Medicaid expansion timeline under Edwards may be slowed because of financing questions

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BATON ROUGE, Louisiana — While he pledged to expand Louisiana's Medicaid program on "day one" in office, Gov.-elect John Bel Edwards is finding out that might be trickier than he thought.

The financing plan enacted by lawmakers is caught up in a swirl of legal questions, and Edwards said after winning the weekend election that it might take a bit longer to expand Medicaid than he promised.

Whatever the delay, the Democratic governor-elect said providing the government-funded health insurance to the working poor remains a top priority for his new administration when it takes office in mid-January.

"We are going to expand the Medicaid program in Louisiana. We're going to do it as soon as we possibly can, as responsibly as we possibly can, and it will be part of the early initiatives that you see in my administration," he said.

Term-limited Gov. Bobby Jindal, a Republican who recently ended his presidential campaign, refused to take the billions in federal health care money to expand Louisiana's Medicaid program. He opposed it as too costly for the state and as an inappropriate expansion of government spending.

Thirty other states have agreed to expand their Medicaid programs as allowed under President Barack Obama's health law, with the federal government picking up most of the tab.

Medicaid expansion offers government-funded insurance coverage to adults making up to 138 percent of the federal poverty level — less than $33,000 for a family of four. It would pour new money into Louisiana for health care expenses as it struggles with deep financial gaps.

As he campaigned, Edwards, a state lawmaker, said he would immediately expand the program as governor. Expansion supporters praised Edwards' victory over Republican U.S. Sen. David Vitter in Saturday's election.

"The majority of the nearly 300,000 Louisianans who would gain coverage under Medicaid expansion are working men and women. They all deserve the peace of mind that comes with knowing that in case of a sudden accident or illness, they will get the health care they need," said Ron Pollack, executive director of Families USA, in a statement.

But questions have been raised about the workability of legislation passed earlier this year to help cover the state's cost-share of a Medicaid expansion. Edwards said he doesn't want to enact the expansion until he's sure the state's financing share, which will grow to 10 percent of the expansion price tag over time, is covered.

"I am not moving away from expanding Medicaid as early as I possibly can. I just know that there may be a hurdle that we have to overcome first with respect to making sure that we do it properly," he said.

Lawmakers approved a financing tool devised by the Louisiana Hospital Association that involves hospitals pooling their money to help pay Louisiana's share of the expansion.

In a recent analysis, however, the nonpartisan Legislative Fiscal Office suggested that legislation doesn't work the way lawmakers anticipated and wouldn't provide the short-term savings expected with a Medicaid expansion.

Instead, the savings would be steered to boost payments to hospitals, according to the fiscal office analysis. In addition, the financing tool doesn't pay for the entire state cost of the Medicaid expansion.

That is prompting reconsideration of whether the hospital association plan is the best approach — or whether the state should look at other options.

Reworking the financing plan could require new legislation. The first legislative session planned by Edwards is a special session expected sometime in February.

Follow Melinda Deslatte at .

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