Louisiana’s Medicaid program has become a scapegoat for fiscal conservatives, who falsely blame the federal-state health care program for the state’s structural budget shortfall. In reality, state spending per enrollee is relatively low compared to other states and the Medicaid expansion is saving state general fund dollars. What’s more, in the current fiscal year, the state is projected to spend less than budgeted for Medicaid, freeing up funds for other priorities. The Associated Press has details:

The latest Medicaid forecast, released Tuesday shows the $12.5 billion program is expected to spend as much as $612 million less than estimated for the financial year that ends June 30. Most of that money would be unused federal spending authority, not dollars that can be allocated to other state programs. But the Louisiana Department of Health says $26 million would be a state general fund surplus that could be spent elsewhere, if the trend continues. More than $535 million of the less-than-projected spending is in the Medicaid expansion program that has added 446,000 adults to the government-financed insurance coverage.

The Advocate’s Elizabeth Crisp has updates from the Task Force on Coordination of Medicaid Fraud Detection & Prevention Initiatives. The panel, created to catch and correct compliance irregularities, may extend their work another year to set legislative and administrative goals.  

Jen Steele, the state Medicaid director who is also a member of the task force, noted that some of the panel’s recommended changes can’t be made because of federal regulations, medical guidelines and industry standards. She said LDH is in the process of enhancing its eligibility verification, but cautioned that some of the proposals from the task force could cost the program additional resources.

House GOP members have claimed that adding a work requirement to the state’s Medicaid program would somehow improve the state’s fiscal situation. Kaylee Poche and Ryan Noonan of LSU Manship News Service spoke with a state health department official and a legislator who don’t believe Medicaid work requirements would actually save state dollars:

“Of the 30 percent of those who aren’t working, only a small part of those folks are able-bodied and able to work,” [Louisiana Department of Health chief of staff, Andrew] Tuozzolo said in an interview. “Many of these people are students, disabled or family caretakers.” Tuozzolo added that the Medicaid work requirements probably would not save much money as the state tries to close a looming $1 billion budget shortfall. Long term savings for the state remain indefinite, he said. Louisiana legislators have also expressed similar concerns. “I’m skeptical that it’s going to be any real savings,” said Rep. Kirk Talbot, R-River Ridge. “I like the concept, and I believe in the concept, but I’m not counting on that being a lot of saving that we can point to right away.”

TOPS Task Force hot potato

The Legislature wrangled with various proposals intended to reduce spending on the popular TOPS scholarship program in 2017, but were ultimately unable to agree on any significant changes. Instead lawmakers did what they usually do when they can’t come to agreement: created a task force to study the issue.  After meeting for five months, the TOPS task force developed nine proposals to change the scholarship program, but at its final meeting on Wednesday, the chairman of the group, Sen. Blade Morrish, decided not to bring any of the proposals to a vote. Instead, the task force will forward all nine ideas to the Legislature for consideration by the full body. The Advocate’s Will Sentell has the story:

[Sen. Blade] Morrish, who is also chairman of the Senate Education Committee, is the author of the highly-controversial effort to convert the most common form of TOPS – called TOPS Opportunity – into a $4,000 per year stipend. The average tuition at four-year schools is $5,620, and LSU students get $7,462 from TOPS Opportunity in the current school year. …  One of the nine plans that sparked arguments would revamp the little-used TOPS Tech award. Under the plan, those students could qualify for TOPS Opportunity if he or she earned an associate degree with a GPA of at least 3.20, and quickly moved into a baccalaureate program. Students have to earn a 17 on the ACT – which measures college readiness – for TOPS Tech compared to at least a 20 for TOPS Opportunity.

ITEP debate continues
The head of the Baton Rouge Area Chamber comes out in defense of Louisiana’s unique Industrial Tax Exemption Program (ITEP), which gave, until recently, a 10-year break on property taxes to qualifying manufacturing industries. A 2016 executive order by Gov. John Bel Edwards reduced the break to a maximum of 8 years, required that the tax breaks be tied to job creation or retention, and gave local authorities a say in the matter. Writing in The Advocate, Knapp says the tax break is a net gain for the capital region:

A serious question is missing from the long list of questions asked by ITEP’s detractors. It’s the question our organization, the Baton Rouge Area Chamber, asks in guiding use of any economic development incentive: what is the incentivized project’s net return on investment to the community? If the project creates economic activity enough to generate a net positive return in increased tax revenue, the community will be objectively richer with the project than without.

But Knapp fails to ask an equally – if not more important – question: Would the industries receiving the tax break still invest in Louisiana if they did not receive the same level of property tax forgiveness? Forty-nine other state manage to attract manufacturing industries without the same level of generosity.

Re-entry court moves forward

Rehabilitating Individuals through Strategic Encounters, or RISE, is a year-long voluntary program that supports nonviolent offenders as they transition out of federal prison. Programs like it in other states have been successful, and Louisiana’s pilot is energizing the court system with new possibilities for nonviolent offenders. The Advocate’s Grace Toohey reports:

While many other federal and state courts have similar programs, the Middle District of Louisiana had nothing like it until last February. Dick and Rambo hope they can continue to expand the program and, in the future, begin a pre-entry diversionary court, which would work with offenders on the front-end of the criminal justice system instead of the back-end, they said. … “So many of our black fellows grow up in a poor neighborhood and they don’t have people willing to give them a chance,” Brandi LeFlore said. “All these people here know him, they believe in him and trust him. I think it’s something they need. … Though they made mistakes it’s alright, they have a chance.”

Number of the Day

23.49– Percentage drop in Louisiana’s total enrollment in individual marketplace plans between 2017 to 2018, the largest drop of any state. (Source: National Academy for State Health Policy)