HJNO Nov/Dec 2023

DIALOGUE 14 NOV / DEC 2023 I  HEALTHCARE JOURNAL OF NEW ORLEANS Then of course, the federal government par- ticipates in paying us back for a portion of those rates that we set, and that’s based on per capita income. So, poor states should be getting higher FMAP, up to a maximum of 83%. Those states that have a higher per capita income for Medicaid, they could be getting as low as 50 to 55%. Editor Medicaid is more balanced, it sounds, than Medicare. The hospitals in rural areas, or the areas that have a lower wage index are getting lower reimburse- ments than a hospital in Boston would get for the same procedure because of the Medicare hospital area wage index (AWI). Secretary Russo Yeah, Medicaid’s pretty bal- anced, and really based upon what the state, with their state’s matching percentage, how high we can get the rates up, based upon state dollars we have. So, the federal gov- ernment’s contribution, for lack of a better word, is higher for states that have a lower per capita income. Really, the only limiting factor to the rates Medicaid can pay is more or less how much a state can match. Editor Any other thoughts on Medicaid? Secretary Russo Yes, what folks don’t seem to grasp when the governor expanded Med- icaid, is that we were paying for those folks anyway. What was happening is those folks weren’t getting preventative healthcare, so once they got sick enough to where they had to present at a hospital emergency room, or a hospital, those costs, would roll into what we call, “uncompensated care costs.”So, we ended up paying for that anyway when the person got sick enough, but at a much lower federal match rate than what we get if the person is on expansion for Medicaid, which is right now 90/10 match. I think that is something that might be lost upon the general public. Medicaid expansion, without question, has saved us money and has led to healthier people, which is really our goal. When you put the money aside … we have a duty to the public to make sure we spend our money wisely, and that’s something that stays top of mind. But our primary mission is to increase the healthcare of folks in Louisiana. That’s the primary mission. I don’t think anybody can question that expansion accomplished that. Editor There was a recent Medicaid unwind, where people were dropped from the roles after the COVID emergency. How has that impacted Louisianians and their providers? Secretary Russo That is something we are unbelievably focused on and will be, prob- ably, for about the next nine months. What we’re seeing right now is around 50,000 to 55,000 being dropped off of our Medic- aid rolls. What I’ve testified to many times is that we want to see folks who meet the Medicaid eligibility criteria remain on the roll. Because they get preventative health- care and are overall healthier folks who then can contribute in many ways to Louisiana and also just enjoy a much better quality of life. Now, what we have seen though, is since most of those have been procedural denials, and what I mean by that, is for a vast major- ity of the folks that we are having to redeter- mine eligibility, we are sending out pre-pop- ulated packets, and those folks just have not gotten back to us. Those are the folks that have been dropping off of our rolls. We are starting to see what we call “churn.” Ten to 14,000 each month are coming back onto the rolls. That’s encour- aging to see. Our biggest deal right now is working with the provider community to make sure that when they see their recipi- ents, when they come in, they’re encourag- ing them to make sure they keep their Med- icaid information up to date, to be on the lookout for a Medicaid packet so that we can redetermine their eligibility in Medic- aid. Since it hasn’t happened since the pan- demic, what we’re fearful of and concerned about is that folks just may not understand that we’re supposed to redetermine you for Medicaid yearly. So, we’re concerned that they may be getting this packet and may not think they need to do anything with it despite the massive outreach that we’ve had. We are very concerned that there may be folks that technically qualify for Medic- aid that have just not basically updated the information and/or responded to the pack- ets that we sent out. Editor So, if I’m a primary care physi- cian that handles Medicaid patients, and somebody comes to me needing care, and they’ve been dropped or they haven’t filled that package out, what does that provider do at that point? Secretary Russo Providers should know, if somebody who has been a Medicaid person and is a long-term recipient of that provider, and all of a sudden, they scan that patient’s Medicaid card, lo and behold, it comes back that they’re “no longer eligible,” hopefully that provider would touch base with that member and say, “Hey, have you received a packet fromMedicaid? Did you keep Med- icaid up to date on where you live, so that they can contact you?”What I think is prob- ably happening, where that 10 to 14,000 churn is coming from, because once that provider scans the card and sees the per- son’s not eligible, that person is then con- tacting Medicaid and then getting back onto the rolls. We would rather see those folks proactively make sure that they update us with the information, respond to the mail that we send you so that you never drop off of those rolls. Editor You mentioned the department’s goal, obviously, is to increase the health of our citizens. And historically, Louisiana has ranked either last or second to last in the country regarding our citizens’ health. What is the solution? Secretary Russo Well, the solution to that is really a complex answer to a very simple question. We have a business plan, a living document that we’ve been developing and working with over the last three years. We set yearly, very ambitious goals. I’mproud to