In many measures of well-being, Louisiana ranks dead last or in the bottom few. But not all. "Not when it comes to Medicaid. We're the poster child," says Sharon Pomeroy, director of Covering Kids and Families Louisiana, part of the group Agenda for Children. For the past several years, national groups have praised the state of Louisiana for covering uninsured children and pregnant women through Medicaid. Louisiana's LaMOMS program receives special praise. Uninsured pregnant women in Louisiana now receive a Medicaid card in less than a week and become part of LaMOMS, which covers pregnant women in households earning up to 200 percent of the federal poverty level. In January alone, the Louisiana Department of Health & Hospitals (DHH) processed 4,187 eligible LaMOMS applications, with an average turnaround time of five days. Previously, enrollment might take up to two months, leaving uninsured expectant mothers without paid prenatal services for their first trimester.
Several health care groups have also praised Louisiana for enrolling large numbers of uninsured children in LaCHIP, the state's children's health care program. In 1997, the U.S. Congress passed legislation creating state health insurance programs for kids with a goal of helping working-poor families -- those with incomes that are too high to qualify for traditional Medicaid but too low to afford private insurance. The following year, DHH expanded the state's Medicaid program and launched LaCHIP, which covers children in Louisiana even when their family's income is twice the federal poverty level. The state now covers nearly 350,000 new kids through LaCHIP, double the number it had covered through its traditional Medicaid plan seven years earlier, according to the Kaiser Commission on Medicaid and the Uninsured.
On Jan. 26, President George W. Bush led a panel at the National Institutes of Health titled "Strengthening Healthcare." One of his five on-stage panelists was Tammi Fleming, the program manager of Kingsley House's program Health Care for All, which sends outreach teams of "walkers and talkers" into the city's housing projects and surrounding areas. Anywhere, anytime, Fleming's staff can complete applications for Medicaid, LaMOMS or LaCHIP. "Walkers and talkers. That's good; good job," said Bush, applauding Fleming's comments. He then explained why this work is highly necessary and advocated "a grassroots effort across the country" to enroll children in programs like LaCHIP.
Bush made good on his word -- the administration's budget for fiscal year 2006, unveiled about a week later, includes $11.3 billion for a "Cover the Kids" outreach initiative. Ironically, that same administration proposes to reduce federal Medicaid funding by $45 billion over the next 10 years. "The President wants to put billions of dollars into outreach, yet he wants to cut state funding to cover kids," says Pomeroy.
There is no question that Medicaid growth has been explosive -- spending on the program grew by about one-third between 2000 and 2003. But researchers from the Urban Institute's Health Policy Center attribute most of that spending growth to the large numbers of children who became covered by Medicaid during the economic downturn, when their parents lost employer-sponsored health coverage or couldn't afford soaring premiums. "Medicaid was the net to catch these kids," says Marjorie Tharp, spokesperson for the American Academy of Pediatrics.
Currently, Medicaid and programs like LaMOMS and LaCHIP are jointly funded by the federal government and the states through matching rates determined by each state's per capita income. Because our state's per capita income is low, the federal government pays 70 cents of every dollar spent on a Medicaid patient here and 80 cents for every LaCHIP patient. Other states receive anywhere from 84 cents down to 53 cents. This could change, if the administration -- as suggested in its proposed budget -- implements a Medicaid block grant, which would cap these federal contributions.
It is in everyone's interest to have insured moms and kids who will enjoy the well-documented benefits of prenatal care and preventive medicine. When compared with insured children, uninsured kids are half as likely to have had a well-child visit during the past year. Plus, the expense is relatively minor. Today, children make up nearly two-thirds of Louisiana's Medicaid population -- but their care amounts to only one-third of the state's Medicaid expenditures. In the year 2000, Louisiana spent $798 per year for each child enrolled in its Medicaid program; like other states, Louisiana spends the most money for the care of its elderly, blind and disabled Medicaid enrollees, whose fragile health requires roughly $7,000 a year per person.
Enrolling more people into an underfunded program and simply shifting federal costs to states is no way to solve the growing costs of Medicaid. Louisiana's congressional delegation should work to ensure that reforms to Medicaid save the program for those who need it. Because of Louisiana's excellent outreach efforts, nearly one in five citizens here depend on that program for good health. We must not let them down.