Medicaid cuts would hurt 18,000 Avoyelleans

As this parish and the state prepare for Mardi Gras and the solemn season of Lent that follows, state legislators are getting ready for a special session to fix a major budget crisis.

Gov. John Bel Edwards told a joint meeting of three area Rotary Clubs this past Monday that a special session of the Legislature would be called after Mardi Gras. On Wednesday, word was the special session would tentatively start next Monday (Feb. 19) and end March 6.

Edwards’ speech to the Rotarians touched on several “fiscal cliff” issues that have been discussed for the past month. Of particular interest in this parish is the impact the $1 billion budget deficit will have on Medicaid. With over 40 percent of Avoyelles Parish dependent on Medicaid, any cuts to that program could be painful here.

Although there are some mandatory programs the state must fund despite its budget problems, there are some important “optional” programs that can be cut.

“Optional services like dialysis and hospice care could face cuts,” Edwards said. “It will cost more to put patients in the hospital to die than sending them home on hospice.”

Medicaid is a federal program available in all states to provide medical insurance to those who cannot afford insurance or qualify for other reasons, such as the elderly and disabled. Each state has its own eligibility criteria for the Medicaid program in that state.

There were 18,040 Avoyelles Parish residents enrolled in Medicaid as of Jan. 6, which is over 40 percent of Avoyelles' population.

Avoyelles Parish Coroner Dr. L.J. Mayeux said cuts to Medicaid would be devastating -- not only to those on Medicaid, but also to those who have insurance.

“It hurts those on Medicaid because they would lack medical care, lack of medication needed for good health, puts a burden on hospitals because of the medicaid patients inability to pay and hurts the doctors because they will not be reimbursed,” Mayeux said. “This would affect both sides. It’s a double-edged sword because the hospitals and medical care providers need to pay the bills.

“If they don’t have Medicaid patients, then those with insurance will pay higher rates,” Mayeux continued. “People who have insurance because of Obamacare, with high deductibles, will have to pay more out-of-pocket expense.”

Mayeux said the system is broken and needs to be revamped. However, he added, politicians don’t ask physicians or medical providers for help addressing the issue because they are only interested in taking action they think will win them votes at election time.

“The politicians don’t want to bite the bullet and fix the system,” Mayeux said.

Concerning some calls to require Medicaid recipients to work for their benefits, Edwards said many on Medicaid are too old or have an illness that would prevent them from working. He said he is in favor of Medicaid recipients working if they are able.

State Rep. Robert Johnson said after the event that it “doesn’t make sense” to refuse federal funds to expand Medicaid to the “working poor.” It also does not make sense for the state to refuse to accept money the federal government has available.

Johnson also pointed out that some aspects of Medicaid are untouchable. They must be funded. The state can cut other areas, including hospice care and dialysis costs that Edwards mentioned in his speech.

It could also do away with the expanded coverage, which allows coverage to those earning minimum wage, or only with a part-time job, who earn too much to qualify for Medicaid based on income.

“These are the ‘working poor,’” Johnson said. “They don’t make enough to afford health insurance.”

Johnson said the state has $3 billion in federal funds available due to Medicaid expansion.

“We lose that $3 billion if we don’t expand Medicaid.”

The reality is that a person without Medicaid or health insurance who is having a medical emergency must be treated by the hospital, Johnson said.

“If he is covered by Medicaid expansion, the federal government pays the state and the state pays the hospital,” he said. “If there is no Medicaid expansion which would have covered that patient, the state pays the hospital out of the General Fund.”

He said the medical provider probably does not get full reimbursement for its costs under that scenario. Eliminating hospice care, which allows terminal patients to spend their last months in their home, just means those dying patients will have to be treated in a hospital where Medicaid is available for the treatment.

“It costs more to die in a hospital than it does at home,” Johnson said. “The state will end up paying more for that person than if we had allowed hospice treatment.

“And yes, we can eliminate paying for dialysis,” Johnson continued, “but do we really want to do that?”

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