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The Medicaid Forecast report is sent monthly to the members of the Joint Legislative Committee on Budget. This report covers the months of December, 2024, through January, 2025, and utilizes actual revenue and expenditures through January 31, 2025 and trends them forward through June 30, 2025.
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- Legislative & Governmental Relations
- Public Health
As required by Act 534 of the 2014 Regular Session, the state superintendent of education, secretary of the Department of Children & Family Services (DCFS), and the secretary of the Louisiana Department of Health (LDH) shall review and evaluate the effectiveness of current state programs, including but not limited to sex education provided by public schools, aimed at reducing the rate of teen pregnancy and preventing the spread of HIV and other sexually transmitted diseases among youth of Louisiana.
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- Legislative & Governmental Relations
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This report is submitted to the Joint Legislative Committee on the Budget. LDH is required to publish quarterly a report containing data directly related to payment for health care services through the implementation of a health coverage expansion of the Louisiana medical assistance program, in addition to directed payments and other supplemental payments made to hospitals.
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- Legislative & Governmental Relations
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Act 17 of the 2023 Regular Session requires an annual report to the legislature of any condition added to the Recommended Uniform Screening Panel (RUSP) related to newborn screening and the Louisiana Department of Health's review and determination on the conditions.
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Monitoring the health status of a population is an essential step in evaluating the effectiveness of various health programs and in developing programmatic policy for the future. Monitoring the status of a population relative to certain health indicators over a number of years is an especially effective tool for health planning. Act 985 of the 1995 Louisiana Regular Legislative Session, enacting R.S. 40:1300.71, requires that the Louisiana Department of Health annually prepare a report card relative to health and health-related issues.
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- Legislative & Governmental Relations
- Medicaid
Keywords: HCBS, Home and Community Based Services
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- Legislative & Governmental Relations
- Medicaid
In response to Act 207 (SB 305) of the 2003 Regular Session, LDH is required to submit certain information regarding the Medicaid Buy-In Program to the legislature, including the status of the buy-in program, a report relative to the estimated value of the state, federal and FICA taxes paid by the participants in the buy-in program, and any recommendations for expanding coverage in the buy-in program.
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- Legislative & Governmental Relations
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The Task Force on Alopecia Awareness, established by Senate Concurrent Resolution 32 by Senator Price, is dedicated to raising awareness, improving access to care, and supporting individuals living with alopecia and other hair and scalp disorders in Louisiana. To achieve this goal, the task force conducted a comprehensive review of existing research, consulted with healthcare professionals and community stakeholders, and surveyed individuals affected by hair loss conditions.
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- Behavioral Health
- Legislative & Governmental Relations
The charge of Act 158 of the 2015 Regular Legislative Session was to provide transparency relative to Medicaid managed care programs. Within the Office of Behavioral Health (OBH), this involves the Coordinated System of Care (CSoC) program. Magellan Health Services of Louisiana, Inc. (Magellan) administers the CSoC program. This report outlines responses to the requests made by the legislature in Act 158 relative to Magellan's management of care within CSoC program.
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- Legislative & Governmental Relations
- Medicaid
- Managed Care
Managed Care 2.0 Amerigroup Healthy Blue AmeriHealth Caritas Louisiana Healthcare Connections UnitedHealthcare Community Plan Aetna Better Health This report is the ninth in a series produced by the Louisiana Department of Health (LDH, or the Department) to satisfy statutory reporting requirements intended to ensure the following outcomes are being achieved by Louisiana’s Medicaid managed care program (R.S. 40:1253.2): • Improved care coordination with patient-centered medical homes for Medicaid enrollees; • Improved health outcomes and quality of care; • Increased emphasis on disease prevention and the early diagnosis and management of chronic conditions; • Improved access to Medicaid services; • Improved accountability with a decrease in fraud, abuse, and wasteful spending; and • A more financially stable Medicaid program. Beginning in February 2012, the original Medicaid managed care program included two models of coordinated care networks: a full-risk, managed care organization (MCO) model delivered by prepaid health plans and a primary care case management (PCCM) model delivered by shared savings plans. The state contracted with three prepaid and two shared savings health plans, and individuals were given the option of choosing the plan that best met their needs. Not all Medicaid services are available from health plans, and some enrollees continue to receive certain services under the fee-for-service program. In addition, some populations covered by Medicaid were not eligible to enroll in and receive services from a health plan. LDH has progressively integrated services and populations into the Medicaid managed care program. The following timeline includes major milestones in the growth of the managed care program: • Pharmacy benefits were “carved-in” to the prepaid plan benefit package on November 1, 2012. • The provision of dental benefits to most Medicaid populations was contracted to a single prepaid ambulatory health plan referred to as a dental benefits program manager (DBPM) beginning July 1, 2014. • The delivery model transitioned from three full-risk MCOs and two shared-savings PCCM models to five full-risk MCOs on February 1, 2015. • Hospice benefits were added on February 1, 2015. • Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) – Personal Care Services were added on February 1, 2015. • Retroactive linkages to a Medicaid managed care plan were implemented on February 1, 2015. • Specialized behavioral health benefits were added on December 1, 2015. • Non-emergency medical transportation and specialized behavioral health services were added on December 1, 2015, for enrollees not entitled to receive physical health services through an MCO. • Eligibility for Medicaid services expanded to include the new adult population on July 1, 2016. • Effective January 1, 2021, the DBPM program expanded to include a second contracted dental plan. • Effective January 1, 2021, covered dental services (EPSDT and Adult Denture) for individuals with intellectual disabilities (ICF/IID) moved from the fee-for-service (FFS) program to coverage through one of the two DBPMs. Transparency Report Measures and Data This report includes 31 areas of measurement outlined in La. Revised Statute 40:1253.2 and covers program operations for State Fiscal Year (SFY) 2022. All measures are reported for the SFY, July 1, 2021, through June 30, 2022, except for the following that are reported on a calendar year basis per the contract between the Department and the managed care entities: Section 7 – Medical Loss Ratio, Section 8 – Health Outcomes, Section 9 – Member and Provider Satisfaction Surveys, and Section 10 – Audited Financial Statements. The information included in this report was collected from multiple sources. To the greatest extent possible, the data were extracted from state systems that routinely collect and maintain operational data on the Medicaid managed care program. When unavailable from state sources, data were collected from the managed care entities or sourced from either routine reporting deliverables1 or ad hoc reports requested specifically for this purpose. The Medicaid Management Information System (MMIS) and the Management Administrative Reporting Subsystem (MARS Data Warehouse, or MDW) are maintained by the Medicaid program’s contracted fiscal intermediary, Gainwell. Detailed enrollee and provider information, as well as claims payment data for this report, was extracted from the MARS Data Warehouse. The state administrative system, LaGOV Enterprise Resource Planning System – Finance Module (LaGOV) maintained by the Office of Technology Services within the Division of Administration, was used to extract information on payments to the MCOs and DBPMs. As part of routine operations and as required by the Centers for Medicare and Medicaid Services (CMS), internal policies and procedures for the collection of data were validated by the Department’s contracted External Quality Review Organization (EQRO), Island Peer Review Organization (IPRO). In addition to standing operational quality assurances and EQRO reviews, the data included in this report were independently validated by Myers and Stauffer, an audit contractor of the Department. Myers and Stauffer reviewed for reasonability the data extraction code or process that the managed care entities or the Department used to generate data. For data originating from the MARS Data Warehouse, Myers and Stauffer directly aggregated data from encounters or data extracts for each plan and compared its results to the results the Department produced. For data originating from the plans, Myers and Stauffer (MSLC) reviewed plan responses to a survey developed by Myers and Stauffer to document the process the plans used to generate the data as well as policies and procedures in place to collect, track and report data. Where Myers and Stauffer found inconsistencies above or below the 10% variance threshold established by the Department, it made recommendations to the Department or the health plan to improve the method used to collect data. See Appendix XIX and Appendix XX for the survey instruments.
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- Legislative & Governmental Relations
- Medicaid
In accordance with the preamble language to Schedule 09 in Act 447 of the 2023 Regular Session, the Louisiana Department of Health (LDH) will provide monthly projected expenditures and anticipated revenue collections in the Medicaid program for Fiscal Year 2024.
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- Legislative & Governmental Relations
- Medicaid
In accordance with the preamble language to Schedule 09 in Act 447 of the 2023 Regular Session, the Louisiana Department of Health (LDH) will provide monthly projected expenditures and anticipated revenue collections in the Medicaid program for Fiscal Year 2024.
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