BATON ROUGE, La. (AP) — Proposals that would make it more difficult to cut the rates paid to private hospitals and nursing homes for taking care of Medicaid patients are nearing final passage in the Louisiana Legislature.
Overwhelming support from lawmakers comes despite concerns the constitutional amendments would further limit budget areas available to cut when Louisiana has financial woes — and leave public colleges more vulnerable to slashing.
The House-approved proposals by House Speaker Chuck Kleckley, R-Lake Charles, received backing Monday from the Senate Finance Committee and move next to the Senate floor. They also would need support from voters in a statewide election to add the language to the Louisiana Constitution.
One measure would let hospitals pool their money and use those dollars to draw down federal Medicaid matching money. In exchange, cuts to hospital payments would be limited and would require two-thirds votes from lawmakers.
Rep. Walt Leger, D-New Orleans, said the proposal would help stabilize funding for hospitals that are currently being reimbursed about 60 cents on the dollar for services provided to Medicaid patients.
"We believe with this, they'll be able to get closer to 80 cents," Leger said.
Though critics have raised questions about whether patients would be charged a "bed tax" to draw down the federal match money, Sen. Sherri Buffington, R-Keithville, said the money would come from existing hospital dollars, not from new charges to patients.
The Louisiana Hospital Association has pushed the legislation as a way to bring in new dollars for the state Medicaid program and help offset cuts that have repeatedly hit hospitals since 2009. The association says hospitals will get a predictable funding stream that would help protect patient access.
The other proposal would set a floor on Medicaid patient reimbursements paid to nursing homes, pharmacies and institutions for the developmentally disabled based on next year's rates — and require the rates to increase annually with an inflation index.
Limits would be placed on how cuts could be made.
Jindal administration leaders, the left-leaning Louisiana Budget Project and the nonpartisan Public Affairs Research Council of Louisiana all raised concerns that the bills would further limit flexibility in a budget where most money already is locked up through constitutional and statutory requirements for spending.
That has left higher education and health care as the two areas most vulnerable to slashing.
"It leaves education kind of out there by itself," acknowledged Sen. Jack Donahue, R-Mandeville, committee chairman and a supporter of the legislation.
Kathy Kliebert, interim secretary for the state Department of Health and Hospitals, said the changes would leave at-home and community-based services for the elderly and disabled more likely to take a hit when cuts need to be made in the Medicaid program.
"It leaves us limited places to go in terms of making rate reductions and other changes," she said.
Jan Moller, head of the Louisiana Budget Project, said, "You're essentially locking away large segments of the Medicaid budget."
Leger said the facilities whose rates would be protected generate dollars that are used to bring in the federal match money, so he said they should be afforded some level of protection.
"I think that's reasonable to expect when you ask for that kind of private investment into the Medicaid system," he said.
The Senate Finance Committee backed both measures with a 9-1 vote. Only Sen. Dan Claitor, R-Baton Rouge, opposed the bills.