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Jindal won't seek to follow Arkansas on Medicaid

Melinda Deslatte, Associated Press

BATON ROUGE, La. (AP) -- Gov. Bobby Jindal's administration announced Tuesday that it won't seek to replicate a private insurance Medicaid expansion model like Arkansas, despite requests from Louisiana lawmakers to consider it.

Jindal's interim health secretary, Kathy Kliebert, told the Senate Health and Welfare Committee that the federal guidelines outlined for the Arkansas proposal don't offer enough flexibility and leave too much uncertainty about future financing and regulations.

Arkansas has asked federal officials to let it use the Medicaid money to buy private insurance policies, and the Obama administration is working with the state on that idea. An Arkansas health official outlined the proposal to Louisiana senators Tuesday.

Louisiana lawmakers have several times urged the Department of Health and Hospitals to consider something similar, so Louisiana can tap into the billions of available federal dollars to cover as many as 400,000 uninsured people in the state.

"We have looked at it, but no, we are not entertaining it," Kliebert said.

Sen. Fred Mills, R-Breaux Bridge, said the Arkansas model appeared to address the concerns outlined by the Jindal administration about Medicaid being an inefficient and outdated way of providing health care, because the Arkansas program would use the expansion money to pay for private insurance.

"I think the risks are still just too high for us," Kliebert said.

Her comments came as Louisiana's private hospitals announced Tuesday they are supporting a Medicaid expansion, despite the governor's opposition.

Louisiana Hospital Association President John Matessino urged that expansion to include more stable financing for the doctors, hospitals and other providers who see Medicaid patients, however.

"While it is critically important for Louisiana to take advantage of the significant federal resources available to expand health care coverage, such an expansion must be done in a thoughtful manner," Matessino said.

The potential expansion would cover adults making up to 138 percent of the poverty level — $15,420 a year for an individual or $31,812 for a family of four. The federal government will cover the full costs of the Medicaid expansion from 2014 to 2016 and pick up most of the price tag after that, requiring states to pay up to 10 percent.

As pressure from Republican and Democratic lawmakers rises to consider an expansion, Kliebert laid out the Jindal administration's case for rejection in the Senate committee.

She said Medicaid has poor outcomes and inefficient spending. She said the overhaul was being rushed with insufficient guidance, and she questioned whether states could rely on the promised federal financing — or if that would later shrink.

Kliebert also said the expansion would cost Louisiana $1.7 billion over the first 10 years, the high end of DHH estimates. But in some scenarios in DHH's own analysis, the state could save millions instead by shrinking its costs for uninsured care.

Even if Louisiana could save money, Kliebert said the state's residents still would be on the hook for its federal tax dollars covering the costs of the program.

"This is not free money," she said.

Senators questioned whether the state can continue to reject the federal Medicaid expansion money as other federal financing pools for uninsured care will be shrinking.

Sen. Dan Claitor, R-Baton Rouge, said he was frustrated that he hasn't seen an alternate plan for covering more of the uninsured, citing the Arkansas model.

"I for one would like a more visible plan," Claitor said. He added, "If you guys aren't going to come with it, we are."