Parties involved need to fix Medicaid system

Published 9:50 am Thursday, September 18, 2014

Louisiana legislators who want to know how well the state’s new system for handling Medicaid is working should have asked the patients who are served by it and the doctors who treat them. A report from the state Department of Health and Hospitals (DHH) didn’t give them the complete information they wanted.

Medicaid is the federal-state health care program for Louisiana’s poor and low-income workers. The Jindal administration privatized much of the system in 2012. The changes affect almost 900,000 of the state’s 1.4 million Medicaid recipients, and most of them are children and pregnant women.

A 2013 law requires DHH to submit a yearly report about the performance of the state Medicaid program that is now called Bayou Health. The legislative auditor reviewed the first report and said it lacked important financial information and its rosy review wasn’t corroborated by data.

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Ruth Kennedy, state Medicaid director, disagreed with the auditor’s report. She said it didn’t give DHH enough time to compile the information and didn’t paint a complete picture.

Lawmakers should have asked the Louisiana State Medical Society what it thought of the newly privatized state Medicaid system. Jeff Williams, the society’s executive vice president and chief executive officer, minced no words about the program in a report to its members.

“Gov. Bobby Jindal, DHH and legislators need to make immediate changes to Bayou Health and properly manage the health plans that have been contracted to provide services,” Williams said. “Since its inception, physicians who provide care to Medicaid patients have only seen their administrative burden rise exponentially as they now spend additional time, effort, energy and staffing resources navigating these plans, attempting to avoid excessive claim denials for their patients. Oftentimes, physicians spend more time appealing a claim denial than the claim is actually worth. Simply put, this program is an administrative nightmare. Is this really the key to ‘savings’ in the Bayou Health Medicaid program?”

Williams said as the administrative burden continues to increase reimbursement rates continue to decline. Many doctors are deciding whether they want to continue providing the services, he said.

The medical society said it has proposed “numerous solutions” to the state that would help minimize “unnecessary administrative burdens.” It listed eight of those suggestions.

DHH has praised the privatized program, saying it provides better care for those who need it. It has been standard procedure for the Jindal administration to defend its programs, even when they come under fire from others.

That is unfortunate because the state is getting ready to accept new bids from companies wanting to participate in the new program at a time when the medical society said “providing services under the Bayou Health Medicaid program is simply unsustainable.”

Both sides in this controversy need to sit down together and work on solutions before new contracts are signed. And legislators need to ensure that it happens. Medicaid patients deserve nothing less.(MGNonline)