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Inadequate defense trial balloon for Edwards?

Perhaps the reply was well meaning, but it featured an awful lot of tap-dancing, some of it inaccurate, that won’t serve well as a counterargument.

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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