HealthNet Susan Todd.

Anyone 19 to 64 years old with a household income less than 138 percent of the federal poverty level may apply.  Application can be submitted through the website,, as well as in person and by telephone.

Eligible incomes range from $16,395 for a single household to $44,961 for a six-person household.

Former governor Bobby Jindal refused to expand Medicaid with the help of federal dollars in accordance with the federal health reform law. He said costs to the state could soar in future years.

But on his first full day in office, Edwards signed an executive order authorizing the expansion of Medicaid eligibility. Under the federal law, through 2016 the federal government covers 100 percent of the costs for new enrollees; 95-percent for calendar year 2017; 94 percent in 2018, 93 percent in 2019 and never less than 90 percent thereafter.

Louisiana’s Department of Health and Hospitals said for FY17, the state’s share of the costs is $51.2 million and the federal match is $1.7 billion.

The millions in costs the state will bear rubs some the wrong way.

“He just pretty much went with the DC model and now we’re stuck with a $51 million bill,” said State Rep. Cameron Henry, R-Metairie.

He thinks the expansion of Medicaid may come back to haunt the current governor and the state.

“This isn’t something that the legislature voted on. I think that’s one of the underlying issues that the governor has, why he’s trying to raise so much money so fast right now is that he sees that Medicaid is going to have an issue long term,” Henry said.

The Edwards administration insists that the state will save much more because of the expanded Medicaid program. It maintains that the move will save the state $677 million over the next five years and $1 billion over a decade.

“The savings we know we will see just because we have right now a much smaller piece of federal dollars that’s going to fund our Medicaid Program,” said Gee.

“Politics aside, we’re excited to have this opportunity,” said Michael Griffin, CEO of Daughters of Charity Services New Orleans.

Daughters of Charity has some of the in-person application centers for Medicaid expansion.

“Adults who don’t have dental access, they’ll have $500 annually for screenings for dental, access to specialty care, access to diagnostic to services,” said Griffin.

Close to 400,000 people, many in New Orleans, are expected to benefit. Still, some of the uninsured will be left out.

“No, it won’t be the end-all, be-all cure for everything, but it is a huge step for a large number of people to get access to health care services,” said Todd.

The insurance industry said having more people with primary health care will not only save everyone with coverage money in the long run, but could also expand the insurance marketplace in Louisiana.

“Other health insurers might look to the state and consider coming to the state because we might have a healthier pool for them to participate in,” said Jeff Drozda, CEO of the Louisiana Association of Health Plans.

As for Laird, there remains a mountain of health bills.

“I give them $5 a month. I won’t be anyway close to that anytime soon,” he said.

The state said people wishing to enroll can also sign up at some local hospitals, including University Medical Center, Touro and Ochsner.

The private manager of UMC issued this statement:

“Thanks to the leadership of the Governor and the Department of Health and Hospitals, Medicaid expansion will help improve the health and lives of those who need it most in Louisiana. Medicaid expansion will benefit our State’s financial health and the physical health of our community. As a nonprofit, academic health system, LCMC Health’s mission is to serve all in our community with compassion while supporting our teaching mission, and expansion will allow us to continue providing high-quality care to these new Medicaid beneficiaries starting in July,” said Greg Feirn, CEO of LCMC Health.”

Coverage officially begins July 1.

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