Despite pushback from Louisiana House Republicans, Gov. John Bel Edwards’ administration isn’t making any changes to contract extensions sought for the companies that manage care for 1.5 million Medicaid patients.
The Department of Health is presenting the same contract terms to lawmakers for consideration Friday (Nov. 17) that already were rejected by House GOP lawmakers this month, said agency chief of staff Andrew Tuozzolo.
“They will be identical” to the extensions blocked on Nov. 3, he said.
The Edwards administration hopes more individual outreach to lawmakers and education about changes it’s already made to the deals will sway votes when the contracts are heard for a third time by the Joint Legislative Committee on the Budget, Tuozzolo said.
The proposal would keep the five managed-care companies in place for 23 months beyond their January contract expirations, extensions estimated to cost $15.4 billion in federal and state cash.
Republican and Democratic senators on the budget committee voted unanimously for the extensions two weeks ago. But House Republicans, led by Appropriations Chairman Cameron Henry, sought more work from the health department to squeeze savings out of deals that account for roughly one-quarter of the state’s operating budget annually. They also asked for responses to audits raising concerns about the managed-care companies’ performance.
Edwards, a Democrat, criticized the move as obstructionism.
Tuozzolo said Health Secretary Rebekah Gee, health department staff and the governor’s office have been speaking with lawmakers to answer questions about the contract terms for weeks. But he said the deals’ price tags are dictated by federal rules and the services that lawmakers agree to provide through the Medicaid program.
Supporters of the contract extensions say they include more accountability measures and link $250 million in managed-care payments to health quality metrics. The agency says it will use the 23-month extensions to do a more wide-ranging system redesign before seeking new managed-care contracts.
“At least we have a contract (that) now measures outcomes and will reward good outcomes and penalize bad outcomes,” said Senate Finance Chairman Eric LaFleur. “That is a way to drive down the overall cost of Medicaid.”
It wasn’t clear if the lobbying effort would change the minds of House Republican leaders. Henry and House Speaker Taylor Barras, who also voted against the contract extensions, didn’t return calls from The Associated Press to talk about the upcoming hearing.
At the time the deals were rejected, Henry said he expected another meeting on the proposals in December. But LaFleur, who currently serves as chairman of the joint budget panel, added them to Friday’s agenda.
“The answers and the clarifications that people are seeking are not going to change between now and next week and two weeks from now,” LaFleur said. He added: “Waiting a month only puts the department in a bigger bind if for some reason the members would not approve it.”
Former Gov. Bobby Jindal moved to the insurance-based model for much of the Medicaid program in 2012, shifting from a previous system of directly reimbursing doctors and hospitals with a fee paid for each service rendered to a Medicaid patient. The private companies coordinate services for 90 percent of Louisiana’s Medicaid recipients.
Health department officials don’t appear to have a backup plan for what would happen if the contracts aren’t renewed. The financial structure of the program and Louisiana’s agreements with the federal government were changed for the managed-care model, and health department officials say that couldn’t quickly be unraveled.
“There would be chaos,” Tuozzolo said.
– Melinda Deslatte, Associated Press