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Medicaid Expansion: Louisiana’s Multifaceted Decision Elizabeth Scheer RN, MN, MBA Vice President, Health Grants Baptist Community Ministries Societal Dimensions of This Discussion • Political • Financial • Moral • Socioeconomic • Historic Short-term Financial Implications: BCM study developed by Dr. John Holahan, Urban Institute (June, 2013) • Reduce the uninsured by 515,000 in 2016; 60% drop, including all of ACA • Increase federal payments by $1.6 billion in 2016 and $15.8 billion between 2013 and 2022; state spending by $17 million and $1.2 billion in 2016 and 2013-2022 respectively • $6.7 billion in hospital payments between 2013 and 2022, offsetting ACA cuts to Medicaid DSH, Medicare DSH, and Medicare fee-for-service • State can offset new Medicaid spending through savings elsewhere in budget and increased revenue • Federal payments dwarf new state spending and will have positive effects on state GDP, employment, and tax revenue Medicaid Expansion and Improved Maternal Child Health: One Insight Into a Vexing Problem A Few Facts: • LA:70% of all births are to Medicaid insured women • LA ranks 49th in the country for Infant Mortality, Preterm Births, and Percentages of Low Birthweight (LBW) and Very Low Birth Rates Local Birth Outcomes and Issues of Disparity NO Low Birthweight: 11.4% Statewide Average: 10.6% US Average: 8.2% Regionally African-American Women: 14.2% vs. 7.4% for Caucasians LBW: Tragic, Expensive and Preventable • Average pre-term birth costs LA Medicaid $33,433 in the first year of life vs. average costs of only $3,671 for a term birth • Prematurity is a leading cause of neonatal and infant mortality • Lifetime consequences of prematurity often include struggles with physical, intellectual and behavioral difficulties vs. babies born full-term Public Private Partnership to Reduce Poor Birth Outcomes • Interpregnancy Care Project: Women with a previous poor birth outcome will be targeted for referral to selected primary care clinics • DHH, LPHI, City Health Department & national experts are developing: • regional primary care clinics capacity to implement evidence based care protocols that reduce subsequent preterm deliveries • Include the added component of social services support (housing assistance, transportation, food stamps, etc.) to address social determinants of health