Becoming “Healthy Louisiana”: An Overview of Planning Efforts to Implement the Medicaid Expansion
As the first act of his new Administration, Louisiana Governor John Bel Edwards signed the state’s Affordable Care Act (ACA) Medicaid expansion into law, setting in motion a key initiative that is anticipated to have far-reaching benefits for the state. Louisiana became the 32nd state in the nation (including DC), and the 7th of the 17 states that make up the American South, to adopt the Medicaid expansion to adults with incomes up to 138% of the federal poverty level (FPL), $16,394 for an individual as of 2016. Until now, childless adults in Louisiana were not eligible for Medicaid and eligibility for parents was limited to 24% FPL ($4,838 for a parent in a family of three as of 2016).1 As the newest state to expand, Louisiana’s experience may provide guidance for other states that expand Medicaid in the future. This fact sheet provides an overview of the state’s expansion planning activities. Future work will examine implementation experiences and identify results and lessons learned.
The stakes and expectations for Healthy Louisiana, as the expansion is called, are high. According to state data, up to 450,000 people may potentially be eligible for the expansion, and the state must enroll 375,000 to realize its projected state general fund savings of more than $180 million for FY2017.2 If this goal is achieved, enrollment of nonelderly, nondisabled Medicaid beneficiaries, which was 983,000 as of May 2016, would increase by 28%.3 This increase would be generally consistent with the average enrollment increase during the first year of implementation among states that expanded Medicaid, although enrollment increases across expansion states vary widely.4 The state launched enrollment in Healthy Louisiana on June 1st, and the state reports that over 200,000 individuals had been enrolled as of June 10th.5 This enrollment reflects the state’s shift of individuals from existing limited benefit health benefit programs to the full-benefit expansion.
Coverage under Healthy Louisiana will become effective July 1st, but expansion planning has been underway for several months. Preparation efforts brought together experts in Medicaid policy and procedure, communications, outreach and enrollment, IT services, and other areas. Ongoing progress will depend upon leadership, an effective federal-state partnership, buy-in from state employees and an involved stakeholder community. As the state continues its enrollment efforts, it will draw on its experience simplifying administrative practices from nearly two decades ago during the implementation of its children’s health insurance program, LACHIP. The state is planning coordinated outreach and enrollment efforts and will utilize data-driven approaches designed to accelerate enrollment. Louisiana’s planning efforts span these key areas:
- Communications and Messaging: As one of its first implementation steps, the state established Healthy Louisiana, a brand intended to convey the state’s vision for health coverage opportunities and better health outcomes. The state created a Healthy Louisiana website to provide program information, enrollment instructions, and news. A state tour was conducted in May, concluding June 1st at an event in New Orleans, at which the Governor, other officials and advocates focused attention on the launch of the new coverage and the enrollment work that lies ahead. The state is continuing to refine its messaging strategy and to develop outreach materials, which it plans to evolve over time to maintain momentum after coverage becomes effective, July 1.
- Systems-Assisted Approaches: Recognizing the central role that eligibility systems will play in successful enrollment efforts, the state has already begun taking steps to establish coordination between HealthCare.gov and the state Medicaid eligibility system. Louisiana also plans to employ a number of data-driven, “low touch, high impact” strategies to enroll specific populations as quickly and seamlessly as possible. By mining existing databases to identify people eligible for Medicaid – such as individuals already enrolled in limited health benefit programs and targeted households participating in the Supplemental Nutrition Assistance Program (SNAP) –the state aims to facilitate enrollment of some groups of eligible people into Medicaid without an application or by asking them to respond to an offer letter and answer a few simple questions. These approaches will help enable eligibility workers to focus their attention on applicants who need more extensive help and embed streamlined approaches into state enrollment and renewal processes over the longer term.
- Application Assistance and Community Supports: Even with these facilitated enrollment efforts, many eligible people still will need to complete an application to enroll in Medicaid. Through both traditional and new approaches, Louisiana is planning to make enrollment assistance available where and when people need it. The state intends to expand deployment of outstationed Medicaid eligibility workers within the community and to enhance the efforts of its regional Medicaid Application Assistance Centers by providing supports and incentives. In addition, community organizations and institutions – many of which have gained experience over the past few years as navigators and certified application counselors — will be vital partners in this “all hands on deck” endeavor.
- Targeting Specific Populations for Outreach and Enrollment: Louisiana plans to mount new efforts to find and enroll specific groups of people who are eligible for Medicaid for the first time. For example, the state is planning special activities to help connect eligible individuals to Medicaid when they reenter the community after a period of incarceration. People engaged in school-based strategies will expand their focus beyond eligible children to find and enroll newly eligible parents. There will be other opportunities for outreach and enrollment efforts targeted to other groups as well.
This fact sheet provides an initial look at the state’s planning activities. Future work will dig deeper to explore the state’s implementation experiences; the impact of its policy choices and strategies on enrollment; and the effects of the Medicaid expansion on new enrollees, providers, and the state. Louisiana’s experiences may provide lessons about productive avenues for outreach and enrollment and inform other states that may expand in the future.
Tricia Brooks, Sean Miskell, Samantha Artiga, Elizabeth Cornachione, and Alexandra Gates, Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost-Sharing Policies as of January 2016: Findings from a 50-State Survey, (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, January 2016), https://www.kff.org/medicaid/report/medicaid-and-chip-eligibility-enrollment-renewal-and-cost-sharing-policies-as-of-january-2016-findings-from-a-50-state-survey/
“Governor Edwards: Enrollment for Medicaid Expansion to Begin on June 1,” Louisiana State Website, (April 18, 2016) http://gov.louisiana.gov/news/enrollment-for-medicaid-expansion-to-begin-on-june-1 and presentation by Rebekah Gee, MD, Secretary of the Louisiana Department of Health and Hospitals, (May 9, 2016).
Calculations based on data provided by Louisiana Department of Health and Hospitals, MEMO981R2 INFOPAC Report, May 20, 2016.
Centers for Medicare & Medicaid Services, Medicaid & CHIP January 2015 Application, Eligibility, and Enrollment Data (Updated), (Baltimore, MD: Centers for Medicare & Medicaid Services, March 2015), https://www.medicaid.gov/medicaid-chip-program-information/program-information/downloads/updated-january-2015-enrollment-data.pdf
Communication with Louisiana Department of Health and Hospitals, June 8, 2016.