Time: D H M S

Louisiana Medicaid expansion: OK, yeah, that makes a little more sense...

On Wednesday I noted that a whopping 175,000 Louisianans had somehow managed to enroll in the state's just-launched Medicaid expansion program within less than 12 hours of the floodgates being opened up. This was even more amazing when you consider that number represents 47% of the total people estimated to be eligible for the program state-wide (375K).

Now, obviously there's no way that 16,000 people per hour were individually visiting HealthCare.Gov or their local state health agency; on it's busiest day (December 15, 2015), HealthCare.Gov was averaging 25K/hour...but that was across 38 states, many of which are much larger than Louisiana. Instead, I assumed that LA had done something similar to Oregon/West Virginia's "fast-track" programs, where they use existing food stamp/welfare databases to automatically enroll people, not "officially" pulling the trigger until after the stroke of midnight.

Well, Andrew Sprung (Xpostfactoid) has done some legwork and found out what actually happened...and most of the answer is less dramatic than tens of thousands of residents frantically typing away at their keyboards at the same time (if no less excellent in the outcome):

1. Virtually all of those enrolled as of yesterday, a total of 189,000 by day's end, were transfers from existing limited-benefit public plans. These include 132,000 enrollees in Take Charge Plus, a program focused mainly on family planning, along with a few free office visits; and 56,000 from the Greater New Orleans Health Connection (GNOHC), a no-cost primary care program for low income people in the greater New Orleans area. GNOHC does not provide drug or hospital coverage.

2. Letters went out to enrollees in these programs in early May, inviting them to return a short form and enroll. Enrollees can choose from among several managed care Medicaid plans. Those who do not respond are assigned a plan and auto-enrolled.

...and so forth. None of this makes LA's first day results any less impressive, but it does help explain how common sense and hard organizational work on the part of the state healthcare officials can make a huge difference.

What this does mean is that the theoretical drop in the net uninsured rate, which I had pegged as being up to 276,000 people after subtracting those who *switch over* from private exchange policies, won't be nearly as impressive. Once you subtract the 188K who transferred from existing state programs, that leaves just 88,000 truly uninsured residents who could potentially get covered for the first time. Still pretty cool.

Anyway, I mention this because there's been a slight update to the tally:

#Louisiana is on Day 3 of #Medicaid expansion. Already over 192k people will have coverage on July 1. BAM!!!!!

— Jessica Kahn (@JessPKahn) June 3, 2016

OK, so that's 188K autotransfers, plus another 4,000 manually enrolling in the first 3 days. At a rate of 1,000 per day, it'll take about 5-6 months for every single eligible person to enroll, just in time for the 2017 Open Enrollment period.

UPDATE: On the other hand, as Sprung clarified, the old programs that these people were transferred from weren't necessarily "real" healthcare coverage to begin with; here's a summary of the GNOHC program, for instance:

The Greater New Orleans Community Health Connection or GNOCHC (no-kee) program provides no-cost health insurance coverage to uninsured adults ages 19 - 64. Medical services are provided at participating GNOCHC clinics in Orleans, Jefferson, St. Bernard, and Plaquemines parishes.

...What does GNOCHC cover?

  • Primary care
  • Preventative care
  • Immunizations and vaccinations
  • Care coordination
  • Lab work and x-rays
  • Behavioral health for mental health and substance abuse services
  • Some specialty care

...What does GNOCHC NOT cover?

  • Prescription drugs
  • Inpatient and outpatient hospital services
  • Emergency room visits
  • Dental care
  • Other services not listed as covered above

So, while I'm not trying to knock GNOCHC as a service, it sounds like these 188K people are still far better off now, since Medicaid is actually fairly comprehensive.