Spending on Social Welfare Programs in Rich and Poor States. Final Report.. Other Federal Social Welfare Programs

07/01/2004

Louisiana's Medicaid and LaCHIP (Louisiana's SCHIP program) programs are administered by the Department of Health and Hospitals (DHH). The number of Medicaid enrollees including LaCHIP, increased 17 percent from 1997 to 2002. This enrollment increase was primarily for children, due to the successful outreach efforts to enroll them in LaCHIP. In SFY 2003, Louisiana's Medicaid program was further expanded for children, aged, and the disabled. Changes were also made for pregnant women by expanding the program in January 2003 to cover those under 200 percent of federal poverty level (after a 15 percent income disregard).

Louisiana also has a high disproportionate share hospital (DSH) cap. The availability of these large DSH funds allows the state, primarily through the state charity hospital system administered by the Louisiana State University Health Care Services Division, to provide medical care to approximately 800,000 uninsured citizens in Louisiana. DHH continues to explore ways to provide more primary care through DSH funding.

Health care comprises almost a third of the Louisiana's total budget. The state is projected to receive $3.6 billion in federal Medicaid funds for FY 2004. In SFY 2003, federal fiscal relief reduced the severity of originally planned long-term care and pharmacy cuts that had been proposed to reduce state Medicaid funding.

The SFY 2004 budget adopted by the legislature included a significant policy change affecting the operation of the state's charity hospitals. Louisiana State University (LSU) was granted more power to manage the public (charity) hospitals that it operates for the state. This allowed them to cut hospital spending by up to 35 percent of a previous year's actual expenses without legislative approval, as opposed to the up-to-10 percent previously allowed by law. Hospitals will be allowed to charge non-emergency patients whose incomes are at least twice the poverty level. Governor Blanco and the DHH secretary discussed several short-term improvements that involved (1) enrolling as many eligible children as possible into Children's Health Insurance Program and, (2) increasing the number of federally qualified health centers.

The programs administered by the DHH have a powerful lobby, unlike the ones administered by the DSS. The Nursing Home Association is one of the most powerful lobby groups in Louisiana. Other influential advocacy groups include the Area Health Education Consortium, groups representing Mental Retardation Developmental Disability (MR/DD), and drug industry associations.

Louisiana's Office of Family Support within the Department of Social Services is the lead agency for the Child Care and Development Fund (CCDF). According to federal administrative data, Louisiana's total CCDF expenditures decreased from $128 million in FFY 2001 to $33 million in FFY 2002, or by 74%. This decrease is largely due to an 82 percent decline in discretionary spending, from $104 million in FFY 2001 to $19 million in FFY 2002. From FFY 2001 to FFY 2002, the TANF transfer to CCDF was cut by 25.7%. In Louisiana, recent childcare policy changes include increased co-payments, restrictions on the number of eligible families, and an increase in the number of hours parents must work to qualify for childcare assistance.

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