Little time left for deal

• By MARSHA SHULER
• Advocate
• Published: Nov 10, 2008 - UPDATED: 12:05 a.m.

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The “window is closing” on the potential for a new state-federal health-care deal before Republican President Bush leaves office, Louisiana’s health chief Alan Levine said.

“If we are not in a position to announce something next week, I think this becomes very, very difficult to get done,” Levine said. 

Then the state will have to start negotiating with the administration of Democrat Barack Obama, who becomes president Jan. 20. The change in administrations will delay action six months to a year, Levine said.

For months, Louisiana officials have tried negotiating a complex deal with federal officials involving $771 million that the federal government claims the state owes. Much of it is in federal overpayments for the Medicaid health insurance program for the poor and uninsured.

At the same time, Gov. Bobby Jindal’s administration is talking behind closed doors with the federal Center for Medicare and Medicaid Services as he seeks approval for a proposed health-care restructuring and expanding coverage to more of the state’s adult uninsured.

Jindal’s team is arguing for a move to a system in which the poor and uninsured pay private hospitals, clinics and doctors for medical care instead of receiving treatments at charity institutions.

Levine says the plan would improve care and limit the cost taxpayers have to pay to provide health care for the one in four Louisiana residents who cannot afford it on their own.

The two negotiations are linked because of finances.

The state wants the federal government to let it use money it would otherwise have to repay to help fund the experiment in Medicaid managed care.

Despite lengthy negotiations, no deal has been struck with the federal government.

“Can we do the expansion if we can’t come to terms?” Levine said. “It becomes extra difficult given the budget challenges the Legislature has.”

Medicaid is a program for which the state covers part of the costs of care for poor and uninsured patients, while the federal government pays a much larger portion.

Levine’s state Department of Health and Hospitals, or DHH, already is seeking $450 million in additional funds next year just to keep the $7 billion-plus Medicaid program at a standstill level.