BATON ROUGE, Louisiana — Before anyone can get insurance coverage through Louisiana's planned Medicaid expansion, the state needs to hire the workers who will sign patients up for that coverage.
Gov. John Bel Edwards' administration wants to have health care providers pick up that short-term $2.8 million cost for salaries, training and equipment — rather than the cash-strapped state health department, which is threatened with steep budget cuts.
As he announced his Medicaid expansion roll-out, Edwards praised health secretary Rebekah Gee, saying "she has already secured pledges from providers to cover the state's portion of that cost, so for the remainder of this fiscal year there will not be a net cost to prepare for expansion."
The unusual staffing proposal first requires federal approval before any of the estimated 248 workers needed to staff the Medicaid expansion work can be hired. It's unclear whether the state would have to pay the long-term costs of the employees in future years if the Department of Health and Hospitals continues to keep the workers on its payroll.
Gee was in Washington this week meeting with federal officials about Louisiana's Medicaid expansion plans. She didn't respond to requests for comment, about the long-term liabilities for her department or a timeline for beginning hiring.
At the expansion announcement, Gee described health care providers sending money to the state and the state hiring employees who work on site at health care facilities. That means people who are eligible under the Medicaid expansion could enroll at the place where they seek care like a clinic, doctor's office or hospital, rather than at a separate state office.
"I like this because it represents both a better way for patients to access enrollment services as well as, I think, a really important commitment on the part of the providers to say, 'We care about this. We want to make this successful,'" she said.
Health providers would pay money that is used as state matching cash to draw down additional federal Medicaid dollars that cover a portion of the staffing costs. Gee called it "out-stationing" and said the federal Medicaid agency has approved it in other places, though Louisiana hasn't previously used the method.
South Carolina has a similar "sponsored Medicaid worker program."
Quick approval — and hiring of the enrollment workers — will help determine whether Edwards can achieve what he admits is an aggressive timeline, of having government-funded health insurance cards in more people's hands by July 1.
The Edwards administration estimates that more than 300,000 additional people, mainly the working poor, will be added to Louisiana's Medicaid program under the expansion, which covers adults making up to 138 percent of the federal poverty level — about $33,400 for a family of four.
Under the governor's plan, Louisiana will join 30 other states that have undertaken Medicaid expansions, including several overseen by Republicans. GOP legislative leaders in Louisiana haven't decided whether they will try to create roadblocks for expansion.
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