Louisiana Department of Health and Hospitals Secretary Alan Levine and state House members, as well as physicians and representatives from hospitals and insurers and Louisiana State University met on Monday for an out-of-session briefing to discuss Gov. Bobby Jindal's (R) plan to expand and increase the cost-effectiveness of Medicaid by enrolling beneficiaries in managed care plans, the New Orleans Times-Picayune reports. Under the "Louisiana Health First Plan," managed care pilot programs would be established in New Orleans, Baton Rouge, Lake Charles and Shreveport. Medicaid beneficiaries would work with state-approved counselors to choose between two or more private health plans. Insurers would be paid a flat monthly fee per beneficiary, which would vary depending on the beneficiary's health. Plans then would negotiate fees with doctors, hospitals and other providers in the network and collaborate to provide coordinated care. Eventually the plan will expand coverage to 106,000 uninsured state residents.

Jindal and his advisers have said the current state Medicaid program, which spends about $6.7 billion annually through a fee-for-service model, is financially untenable as costs rise faster than inflation. Levine said, "It is time for us to do something different, and dramatically different," adding, "We cannot change the system on the margins."

The plan would be funded by asking the federal government to excuse debt owed by the state for past overspending and by redirecting money that now goes to LSU Charity Hospital System for treating uninsured patients. The plan also would generate savings through better coordinated care. However, Louisiana Hospital Association President John Matessino said, "The hospitals out there are very concerned about how we're going to pay for" the changes (Moller, New Orleans Times-Picayune, 12/2). State Rep. Rick Nowlin (R) said Jindal's plan to use $350 million in one-time federal dollars to fund the program means that at "some time in the future we will have to replace that money with state funds" (Shuler, Baton Rouge Advocate, 12/2).

Floyd Buras, a pediatrician and former president of the Louisiana State Medical Society, said placing beneficiaries in managed care networks would harm them by limiting their choice of providers. In addition, state Rep. Herbert Dixon (D) said, "Why do we need to act now when a comprehensive federal plan is forthcoming" in the form of an overhaul proposed by President-elect Barack Obama and Democratic congressional leaders (New Orleans Times-Picayune, 12/2).