Medicaid expansion in Louisiana may come with challenges

Louisiana saw 200,000 new Medicaid enrollees during its first week of enrollment, and expects that number to only rise. Yet an increase in enrollees will not come without challenges once Medicaid expansion begins in July, The Advocate reported.

Gov. John Bel Edwards (D) signed an executive order expanding Medicaid under the Affordable Care Act in January, expanding coverage to 298,000 uninsured adults, as well as to 224,000 with private insurance. Under the expansion, adults with salaries 138 percent below the federal poverty line, or $33,500 annual income for a family of four and $16,200 annual income for single adults, gained eligibility, according to The Advocate.

But some predict adding so many people to no-cost health insurance instead of using the state's "charity" hospital system — established in the 1930s to offer care to people who can not afford it — could present challenges.

Under the state's charity hospital system, poor individuals are encouraged to receive care from hospitals rather than primary care centers. Under Medicaid expansion, the goal is to push patients toward primary care providers rather than hospitals, The Advocate reported. This may challenge the charity hospitals and their private partners, both of which are currently feuding over state funding.

In addition, the Medicaid expansion plan is partially funded with money scaled back from federal Disproportionate Share Hospital payments that funded hospitals serving a large number of Medicaid and uninsured patients. Hospitals depending on these funds could face uncertain futures, The Advocate reported. Additionally, some wonder how adding more Medicaid participants to a system that has struggled to garner provider support will play out.

Benefits under the new expansion are slated to begin July 1, with enrollment continuing throughout the year.

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