Medicaid was created in 1965 as an entitlement program to help states provide medical coverage for low-income families and other categorically related individuals who meet eligibility requirements. Candidates include the blind, aged, disabled, and pregnant women. In essence, Medicaid serves as the nation’s primary source of health insurance coverage for low-income populations. Each state administers its own Medicaid program, establishes their own eligibility standards, determines the scope and types of services they will cover, and sets the rate of payment. The federal organization Centers for Medicare and Medicaid Services (CMS) monitors the state-run programs and establishes requirements for service delivery, quality, funding, and eligibility standards.
Beginning in the 1990s, many states transitioned their programs from “fee-for-service” to managed care programs. Under managed care, Medicaid recipients are enrolled in a private health plan, which receives a fixed monthly premium from the state. The health plan is then responsible for providing for all or most of the recipient's healthcare needs.
Medicaid in Louisiana
Approximately 1.3 million Louisiana citizens are enrolled in the Medicaid program. The state spends on average around $8 billion a year on the program. Like many other states, Louisiana has transitioned a large portion of the program from a “fee-for-service” program into a managed care program now called Bayou Health which is operated by five different health plans.
The Medicaid program poses many challenges for physicians. The most glaring issue is the problem of decreasing reimbursement levels, which are already, in many instances, below cost. This issue has been amplified with the transition into managed care, as the administrative overhead and burden has increased heavily, while reimbursement rates continue to decline. The LSMS continues to advocate for the following with regard to the Medicaid program:
- Providing access to quality and robust care to Medicaid recipients.
- Providing reasonable and timely payments to physicians providing Medicaid services.
- Advocating for funding sources, which are dedicated and stable, thereby allowing the program to remain fiscally sound and sustainable even in the face of budget deficits.
- Empowering Medicaid recipients to own their own healthcare and make decisions about their healthcare needs by utilizing co-payments and deductibles, which are commensurate with what is allowed under federal and state law.
- Encourages privatization based on the principles contained in the LSMS Access to Better Care plan, which calls for the following choices for patients: traditional insurance plans, managed care plans (HMO, PPO, etc.), benefit payment schedule plans, and purchasing pools to enable individuals to achieve group rate premiums.
- Ensuring the program does not discriminate against any physician specialty.
- Complete financial transparency so that it can be easily determined if taxpayer dollars are being used in a manner that maximizes access to quality and robust care.
The LSMS has and will continue to be the premier advocate for physicians who are struggling to maintain a Medicaid practice. We stand ready to assist our members in resolving issues they may have with the legacy Medicaid program or the Bayou Health plans. We also continue to advocate for common sense solutions, which make the program easier for our physician members to do what they were trained to do, i.e. care for patients and not spend time and energy tied up in the red tape of dealing with health plans.
For more information about Bayou Health please click here to visit the Department of Health and Hospital’s Medicaid Website
or click here
for additional provider resources.