HJNO Nov/Dec 2023

HEALTHCARE JOURNAL OF NEW ORLEANS I  NOV / DEC 2023 13 Editor Why are Louisiana’s maternal mor- tality and infant mortality rates so high? Secretary Russo That is something we’re really researching right now. Number one, I think it’s a shortage of OBGYNs overall throughout the state. I think it’s a shortage of those specialists in the rural communi- ties. Since the rates are as low as they are, those folks in the rural community have trouble getting the prenatal care that they should be getting. I also think it is an issue of postpartum care as well when you’re deal- ing with infant mortality. We’re also looking at it just from a health equity lens in trying to understand the fact, which is very alarm- ing to us, that if you’reAfricanAmerican and you go into the same hospital as a White woman, you have worse outcomes if you’re anAfricanAmerican lady. And there’s really no explanation for it of which I’m aware of, yet. That is something we definitely need to get to the bottom of, but I think it’s a com- bination of those factors — low rates, the lack of access of mothers to specialists in rural communities, and then that postpar- tum care as well. Editor Explain federal matching for Medic- aid. Are poorer states, like Louisiana, at a disadvantage the way they are with Medi- care? In poorer areas of the country, and parts of Louisiana, Medicare payments from the federal government are lower than they are in richer states because of the Medicare hospital area wage index (AWI). COVID laid this inequality bare as rural hospitals and poorer states found it difficult to recruit on a national basis. Doesn’t that seem almost upside down — poor states with the worst health out- comes are getting paid less from the fed- eral government per procedure than richer states with better health outcomes? Secretary Russo Medicare is a federal health insurance program for those 65 or older. It is not administered by states, so we cannot speak on Medicare payments. Medicaid is a joint federal and state program that helps cover medical costs for those under 65 with limited income resources. The Louisiana Department of Health administers the Medicaid program for Louisiana. In the last year, Medicaid implemented the directed payment model and reimbursement to hospitals increased by $2.1 billion. The new payment model increases hospital payments and prioritizes maintaining adequate funding for safety-net hospitals across Louisiana, without requir- ing additional state general funds. Addition- ally, the model creates more uniform guide- lines and stability for hospital payments. When you’re talking about Medicaid, FMAP, which is Federal MedicaidAssistance Percentage, is really determined on a per capita income basis. I think the lowest fed- eral percentage you can get is 50%, and the highest you can get is about 85%. An issue we experienced during Hurricane Katrina, post-Katrina, since we had a lot of federal money coming in and a lot of rebuilding that we needed to do, our per capita income was really high. That led potentially to a decrease in our federal matching percentage — kind of counterintuitive that all of a sudden, we get hit with a hurricane and have some destruction, you would think that our fed- eral percentage should have gone up dur- ing that case. It did have the effect of reduc- ing it until we got some federal relief, and we got what we called Emergency FMAP. That’s something that lags. Our Fiscal Year ‘24 federal percentage is based on our per capita income from 2019 to 2021. You always see this lag. What we’re getting paid for by the federal government, percentagewise, is really based upon factors that happened two to three years ago. Editor So, why would a poor state get paid less for the same procedures from the fed- eral government than a wealthier state? Secretary Russo Well, they shouldn’t from a Medicaid standpoint. Medicare rates, I think, are standardized state to state. I think where the issue comes into play, is when you’re dealing with Medicaid and you’re dealing with those Federal Medical Assis- tance Percentages because the state is set- ting the reimbursement rates. Under Med- icaid, we are the entity that sets the rates. “The public deserves to know what their drinking water looks like and whether it's safe to drink. We are concerned about what the effects higher chloride levels in the long-term may do to water treatment plants. It's going to take testing. It's going to take monitoring, which the department is well prepared to do — testing not only for lead and corrosion, but for other heavy metals.”