By A.J. Custer
Starting July 1st, low-income adults in Louisiana will gain health insurance benefits, as the state officially becomes the 31st state to expand Medicaid. Enrollment has already begun and the Louisiana Department of Health and Hospitals predicts an estimated 375,000 people will enroll in Louisiana’s Medicaid program over the next year. The program has been renamed Healthy Louisiana. The new name is intended to reflect the Medicaid program’s goal of improving outcomes among all Louisianans, a top priority for Governor John Bel Edwards.
As required by the Affordable Care Act (ACA), individuals are able to apply online or over the phone. And there will also be locations, including hospitals, where people can get assistance with an application. State residents who meet citizenship and immigration status requirements will qualify for Medicaid expansion if their household income is below 138 percent of the federal poverty level. That means income up to $16,243 for a single person; or $33,4654 a family of four.
A concern about the Medicaid expansion is whether there is an adequate health services infrastructure and sufficient supply of health professionals to support the expansion. But thanks to Hurricane Katrina, Louisiana could potentially have one of the smoothest rollouts yet. Post Hurricane Katrina, New Orleans, in particular, had a crippled healthcare system. Access to health in the city was bolstered by federal grants to cover the cost of the health care for the working poor, who were displaced by the horrific storm. The programs they relied on now serve as models for expanding access to health care through Medicaid.
Before Hurricane Katrina, poor uninsured adults in the greater New Orleans area who lacked coverage and could not afford health care had only one choice for care; the emergency room at Charity Hospital. And this was only because federal law provides everyone minimally with access to an emergency room.
Responding to the devastation of Hurricane Katrina and its impact on the health care system in Louisiana, in 2007 Congress approved a $100 million “primary care access stabilization grant “ meant to propel the shattered medical field. This grant created the Greater New Orleans Community Health Connection (GNOCHC) and gave those who were low income and lacked insurance coverage greater access to healthcare facilities, instead of relying solely on the emergency room.
While GNOCHC was a great first step for Louisiana’s healthcare system, it did not provide access to comprehensive services. The program covered access to primary care providers, some specialty care and lab work, but excluded coverage for hospitalization, screenings and medications.
GNOHC enrollees will automatically be enrolled in Medicaid if they have a working address, leaving some advocates concerned about those who are homeless. Meanwhile the state is working on innovative strategies to enroll other eligible individuals. Louisiana became the first state to receive federal approval to permanently implement a policy that links Medicaid eligibility to the Supplemental Nutrition Assistance (SNAP). The SNAP targeted strategy allows the state to fast-track the enrollment in Medicaid of poor and near poor individuals receiving food assistance.
This strategy – considered a heavy policy lift by many health policy experts given the tight implementation timeline- was led by Ruth Kennedy, a seasoned Medicaid official. Kennedy is well known for her tenacity and dedication to promoting the enrollment and retention of children in Medicaid and LaCHip (the state’s children’s health insurance program) by streamlining application and renewal procedures, promoting agency culture change, and engaging community partners in outreach and enrollment efforts. Those approaches will bode well for the state as it embraces the Medicaid expansion and deals with the influx of new enrollees.