[Nov 18, 2008]

      Louisiana Gov. Bobby Jindal (R) and state Department of Health and Hospitals Secretary Alan Levine on Friday announced details of the Louisiana Health First initiative, a pilot program aimed at restructuring the state's Medicaid program by shifting thousands of low-income children and adults from the current fee-for-service model to private managed care networks, the Baton Rouge Advocate reports (Shuler, Baton Rouge Advocate, 11/15).

The proposed plan, outlined in a 65-page concept paper, is designed to cut costs and improve the health outcomes for Medicaid beneficiaries, but details of how it will be financed remain unclear, the New Orleans Times-Picayune reports. The plan also must be approved by the state Legislature and federal government before it is implemented (Moller, New Orleans Times-Picayune, 11/15).

The concept paper outlines some "major reform initiatives" for which the state is seeking federal approval:

• Develop "coordinated care networks" in the Baton Rouge, Lake Charles, New Orleans and Shreveport regions that are similar to private managed care plans and that would provide beneficiaries with preventive health care and chronic disease management services. The networks would be expanded statewide within five years;
  
  
• Expand Medicaid to some parents and grandparents of children enrolled in the program. Eligibility for the benefit would require that household income be no more than 50% of the federal poverty level; and
  
  
• A demonstration project in Lake Charles that would extend Medicaid coverage to parents, caretaker relatives and childless adults with incomes up to 200% of the federal poverty level (Baton Rouge Advocate, 11/15). People with incomes between 200% and 350% of the poverty level would be able to buy into the program on a sliding scale.
  

Jindal said, "Our health care system today is not working to help the very people it's designed to serve," adding that "doing nothing is not an option." He said that Medicaid could become financially unsustainable, adding that the program is projected to account for at least 21% of the state's general fund budget by 2011.

Citing ongoing discussions with the Bush administration over the financial aspects and other details of the plan, Jindal said, "We're not going to agree to terms (with the federal government) that are not in the best interest of the state." The negotiations could extend into 2009, he said (New Orleans Times-Picayune, 11/15).

The white paper and a fact sheet about the plan are available online (.pdf).