Gov. John Bel Edwards has yet to lay out his vision for how to connect Medicaid recipients with jobs; those details are being worked on by an outside consultant. But in a letter to The Advocate, Louisiana Health Secretary Rebekah Gee suggests it won’t be the punitive approach favored by state Sen. Sharon Hewitt and other legislators. Gee notes that the vast majority of “nonworking” Medicaid recipients have a good reason for not being employed.

Studies consistently find these “nonworking” Medicaid recipients are either disabled or too ill to work (36 percent), homemakers, family caregivers (30 percent), or in school (15 percent). The same studies indicate that less than 10 percent of these citizens are eligible for work but unable to find it. It is this group that we want in the workplace and will seek changes to ensure they are connected to work opportunities that help them rise out of poverty. On this, Hewitt and our administration agree. We want all Louisianans to have the opportunity to advance themselves and their families’ well-being through the dignity of work. We intend to fashion a Louisiana-specific Medicaid work-engagement program to do just that. We are now developing a plan to require smart community engagement, focused on reasonable ways to incentivize and support work, volunteering or self-improvement through education or skill building.

The doomsday budget
The 2018-19 state budget plan from Gov. John Bel Edwards, released Monday, contains few surprises. The budget had to account for more than $1 billion in temporary taxes that expire in July, which meant deep cuts to state hospitals, nursing homes, home care services for people with disabilities and a near-total evisceration of the popular TOPS scholarship program. The total state budget – once federal matching funds are included, would drop by $2.8 billion from current-year levels. As always, the AP’s Melinda Deslatte was there:

The state’s child welfare agency, veterans affairs department, coastal protection agency, highway department and Louisiana National Guard would be shielded from cuts. The K-12 public school financing formula also would be protected. But higher education and health programs would be on the chopping block because they have the fewest protected financing sources. About two-thirds of the $1 billion cut — $660 million — would hit health services, ballooning to $2.3 billion with lost federal and other matching cash. Steep reductions would fall on safety-net hospitals and clinics for the poor and programs that help thousands of elderly and disabled people. TOPS, which cost about $291 million this school year, would lose $233 million of its financing for the next academic year. College campuses would take an additional $26 million reduction, and the Go Grants program that provides needs-based funding for students would be cut in half.

Hospitals off the fiscal cliff
With apologies to college students who could lose their college scholarships, the biggest cuts in the governor’s budget would fall on health care providers and their patients. Adult day health and home health waivers for the elderly and people with disabilities, nursing home residents, mental health programs and substance abuse treatment programs would see major cuts. So would the public-private hospital partnerships, which replaced the old charity system. Julia O’Donoghue of Nola.com/The Times-Picayune has more:

Governor Edwards has proposed eliminating $189 million worth of state funding for the private operators that run those hospitals. The reduction would result in a total loss of $769 million because federal money and other revenue generated by the hospitals themselves would have to be eliminated as well. A cut of that magnitude could cause these hospitals around the state to close, especially if the private organizations that partner with the state to run the hospitals decide to walk away from the institutions. “I don’t know that we would have a single partner left” to oversee the hospitals, said Edwards if the health care cuts were adopted. … The hospitals’ contracts for faculty at the LSU Health Sciences Center, one of the state’s public medical schools, in New Orleans and Tulane University School of Medicine would likely be slashed. “If those payments to the hospitals are cut significantly, those would be some of the services that will be affected,” said Paul Salles, president and and chief executive officer of the Louisiana Hospital Association, in an interview last week.

Shutdown ends with a mixed bag
The deal that ended the shutdown and keeps the federal government operating through Feb. 8 also reauthorized the Children’s Health Insurance Program for six years, ending months of uncertainty for a program that serves more than 120,000 Louisiana children. Still to be decided is the fate of 800,000 immigrants who were brought to this country as children by their parents. Over at Vox.com, Andrew Prokop, Dara Lind and Sarah Cliff have the winners and losers:

Yes, this is the third time that Democrats have insisted that DACA recipients’ fate be addressed as part of a must-pass bill, and then reneged. Perhaps most worrisomely, many Republicans who had spent the last several months claiming that of course they wanted to find a solution to help DREAMers — including President Trump and McConnell — spent the shutdown weekend escalating their rhetoric, attacking Democrats for trying to protect “illegal immigrants.” Some Democrats are convinced the public promises from Mitch McConnell will give them leverage when the next funding deadline comes up on February 8. We don’t yet know how that will play out.

Number of the Day

$5.8 billion– Amount of money in tips that workers would lose under a proposed U.S. Department of Labor rule that would allow restaurants to pocket their workers’ tips as long as they pay at least a minimum wage. (Source: Economic Policy Institute)