Louisiana is expanding Medicaid with the new eligibility date starting on July 1st. The Times Picayune reports that Louisiana is using its SNAP (food stamp) database as a means of identifying individuals who are Expansion eligible and then automatically signing them up.
Department of Health and Hospitals officials are “highly confident” they’ll receive federal approval to use data from food stamp applications to qualify people for Medicaid, the first state in the country to use such a method through what’s known as a state plan amendment….
Kennedy said DHH is preparing to send out about 100,000 letters to people that the agency has determined are eligible for Medicaid but aren’t among the state’s 1.4 million enrollees. All the recipients will have to do is respond to the letter, Kennedy said, and they’ll be added to the program….
DHH officials had previously said they would use a “fast track” approach to Medicaid expansion enrollment, but the food stamp enrollment is particularly significant because the federal government had never before approved using food stamp data to qualify Medicaid recipients.
I think this is interesting from a few angles.
First it is an example of a government that wants to do well by maximizing the data that it already holds. The state of Louisiana in a variety of data sources that it owns already has an excellent idea of who is eligible for Medicaid based on income and who is not. The challenge has always been integrating those data sources into a coherent information stream. Using the SNAP database is an excellent starting point.
Secondly, it makes sense that Louisiana is doing this for an expansion roll-out. All else being equal, an individual who otherwise would not have signed up for Medicaid Expansion without being automatically enrolled will be healthier and less expensive once they are signed up via the letter than people who actively sought out enrollment into Medicaid. The active seekers are more worried about their health care costs because they know themselves to have a good reason to worry about paying for health care services. This will lower the average cost on a capitated basis.
The most interesting angle to me is how does this outreach change the Medicaid cost savings for Louisiana. The woodworkers have a FY2017 62/38 Federal/state split on their costs. The Expansion eligible individuals have a CY2016 100/0 split on their costs. A large rush of legacy woodworkers will eat up most of the cost savings gained through lower charity care appropriations, and shifting of voluntary Legacy Medicaid qualified individuals to Expansion eligibility groups.
This is a good problem to have, as more people covered with the Feds picking up most of the tab is a good thing in and of itself. However the problem is Louisiana has a balanced budget constraint and a large structural deficit. Medicaid expansion is taking a decent chunk out of the structural deficit caused by Jindal’s decision to destroy Louisiana to boost his Presidential chances but a 100% Medicaid Eligibility uptake rate would take away most of the savings.
rikyrah
Elections have consequences.
Happy for my fellow citizens that now will have access to healthcare.
Punchy
Losey’anah is flat broke. Not sure if thats relevent here, but “expanded” anything in a state soon to be about a billion in hock would seem tricky, politically.
Roger Moore
@Punchy:
It’s a lot easier when A) somebody else is picking up the tab and B) some of the people going into the new program were already costing you money through other programs. Medicaid expansion is paid for primarily by the federal government (I think it will be 100% this year and 90% in the future), and a lot of the people who will be covered were previously receiving care that was paid for by the state. Moving those people onto a federally funded program will help the state budget, which is a big reason they’re doing it. A lot of the red states that have accepted Medicaid expansion did so because it helped their budget problems.
SarahT
@rikyrah: “Elections have consequences” – yes indeed.
SarahT
@Roger Moore: “A lot of the red states that have accepted Medicaid expansion did so because it helped their budget problems.” – yup. And whatever thereasoning behind a state accepting expansion, the end result is a win for its citizens.
Richard Mayhew
@Roger Moore: Exactly — Medicaid expansion helps state budgets in a couple of ways:
a) 2016 it is 100% free from state POV
b) Going forward it is never more than 10% of the costs
c) States can move quite a few people who qualify for Legacy Medicaid to Expansion medicaid thus switching the state share from 30% to 50% to anywhere from 0% to 10%.
d) Charity care/uncompensated care costs should go down
Those are the easy to model/easy to prove cost reductions…
Now if Medicaid expansion leads to slightly better population health then long term costs go down but that is iffy
NotMax
Assumes facts not in evidence.
Potentially healthier and less expensive, yes.
Richard Mayhew
@NotMax: Take a look at the the health cost profiles of people who signed up for Exchanges in October/November 2013 versus those who signed up in March 2014 — early/motivated enrollees are almost always more expensive than the last/most marginal enrollee
chopper
@efgoldman:
and not only is math hard, doing it makes you look like a terrorist.
liberal
This first part of your sentence is that part that so many right-wing thugs have a problem with.
Gelfling 545
@efgoldman: Which, as we know, is only done by terrorists using foreign letters & symbols.
Annamal
@Richard Mayhew: Even if the population stays at the same health level, there’s an added bonus in people with an increased safety net being willing to take more risks with their employment (i.e. leave a stable job with health care benefits to start their own business or work at someone else’s new business). A healthy economy needs people to be willing to take risks and people are more willing to do that if they won’t lose everything
Richard Mayhew
@Annamal: yep… Plus a good argument that insurance lowers stress and decision overload which leads to slightly better mental health
J R in WV
@Richard Mayhew:
A couple of remarks I want to make, long after the thread is dead. Some years ago Mrs J arrived at the ER and was admitted for septic shock/pneumonia. I made it just in time, and she spent the next 3 weeks on a vent in ICU. And very fortunately we live near a city with a teaching hospital, even better, our family practice Dr graduated there, his office is across the driveway.
Doctor Bill told me after a day or so that the odds were about 60% – against her. So that was a little stressful. Also, I realized that the cost could be – well – high. I asked for advice from a social worker, who quizzed me very gently for a few minutes, and then said she believed that Medicare and supplemental would cover the vast majority.
In the end, Mrs J spent 59 days in the hospital, had lung surgery for a necrotic lobe, chest tubes still when they sent her home. I got a major refresher course in sucking chest wounds in case a tube got pulled out, home health care daily. The home health care RNs had never seen a patient sent home with chest tubes, and I showed them the daily maintenance routine. They helped a lot, otherwise.
The cost to us in $$ was pretty much zilch. The stress on me was amazing. She recovered completely, and we’re enjoying our retirement as planned, so far. Health care, in a nation as rich as ours, should be a right for everyone. If you get cancer, you should be covered. Anything goes wrong, covered.
If all that can be done is hospice, that should be covered. And everyone should know they are all covered from the get-go, with no chance that a Republican administration will screw that up for anyone. The Republicans should be aware that Social Security and pensions and medical care is something that we have all earned by the sweat of our ancestors, our parents, ourselves. If they mess it up, they will pay for that.
Also: Richard, what the heck are the woodworkers you are talking about in the meat of your post? All of a sudden there are woodworkers, and I don’t get it.
Thanks for all you do sharing your expertise and insight with us!!