Republicans bristling about the rising price tag of Louisiana's Medicaid program on Tuesday questioned whether the state health department was doing enough to respond to audits that found waste or misspending.
GOP lawmakers on the House Appropriations Committee grilled health department officials during a budget hearing. They asked about audits from Legislative Auditor Daryl Purpera's office that documented money spent on ineligible services and that suggested millions could have been spent on people who earned too much to receive the government-financed health insurance.
Republican Rep. Rick Edmonds of Baton Rouge said lawmakers need more confidence "in the integrity of the program," which is slated for a nearly $1 billion increase in the upcoming 2019-20 financial year. That will boost the program's budget in state and federal funds to $13.9 billion. Edmonds called the increase "an exorbitant amount of money."
"The reason we're digging so deep is to find any way we possibly can to slow down the fraud or waste to maintain the services we have," he said. Health Secretary Rebekah Gee said the conversations focus too heavily on "a few egregious cases," while ignoring the hundreds of thousands of eligible people who received needed Medicaid health services.
"When you have political discussions, it often involves taking the worst possible case scenario and bringing them up," Gee said. Louisiana's health department booted 30,500 people from Medicaid at the end of March, after an upgraded state computer check determined they earn too much. Nearly all were non-elderly adults enrolled through the Medicaid expansion that Democratic Gov. John Bel Edwards enacted in 2016, an expansion that has rankled Republicans ever since.
Medicaid Director Jen Steele said many of those removed never responded to a letter warning them they would lose the insurance coverage unless they could demonstrate by March 29 that they met income requirements. "We believe there's going to be a significant number of people who come back because they can demonstrate eligibility," she said.
Rep. Tony Bacala, a Prairieville Republican and frequent critic of Medicaid spending levels, questioned whether the upgraded computer system — which does quarterly wage checks — checked the entire Medicaid population.
Nearly 1.7 million people in Louisiana, more than 35 percent of the state's residents, are in the program. "We identified 30,000 people in a portion of the population," Bacala said, suggesting more people likely are ineligible. Steele said the wage check was done for all 900,000 adults in the Medicaid program.
A large portion of the state's Medicaid recipients are children. Appropriations Chairman Cameron Henry, a Metairie Republican, asked if the state could recoup money from the private companies that manage health services for most of Louisiana's Medicaid patients, for the monthly payments they received for people ineligible for coverage.
Health department officials described a process for recovering money if "outright fraud" can be proved. Rep. Jack McFarland, a Winnfield Republican, said he has received too little information about the performance of the managed care companies.
The state is currently shopping for new managed care contracts, and McFarland said lawmakers should have more data to determine what Louisiana is receiving for the deals already in place.
Democratic Rep. Dustin Miller of Opelousas defended the health department's performance, saying he believed it's "on track" in its response to the audits and its work to combat fraud. "Our fraud is no worse than in other states, right?" Miller asked. Steele replied: "That's my understanding."