Health plan to be adding new groups

The state health agency is preparing to add new medical populations and expand services offered through private insurance companies that have taken over care of the poor.

The changes are coming to the Bayou Health managed-care program which went statewide June 1, state Department of Health and Hospitals Secretary Bruce Greenstein said.

Greenstein said the program expansions are on a fast track with the goal of implementation by this fall.

DHH’s budget is predicated on achieving an estimated $43.2 million in savings in the fiscal year that begins July 1 based on the initiatives, $12.2 million in state funds and the remainder federal match.

“We will be going through emergency rulemaking because of the time frame,” Greenstein said.

Legislative health committees would be able to conduct oversight hearings on rules required to implement the program.

Five private companies took over coordination of the care of some 875,000 Medicaid recipients — mainly children — along with $2.2 billion of the state’s Medicaid business beginning June 1.

The initiatives would expand Bayou Health enrollment to include certain nursing home residents, as well as developmentally disabled Medicaid recipients who live in residential facilities or receive community-based services.

In addition, two new benefits would be added to the acute-care services currently offered by the plans — dental and pharmacy services.

The Jindal administration claims the new system of care delivery will save taxpayer dollars and improve health outcomes of those enrolled.

Opponents contend the plan takes money away from health care and puts it into the pocket of insurance companies.

An estimated 10,000 to 15,000 more Medicaid recipients could be added to the private Bayou Health plans under the administration’s proposed expansion, Greenstein said.

“It’s really just the population that could really benefit from the coordination of their complex medical needs,” he said.

“Many advocates and families (of the developmentally disabled) are appealing to us” to be included because of the care coordination and the chronic diseases of many of them, Greenstein said. “We are working on the package of benefits and the time frame to allow them in.”

Because of the unique nature of the population involved, Greenstein said, the state will extend the period for decisions to be made on which plan to align with before they are auto-enrolled.

The developmentally disabled who are in home-based care programs often have complex medical needs with treatment not coordinated at all, Greenstein said. “There’s no relationship with the physician or pharmacist,” he said. The health plans will provide those connections, he said.

On the nursing-home front, Greenstein said only those residents who are not dually eligible for Medicaid and Medicare would be added. For instance, he said, it could be a younger adult in a nursing home.

Greenstein said he and other health officials are traveling around the state to get input on meshing the Medicaid prescription drug program into the private health plans workings.

“We just have to do a better job of managing our own program too,” Greenstein said.

Neighboring Texas added pharmacies into its Medicaid managed-care program this spring. The move continues to upset independent pharmacists who do a large Medicaid patient business. They claim that the reimbursement rates set by the managed-care plans to achieve savings are putting their businesses in jeopardy.

No formal rules have been presented by the administration for implementation of the pharmacy benefit through Bayou Health, even as DHH is conducting public meetings to get input.