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Louisiana and the ACA’s Medicaid expansion

Medicaid expansion means nearly 461,000 more adults have health insurance in Louisiana

Medicaid expansion in Louisiana

On January 12, 2016, newly inaugurated Governor John Bel Edwards signed his first executive order to start the process of Medicaid expansion in Louisiana. Edwards took office the day before, and had promised that Medicaid expansion would be one of his first actions as governor.

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Prior to June 1, 2016, Medicaid eligibility for adults in Louisiana was unchanged from 2013, and childless adults were ineligible for coverage, regardless of how low their incomes were. That created a coverage gap, since people with income below the poverty level cannot obtain subsidies in the exchange, so they had no realistic access to health coverage until Medicaid was expanded.

New Medicaid eligibility and enrollment system launched in November 2018

In November 2018, Louisiana rolled out a new Medicaid eligibility and enrollment that allows for real-time eligibility determinations using data from state and federal systems, instead of relying on manual eligibility determinations. And enrollees will no longer receive phone calls from Louisiana Medicaid when their coverage is up for renewal; notices and requests for additional information will be sent by mail instead, and enrollees will need to provide updated information in a timely manner in order to avoid termination of their coverage.

However, in August 2019, the state temporarily suspended the program that would terminate Medicaid coverage for people who don’t respond to requests for updated information (the suspension is applicable to people whose Medicaid renewed in July or August 2019). Dr. Rebekah Gee, Louisiana Department of Health & Human Services Secretary, had explained in 2018 that the transition from the old system to the new system “is like upgrading from an old flip-style cellphone to a modern smartphone. The new system better ensures eligibility by connecting with state and federal databases to automatically provide more information about income, disability, citizenship status, and other eligibility requirements.” Gee had cautioned, however, that there could be some hiccups with the transition to the new system, and asked for patience as everyone learns their way around it.

Lawmakers considered a Medicaid work requirement in 2018, but legislation didn’t pass

In early 2018, Louisiana Governor, John Bel Edwards had said that his administration was “actively working” on ideas for implementing a “reasonable” work requirement for the state’s Medicaid program. Bel Edwards, a Democrat, was the prime mover in the state’s expansion of Medicaid in 2016.

In 2017, Louisiana enacted S.R.163, which requires the Louisiana Department of Health to provide monthly data to lawmakers on a variety of Medicaid-related metrics, including the total number of Medicaid expansion enrollees and the number of Medicaid expansion enrollees who have earned income.

According to H.B.3, which was introduced in early 2018, the state had reported that as of December 2017, enrollment in Medicaid expansion stood at 453,000 people, and “fewer than 284,000” of those individuals had earned income (even before S.R.163 was enacted, the Louisiana Department of Health had been providing detailed, up-to-date reports about Medicaid expansion enrollment, which are available to the public but do not include data about income or the work status of enrollees).

The Louisiana House passed H.B.3 in March 2018, but the bill did not advance in the Senate. It called for a Medicaid work requirement, but had been amended to ensure that people wouldn’t lose access to Medicaid if they didn’t comply with the work requirement.

S.B.77, which was introduced in the Senate in 2018 but did not progress to a vote, would have directed the state to seek a waiver from CMS, by January 2019, in order to implement a work requirement for Louisiana Medicaid expansion. The work requirement would have applied to people ages 19 to 64, but would have exempted pregnant women and people with disabilities, along with other populations that would have been detailed in the waiver proposal.

H.B.46, which was introduced in the House in 2018 but did not progress to a vote, would also have directed the state to seek a waiver from CMS in order to implement a work requirement for non-disabled adults age 19 to 64 who are enrolled in Medicaid and not caring for a child under the age of one year. Enrollees would have had to work, volunteer, or participate in other suitable community engagement activities for at least 20 hours per week in order to maintain Medicaid coverage. Exemptions would have been available for various populations, including pregnant women, people with disabilities, and people enrolled in substance abuse treatment.

By 2019, Governor Edwards had backed off from supporting a Medicaid work requirement, and his administration was instead supporting a pilot program that provides job training to some Medicaid expansion enrollees.

Louisiana enacted legislation in 2018 to create a workforce training program

H.B.735, which passed 97-1 in the House and 32-0 in the Senate, was signed into law in May and took effect in August 2018. The law directs the state to create a workforce training and education pilot program for “improving employment opportunities and promoting workforce advancement” among people receiving public assistance, including Medicaid. Enrollment in the pilot program is voluntary. Enrollees will receive assistance with job training, job referral, career planning, apprenticeships and other job skills development.

SNAP data used for auto-enrollment

About 105,000 of the newly-eligible individuals were expected to be auto-enrolled under a program the state used to identify eligible residents based on their participation in SNAP (Supplemental Nutrition Assistance Program, often referred to as food stamps).

Several states have used similar auto-enrollment programs for Medicaid enrollment, but only for initial enrollment. Louisiana is the first state in the nation to gain HHS approval to use SNAP enrollment to automate the initial Medicaid enrollment process as well as the annual renewal.

The long path to Medicaid expansion

On November 21, 2015, Democrat John Bel Edwards won the runoff gubernatorial election in Louisiana. Edwards supported Medicaid expansion as called for in the ACA, and his win immediately made Medicaid expansion much more likely in Louisiana.

Former Governor Bobby Jindal was emphatically opposed to Medicaid expansion, but was not eligible to run in the 2015 gubernatorial race due to term limits. There was a primary election in October 2015, but none of the four candidates received a majority of the vote. So a runoff election was scheduled for November 21, 2015, with voters deciding between the two candidates who garnered the most votes in the first election (Democratic Minority leader of the Louisiana House of Representatives, John Bel Edwards; and Republican Senator David Vitter).

All four of the primary candidates had previously expressed at least some degree of willingness to accept federal funds to expand Medicaid, although all but Edwards had called for using a section 1115 waiver to craft Medicaid expansion in a state-specific way. Edwards’ support for Medicaid expansion was unequivocal.

In addition, lawmakers in Louisiana passed House Concurrent Resolution 75 in June 2015, which helped pave the way for the expansion of Medicaid. HCR75 allowed hospitals to implement a fee that would generate the revenue needed to pay the state’s portion of the cost of expanding Medicaid (the federal government will always pay 90 percent of the cost, but by 2020, states will be responsible for 10 percent of the cost of covering the expansion population; hospitals tend to support Medicaid expansion, as they face dire budget cuts in states that haven’t expanded coverage). HCR75 gave Edwards until April 1, 2016 to propose a plan to expand Medicaid, but he wasted no time in issuing the Medicaid expansion executive order the day after taking office.

Louisiana HHS Director pushes to keep Medicaid expansion

On January 5, 2016, Edwards named Dr. Rebekah Gee to be the director of Louisiana’s Department of Health and Hospitals, which is the agency that oversees the state’s Medicaid program. Edwards has said that Medicaid expansion would be one of Gee’s primary tasks, and Gee noted that the state would need to hire almost 250 people to process enrollments and manage the expansion of Medicaid.

Gee also said that Edwards’ administration would focus on working with doctors to ensure that there’s an adequate network of providers who are willing to work with the influx of new Medicaid patients gaining coverage under Healthy Louisiana.

Gee noted that in addition to the state’s portion of the cost of coverage for the newly eligible population, the state also has to pay 25 percent of the cost of hiring the 248 new state employees to handle the additional volume in the Medicaid program. The federal government will pay 75 percent of that cost, but the state’s portion was expected to be $2 million. Gee said that she’s aware of “the budget problems that we’re inheriting,” calling them “humbling” but noting that the new administration has plans to deal with the budget issues.

Who is eligible for Medicaid in Louisiana?

As of October 2020, income eligibility limits for Louisiana Medicaid are:

  • Children ages 0-18: 212 percent of the federal poverty level (FPL); children with family income between 212 percent and 250 percent of FPL are eligible for the Louisiana Children’s Health Insurance Program (LaCHIP)
  • Adults: 138 percent of the federal poverty level.

Individuals who receive Supplemental Security Income (SSI) — who are elderly, blind or disabled — or who meet certain other guidelines can also qualify for Medicaid.

How does Medicaid provide assistance to Medicare beneficiaries in Louisiana?

Many people with Medicare receive help through Medicaid with Medicare premium costs, prescription drug expenses, and expenses that Medicare doesn’t cover — such as long-term care.

Our guide to financial resources for Medicare enrollees in Louisiana provides an overview of those programs, including Medicare Savings Programs, nursing home benefits, and income guidelines for assistance.

How do enroll in Medicaid in Louisiana?

There are several options for applying for Medicaid if you are under 65 (and don’t have Medicare).

If you are 65 or older or have Medicare, use this website or call 888-342-6207 to apply for Medicaid.

Louisiana Medicaid enrollment numbers

In June 1, 2016, state residents with incomes up to 138 percent of the federal poverty level became eligible to start enrolling in expanded Medicaid in Louisiana, with coverage effective July 1, 2016. State projections were that about 375,000 people would enroll in expanded Medicaid. As of September 2016, more than 305,000 Louisiana adults had already gained coverage under the expanded eligibility guidelines.

As of June 2019, nearly 461,000 adults were enrolled in Louisiana Medicaid under the ACA expanded eligibility guidelines.

As of July 2020, total Medicaid and Children Health Insurance Program (CHIP) enrollment in Louisiana was 1,607,959.

The cost of delaying Medicaid expansion

Because Louisiana didn’t expand Medicaid in 2014 and 2015, Governor Edwards’ administration said that the state missed out on up to $3 billion in federal funding prior to their acceptance of Medicaid expansion in 2016.

The Kaiser Family Foundation estimates that 364,000 low-income adults became eligible for Medicaid under expansion (although the state pegged the number closer to 375,000, and more than 471,000 had enrolled by April 2018). Kaiser also estimates that the previous decision against expansion left 242,000 Louisiana residents in the coverage gap from the beginning of 2014 until mid-2016. Individuals in the coverage gap have income too high to qualify for Medicaid (before it was expanded), but below 100 percent of FPL and therefore they are not eligible for premium subsidies to help them buy private coverage through the health insurance marketplace.

An Urban Institute study found that the state would spend $1.2 billion over 10 years on expansion. Yet over the same period, if Louisiana had continued to reject Medicaid expansion, the state would have lost out on $15.8 billion in federal Medicaid funding and $8 billion in hospital reimbursements. The financial struggles faced by multiple Louisiana hospitals, including the closure of the Baton Rouge General Medical Center emergency room, are attributed at least in part to the state’s previous decision against Medicaid expansion.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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Apply for Medicaid in Louisiana

You can apply at the Louisiana Medicaid Online Application Center. Apply by phone at 1-888-342-6207. Apply in person at a Medicaid application center, or fill out a paper application.

Eligibility: Children ages 0-18 with household income up to 212% of FPL; kids with family income between 212-250% of FPL are eligible for the Louisiana Children’s Health Insurance Program. Pregnant women with household income up to 138% of FPL. Parents with dependent children with household income up to 19% of FPL. Visit for those who receive SSI or who are elderly, blind or disabled.

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