My Jul. 22 Baton
Rouge Advocate column
drew a response from Karen Scallan, who identifies herself as a member of the
state’s OCDD System Transformation Workgroup. She is visible in the disability
community as a consultant who helps people unravel the complex world of
Medicaid provision to people with disabilities.
In a Jul. 27 letter
to The Advocate, Scallan refers to my
column as having my “heart in the right place.” My piece applauded the Louisiana Department of Health
for erasing a 10,000-person waiting list for Medicaid waiver services, and
explored ways, using existing revenues sources without raising taxes, to address
that the “changes haven’t helped provide all
necessary assistance [italics added] to 28,000 people with more complex and
intense needs.”
Unfortunately, Scallan didn’t appear to read that part
carefully enough, because in her letter she asserted falsely that I “stated the
changes haven’t helped 28,000 people with more complex/intense needs.” As the
sentence fragment above demonstrates, she somehow misunderstood that.
She also wrote that “We also never had 38,000 on
waiting lists for OCDD services,” as if I had written that. In fact, my lead simply
stated “Ten thousand down, but 28,000 more to go,” which is not the same thing.
There, I merely restated the facts: the Office of Citizens with Developmental
Disabilities had cleared 10,000 names off the various waiting lists (in fact,
the lists in question went as high as 16,000 at their apogee), but still 28,000
remained with incomplete services provision.
Those errors aside, her letter is notable in that it
tries to lay the groundwork for a Gov. John
Bel Edwards Administration defense of its refusal
to adopt a managed care model for long-term services and supports. That
could save the state around $200 million a year – much of that because of a
state 5.5 percent tax on health insurance policies that Edwards ordered doubled
to afford Medicaid expansion – but has faced stiff resistance from the nursing
home industry because some savings would come from moving some clients out of
nursing homes and into the community. At least 14 percent of current Louisiana
nursing home residents paid for by Medicaid would qualify.
Each of the last two years bills have come before
the Legislature to mandate the shift to managed care. Each time, a combination
of nursing home interests and the Edwards Administration – the governor
actually could order it on his own without legislation – have beaten back
these.
Scallan parrots arguments made by the nursing home
industry when she writes that the change to managed care would be “catastrophic
for many with developmental disabilities. There are no actuarially sound bases
for moving people with developmental disabilities into managed care.” She
leaves unanswered the next logical question to her assertion: if so, then why
do 24
states currently run 41 MLTSS systems the likes of which the Gov. Bobby
Jindal Administration initially recommended Louisiana should pursue, only
to abandon the effort in the face of resistance from nursing home lobbyists?
Then, as if to discredit the manage care solution
further, Scallan argues that “OCDD’s Resource Allocation system, which has been
in place for the NOW waiver for years, has saved more money than any shift to
managed care for long term supports in the country.” The Resource
Allocation Model to which she refers, implemented by the Jindal
Administration nearly a decade ago, matched identified needs to provision
requirements – and was highly
controversial then with much opposition from interests that typically
support Edwards today.
But just because Louisiana utilizes a RAM that
saves dollars doesn’t mean it can’t also pursue MLTSS that can do the same.
Scallan implies these are mutually exclusive; they aren’t.
Perhaps the most interesting aspect of the letter
is if its argumentation becomes used as a trial balloon by Edwards to defend
his decision, having promised otherwise in his first campaign, not to pursue
MLTSS. If so, it comes up quite a bit short.
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