WASHINGTON — Louisiana’s Medicaid expansion came to the forefront of a national debate over the health care program for the poor when State Auditor Daryl Purpera was a featured speaker at a Capitol Hill hearing on Wednesday.
Purpera has been a key skeptic of Louisiana’s approach to expansion after Gov. John Bel Edwards signed an executive order in 2016. He told a U.S. Senate panel he’s worried about the national potential for fraud, abuse and waste after studying Louisiana’s program for the past three years.
“States have way too much latitude,” he said, urging more uniform checks and eligibility standards.
Purpera faced a mostly friendly audience on the GOP-controlled committee, which includes U.S. Sen. Bill Cassidy, R-Baton Rouge.
“Medicaid is on an unsustainable path,” said Senate Finance Subcommittee on Health Care Chairman Pat Toomey, R-Pennsylvania.
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Last year, Purpera released an audit that suggested the Louisiana Department of Health may have misspent as much as $85 million providing Medicaid coverage for people who didn’t qualify.
Medicaid in Louisiana and other states has historically relied heavily on recipients to self-report their income.
Since the auditor’s review, Louisiana has instituted a new eligibility system.
About half a million people have been added to the state’s Medicaid rolls through the expansion, which applies to adults whose household income falls below 138 percent of the federal poverty level, which is about $16,600 annually for a single person or $33,900 for a family of four.
State Health Secretary Rebekah Gee sent a letter to the panel that was read into the record defending the program by explaining its health outcomes.
“The Medicaid expansion in Louisiana is saving lives,” she wrote. “The fact is that never in the history of Louisiana have we had more tools to ensure proper eligibility for Medicaid participants.”
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Louisiana expanded Medicaid through an optional provision of the federal Affordable Care Act that provides for a bigger portion of coverage for new enrollees. About 37 states have approved Medicaid expansion, while others continue to oppose the Obamacare feature.
Purpera said state auditors across the country began looking into Medicaid three years ago because it is such a large part of the federal budget.
“Medicaid is a huge issue,” he said after the hearing. “It’s a $600 billion program.”
“We’re just trying to say the current rules need to be complied with,” he added.
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U.S. Sen. John Kennedy, R-Madisonville, also has raised concerns about the program. He said Purpera “makes some very good points,” noting that “his job is to make sure our taxpayer dollars aren’t being wasted.”
Gee repeatedly has said the audits judged it before the overhaul of eligibility procedures and paints a misleading picture.
“It felt like I was being judged on an old car I was sending to the junkyard,” Gee said in an interview last year after the audit’s release. “We would not defend the old system. We absolutely agree it had problems and needed to go.”
Edwards’ administration has defended the program, and the governor has called expansion his proudest accomplishment since taking office.
“Louisiana Medicaid has the most robust eligibility process in our state’s program history, which includes more frequent wage checks, because we want only those who are eligible to have Medicaid coverage,” Edwards spokeswoman Christina Stephens said.
“Medicaid expansion is saving lives and making people healthier in Louisiana,” she said. “And we’re doing more than the state ever has to protect taxpayer dollars from fraud, waste and abuse.”
Sen. Sherrod Brown, D-Ohio, peppered Purpera with questions about the broader health outcomes expansion has had on the state, quizzing him on whether Louisiana’s uninsured rate has dropped and mammograms have gone up. Both are true, but Purpera said he didn’t know because he had not audited those figures.
Cassidy argued that ineligible people on the rolls can weaken the program and that it’s an issue beyond numbers relating to health outcomes.
“No one is debating Medicaid expansion — no one is debating whether Louisiana has these outcomes,” he said. “It’s not about that. It’s about how do we make sure hard working taxpayers are supporting those who need support but not otherwise being defrauded.”
He said there are an “an incredible number of people” receiving taxpayer-funded benefits who shouldn’t be getting them.