Changes to Medicaid expected

Thousands of pregnant women will no longer be eligible for Louisiana Medicaid health insurance coverage after Jan. 1 when Obamacare kicks in.

Also, many of those with disabilities will lose their Medicaid eligibility or face a delay in receiving benefits as the Jindal administration adjusts structures of three state health care programs because of the federal Patient Protection and Affordable Care Act, more commonly called Obamacare. The pregnant and disabled impacted will be able to find coverage at federal marketplace exchanges that generally will allow consumers to compare and choose between various services offered by private companies and public agencies.

How the exchange marketplaces will work — the particulars are still being developed — is part of the worry being voiced by advocates who otherwise say the shift could prove beneficial in the long run.

The lack of certainty concerns physicians, said Greg Waddell, director of legal affairs at the Louisiana State Medical Society, the Baton Rouge-based professional association for physicians and health care providers. Will, for instance, services provided now under Medicaid still be offered after the changes take effect? he asked.

“Is there going to be a coverage gap?” Waddell asked.

The Jindal administration is changing the rules in three state programs that will reduce the number of people eligible for Medicaid. The state anticipates savings of $66.4 million from people moving off state Medicaid rolls and into coverage through health insurance exchanges required by Obamacare.

The changes will shift about 6,200 pregnant women and another 1,200 or so disabled to an insurance exchange where, with the help of government subsidies, they get policies.

Medicaid provides health care insurance to low-income people, and is paid for by the federal government, mostly, and by state taxpayers.

Medicaid pays doctors, hospitals and others providing health care for the poor. Medicaid covers about 1.2 million of the roughly 4.5 million people in Louisiana.

Another estimated 300,000 make too much to qualify, but too little to buy private insurance.

Pregnant women in households with income up to $39,060 for a family of three — 200 percent of the federal poverty level — will no longer be eligible for Medicaid. The income eligibility standard will drop to 133 percent of the federal poverty level, which is $25,975 for a family of three.

For the disabled, eligibility for the Medicaid Purchase Plan is reduced to 100 percent of the federal poverty level or about $19,500 for a family of three. It is more than double that today.

The program provides affordable health coverage to people with disabilities who work. They must be between the ages of 16 and 64 with monthly income less than $2,394.

It is a “buy-in” program in which the individual pays a premium when monthly income exceeds $1,437. About half of the plan’s 2,319 members will be affected by the changes in January.

And the Disability Medicaid program — for about 9,800 people claiming a disability or who are older than 65 — will start requiring a U.S. Social Security Administration determination of Supplemental Security Income eligibility.

The state had made the determination to allow individuals to start receiving the benefits more quickly.

Architects of the change and its supporters say the new subsidized insurance to be offered through the exchange marketplace could prove beneficial for women.

Louisiana Medicaid, today, only provides coverage while the woman is pregnant and a short time afterward. The new coverage could provide health care year-round, something women’s and children’s advocates long have wanted.

“It’s really more the norm people we are trying to get to,” said Sandra Adams, former head of the Louisiana Maternal and Child Health Coalition, a Baton Rouge-based education and advocacy group.

“The theory is good but we have to help people get there,” said Berkley Durbin, executive director of Medicine Louisiana Inc., a Baton Rouge-based organization with more than 700 physicians as members.

“Over the last several years, we finally have a high rate of prenatal care … I don’t want to back slide and affect the birth outcomes.”

Durbin said obstetricians and hospitals are worried that they will start seeing more pregnant women who have received no prenatal care.

Advocates for the disabled are voicing concern because there has been no indication what type of insurance coverage will be provided, with advocates for people with disabilities particularly worried.

“As long as they (disabled patients) have access through the exchanges, everything is going to be OK,” said Sean Prados, vice president of the Louisiana Hospital Association, a Baton Rouge-based professional and lobbying group. “That’s going to take some education.”

Aggressive outreach is part of the plan, State Department of Health and Hospitals Secretary Kathy Kliebert said.

“We will work with them so they know their options,” she said.

Participants in the Medicaid programs would not be dropped on Dec. 31. That would not be decided until their routine annual eligibility reviews during 2014.