Levine warns of coming crisis

With a hole in the state budget and Democratic administration in the White House, will state Department of Health and Hospitals Secretary Alan Levine’s plan to revamp health care in Louisiana—which took a lot of work to put together—ever get out of the starting gate? Expanding Medicaid, a central piece of the plan, may or may not happen depending on what President Barack Obama does in terms of national health care policy. Changing how Medicaid works requires a waiver from the federal Centers for Medicare & Medicaid Services, and CMS is experiencing a temporary post-election leadership vacuum. Other pieces, such as the disease management program Levine wants to set up, don’t require a waiver. “It’s not all or nothing,” he says. The federal money known as disproportionate share funds, in which Louisiana gets to help pay for medical care for the uninsured, is being reduced significantly next year, making it all the more critical that the state find efficiencies in its Medicaid program. In 2004, Louisiana spent 10% of its budget on health care, while this year it was 22%, Levine says. “Next year we’ll have a $456 million hole to plug,” he says. “If we wait until next year or later to deal with efficiency issues, we’ll have a crisis of our own making.”—Steve Clark