Medicaid vouchers could get new life in Louisiana

Washington -- Louisiana physicians plan to draw renewed attention to a Medicaid reform strategy that failed to take hold during the 1990s but that might help the state's low-income patients.

At the beginning of the year, the state's governor, Kathleen Blanco, launched a health care reform panel tasked with addressing several problems, among them a relatively high percentage of uninsured people and increasing Medicaid costs.

Physicians are determined to be a party to those discussions. They have launched an effort to look at reform strategies, starting with a Medicaid proposal originally introduced by the Louisiana State Medical Society that led to successful legislation in 1995. The plan was to create a pilot project that would give out Medicaid vouchers allowing recipients to receive the traditional state-run benefit or "purchase" coverage through managed care companies. It also included a buy-in option that allowed low-income residents who didn't qualify for Medicaid to purchase coverage through the program.

But the Louisiana Dept. of Health and Hospitals decided to first implement a tandem pilot project proposed by the managed care industry. When that strategy failed, the department dropped both, without trying the physicians' plan. "The administration did not like our proposal, and they didn't do it," said Dave Tarver, LSMS vice president.

But the concept still appeals to many Louisiana doctors. Now that the DHH is under new management, there is hope that the idea will get a fair shake.

"Maybe we find it doesn't make sense anymore, or maybe we find it is still a good idea," said Bart Farris, MD, who proposed reviving the plan at a recent LSMS house of delegates meeting. His resolution, which passed, calls for reviewing the Medicaid reform plan as a jumping-off point for devising a new slate of physician-backed proposals.

Dr. Farris is still convinced that the original concept is good. Vouchers would give Medicaid patients a choice and thereby more control over the type of benefits they receive, he said. "I have always believed that it is the best way to involve that population in their own health care."