Lawmakers Clash Over Managed Care for Home Health

Across the country, at least 23 states have begun using managed care services for Medicaid-eligible seniors—but it’s looking like Louisiana won’t be joining them any time soon.

Lawmakers and skilled nursing facility representatives in Louisiana have tabled a bill intended to shift state-funded health care for seniors from skilled nursing facilities to home health care, The Advocate reported.

The legislation, House Bill 790, would have required Louisiana’s Department of Health and Hospitals to designate a private company that would offer Medicaid managed care for long-term services affecting seniors.

As it stands, if a senior on Medicaid requires long-term services, the state is basically limited to sending the senior to a skilled nursing facility, the publication says. If the state were to join with a private managed care provider, however, that provider could serve as a case manager.

Specifically, the provider could offer a wider variety of options, including home health care. The provider could also determine if the patient requires a stay in a skilled nursing facility, and how long that stay would last.

House Bill 790 would likely to save the state millions of dollars annually, supporters of the bill say. On the other hand, the managed care contracts could wind up costing the state more, while withholding services to maintain profits for the provider, according to opponents of the bill.

Louisiana is already ranked among the lowest for reimbursement costs for the skilled nursing facilities, which means it’s unlikely the state would incur savings from changing its system of care, former Louisiana Sen. Joe McPherson, who owns at least one skilled nursing facility, testified before lawmakers.

Managed care organizations are inclined to cut corners in the form of denying requests for care, McPherson and other representatives from the skilled nursing industry said, according to The Advocate.

“The fact of the matter is the shift out of nursing homes and the trend for in-home care has happened and is continuing to happen,” State Rep. Walt Leger III, a democrat who introduced the bill, told the publication. “What are we going to do about it?”

Written by Mary Kate Nelson

Photo Credit: “Louisiana State Capital” by Antrell Williams, under license CC BY-ND 2