The Senate Finance Committee met October 28 to hear a presentation by the Louisiana Department of Health and Hospitals.
Secretary Greenstein began his presentation by saying that he is the luckiest person in the world to have this job; however, he said he feels like he was probably undersold on the challenges. He told the panel that he has visited all the legislative delegations, the public hospitals and the developmentally disabled community. “I knew there was a lot of money in the system but it is not being spent properly” said Greenstein. “We have outstanding facilitated, dedicated and trained physicians and dedicated training providers.”
Secretary Greenstein referred to Jerry Phillips as his CNG – Chief Numbers Guy.
First, he covered a slide titled Medicaid Coverage Groups and Eligibility. He said that the current Louisiana Medicaid program is made up of the traditional Medicaid population which includes children, families, women, the aged, blind and disabled community. Then Medicaid eligibility comes down to certain medical conditions. He said there are higher than average costs for the categories that include newborns, low birth weight babies and neonates.
He then reviewed a slide entitled CMS-Determined Mandated Medicaid Populations. The federal government requires DHH to cover children under 18, newborns, foster care children, pregnant women, the aged, blind and disabled, extended Medicaid which is a congressionally protected group who lost their SSI because of an increase in the annual COLA, emergency alien and QMB and SMLB.
The next slide reviewed was entitled CMS – Determined Optional Medicaid Program. Title 19 requires states who participate to cover certain populations.
Currently, Louisiana covers 28 percent of the state’s population under the Medicaid program. Under the provision of the Affordable Care Act Medicaid eligibility would be expanded to include 45-48 percent of the population.
Mandatory Programs and Services
DHH is in the process of trying to determine which Office of Public Health Programs is mandatory.
The Retail Food Program is legislated in RS 40:4.
School Based Health Care Centers were created legislatively and are codified in Louisiana Revised Statute 40:31.3. Therefore, he said there may be a violation of state law if DHH were to close some school based health centers statewide.
Secretary Greenstein said that school based health centers fund the majority of their operations. He told the senate finance panel that “we have plans to work closer with them to draw down federal match for some of the services they deliver.”
The Onsite Wastewater Program is created by virtue of LRS 40:4(a), 40:5 and 40:31.32
The Children’s Special Health Services, which provides access to care to children with special health care needs and their families.
Savings Related to FY 10 Shortfall - $20.8 MILLION
Secretary Greenstein said that he has taken steps to reduce DHH personnel by 353 positions. He said that DHH adhered to the following philosophy when they went through the allocation of health care cuts, as follows:
- Make administrative changes needed to run agencies more efficiently
- Yield Savings in areas that are not providing much value to taxpayers or program recipients
- Create efficiencies that create continued savings into future fiscal years.
The cuts to DHH are allocated as follows:
Office of the Secretary – $1,012,306
Medicaid Eligibility – $660,506
Medicaid Clawback – $3,415,944
Behavioral health – $2,086,993
Office of Public Health – $6,802,397
Aging and Adult Services – $750,000
Citizens with Developmental Disabilities – $1,503,718
Human Services Districts and Authorities – $2,482,965
DD Council – $32,405
LERN – $57,538
Carry from FY 11 Freeze (July 2010) – $1,999,694
DHH will realize $1 million of savings through the Office of the Secretary and the elimination of 37 positions. Senator Lafleur questioned Secretary Greenstein about his tour of the state and asked him about his preliminary observations. Greenstein said “we need to be able to deliver high quality care at a good value. I want to make sure we match every single dollar that we can.”
Secretary Greenstein told the fiscal panel that first he eliminated vacant positions. He said that DHH will save $1.2 million through more efficient staffing within their own administration. Duties and responsibilities will be absorbed by remaining employees
Medical Vendor Administration
Process and Enrollment Process
This section works on eligibility and enrollment. The section is recognized nationally as being efficient. There are 47 layoffs in this section. DHH is using better technology. As a result, they don’t need as many people in this section.
Senator Donahue asked about the coordinated care networks. Ten percent administrative cost with the program as administered currently.
Community Care Program
“Our goal is to come out of the box as being at the bottom off all the important healthcare indicators,” Greenstein said adding that “while it is accurate to say that the current Medicaid program is being administered efficiently, the state is not getting the yields or outcomes we desire.”
As a result of Act 384, behavioral health and mental health were merged into one division this year.
Senator Karen Carter Peterson said that in her area of the state (Orleans Parish) there is a tremendous problem with behavioral health and mental health, especially Post-Katrina and Post-BP Gulf Oil spill. She said that it’s impossible to do more with less. “You do less with less.” She said that it is not appropriate for the Department of Health and Hospital to say that a cut to behavioral health will have no anticipated impact to clients or services. Greenstein said he agrees with Senator Peterson’s assertion. He said that often times they use budget speak.
Reduce Pinecrest SSC expenditures by 5 percent
Pinecrest is in Rapides Parish. The impact is the elimination of 22 vacant positions and the immediate elimination of 31 filled student labor positions.
The total reduction of this cut is $2,871,252.00
DHH will close the state-owned public health units in Orleans Parish and St. Bernard Parish and will reconfigure DHH staffing of parish owned public health units in selected parishes throughout the rest of the state.
Greenstein said that because of the existence of the new community clinics – in lmost 90 the DHH noted there was duplication in services. The total reduction in the area of public health units is $3, 844,520.
DHH now plans to run some of the parish health units three days on, two days off. These clinics were having a lot of no-shows.
Office of Public Health
Secretary Greenstein said there were 19,740 visits to the public heath units statewide. Karen Carter Peterson questioned the wisdom of closing the Women’s Clinic PHU in Orleans Parish.
HIV, STD and TB – Integration
In other states these public health functions have been combined into one section. DHH is eliminating two positions that are vacant.
School Based Health Clinics
Secretary Greenstein announced that there are fifty-nine contracts with school-based clinics throughout Louisiana. The state's reduction is $600,000. “We are reducing our financial commitment to the SBHCs and will work to ensure that for students eligible, they will be able to receive a Medicaid match,” he said.
Secretary Greenstein said “seventy percent of the children (seen in a SBHC) are Medicaid eligible. This is a great access point for primary and presentation care.”
Secretary Greenstein said “Cuts are cuts. They are hard. This is a 6.5 percent cut. It is critical that we don’t walk away from this. He said he has been meeting with each of the managed care plans who want to participate in the SBHC. “School-based healthcare is a basic bargain.
Clayton Williams, assistant secretary of the Office of Public Health, added, “We are absolutely committed to providing the services. We met two days ago with representatives of the state association. There are a lot of green flags for school-based healthcare. There are federal grant opportunities. We want to lessen their dependency on state dollars.”
Senator Sherri Cheek said that while the slide shows that the reduction to school-based health clinics is only $600,000, it will be very difficult for a school-based clinic to make up this cut in Medicaid billing. The cut equates to about $9,000 per school-based health center contract.
Secretary Greenstein said they will start working with the clinics right away to help them ramp up to bill and ensure that the coordinated care networks include school-based clinics in their networks.