Louisiana pediatricians sue over Medicaid managed care pilots

After Louisiana health officials allegedly rebuffed multiple requests by the state's chapter of the American Academy of Pediatrics for more information on a proposed Medicaid reform plan, the physician organization is asking a trial court to force the state's hand.

Gov. Bobby Jindal has proposed pilot projects in four regions of the state that would allow private insurance networks to administer the Medicaid program in place of the current fee-for-service structure. State officials say the plan -- part of a larger proposal to cover the state's uninsured -- will help expand access to care and ensure timely treatment for thousands of children as well as adults. The Legislature is expected to take up the proposal when it reconvenes in April.

But doctors fear the opposite effect on the state's most vulnerable children. Pediatricians want the Dept. of Health and Hospitals immediately to produce more detailed information on the managed care plan, according to the complaint filed in December 2008 in the 19th Judicial District in East Baton Rouge. The AAP is not contesting other aspects of the health reform proposal.

Louisiana already ranks at the bottom of the list for physician Medicaid payment, said Sandra Adams, a staffer with the pediatric academy's state chapter.

"That's the number we have to work from, and if we take those kids and put them in managed care, and [insurers] take another 15% off the top, we can't make the math work," she said. "We need to make sure children's health care is protected, and we're trying to get as much information as we can to try to work through this."

Adams said the health department appointed a committee of various stakeholders to study the issue. But doctors complain that the panel has largely ignored physicians' input and requests for additional public documents related to the deal, such as cost analyses, payment methodologies, and correspondence between state and federal officials. Louisiana health department officials also are leveraging the proposal in hopes the U.S. Dept. of Health and Human Services will forgive the $771 million owed by the state for alleged Medicaid overspending by allowing Louisiana to invest the funds in the new expansion, she noted.

Under the plan, known as Louisiana Health First, Jindal also proposes to:

• Expand Medicaid eligibility for children and adults to as high as 50% of the federal poverty level, up from 12%.
• Create medical home networks to coordinate care for Medicaid enrollees.
• Overhaul the state's safety net hospital system.

The Dept. of Health and Hospitals did not return calls seeking comment.