|Bayou Health (Medicaid) Reform|
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:
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.
The LSMS is one of the provider community representatives at the Louisiana Department of Health and Hospital Bayou Health Quality Committee and Medicaid Administrative Simplification Committee. Both committees provide an opportunity to work collaboratively with DHH to reduce red tape or barriers to care. If you have an issue you would like brought before the committee please contact Sabrina Noah by email or phone at 225-763-8500.