HLS 14RS-1185 ORIGINAL
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Regular Session, 2014
HOUSE BILL NO. 536
BY REPRESENTATIVE SMITH
MEDICAID: Provides for the Louisiana Health Care Independence Act
AN ACT1
To enact Chapter 8-B of Title 46 of the Louisiana Revised Statutes of 1950, to be comprised2
of R.S. 46:979.1 through 979.6, relative to the Louisiana Health Care Independence3
Act; to provide for the creation and administration of the Louisiana Health Care4
Independence Program; to provide for access to basic health insurance coverage for5
Louisiana citizens with certain levels of income; to provide for legislative findings6
and intent; to provide definitions; to provide for certain waiver applications and7
Medicaid state plan amendments; to provide for medical assistance programs; to8
provide relative to funding and legislative oversight; to provide for eligibility factors;9
to provide for reports; to provide relative to termination of the program; to provide10
terms, conditions, and procedures; and to provide for related matters.11
Be it enacted by the Legislature of Louisiana:12
Section 1. Chapter 8-B of Title 46 of the Louisiana Revised Statutes of 1950,13
comprised of R.S. 46:979.1 through 979.6, is hereby enacted to read as follows:14
CHAPTER 8-B. LOUISIANA HEALTH CARE INDEPENDENCE PROGRAM15
§979.1. Title16
This Chapter shall be known and may be cited as the "Louisiana Health Care17
Independence Act".18 HLS 14RS-1185 ORIGINAL
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§979.2. Definitions1
As used in this Chapter, the following terms have the following definitions,2
unless the context clearly indicates otherwise:3
(1) "ACA" and "Affordable Care Act" mean the following acts of Congress,4
collectively:5
(a) The Patient Protection and Affordable Care Act, which originated as H.R.6
3590 in the One Hundred Eleventh United States Congress and became Public Law7
111-148.8
(b) The Health Care and Education Reconciliation Act, which originated as9
H.R. 4872 in the One Hundred Eleventh United States Congress and became Public10
Law 111-152.11
(2) "Cost sharing" means the portion of the cost of a covered medical service12
that must be paid by or on behalf of eligible individuals, consisting of copayments13
or coinsurance, but not deductibles.14
(3) "Department" means the Department of Health and Hospitals.15
(4) "Health insurance marketplace" means the federal vehicle created to help16
individuals, families, and small businesses shop for and select health insurance17
coverage in a way that permits comparison of available qualified health plans based18
upon price, benefits, services, and quality, regardless of the governance structure of19
the marketplace.20
(5) "Medicaid" and "medical assistance program" mean the medical21
assistance program provided for in Title XIX of the Social Security Act.22
(6) "Program" means the Louisiana Health Care Independence Program23
established by this Chapter.24
(7) "Qualified health plan" means a federally certified individual health25
insurance plan offered by a carrier through the federal health insurance marketplace,26
or any state certified individual health insurance plan approved by the Centers for27
Medicare and Medicaid Services.28 HLS 14RS-1185 ORIGINAL
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(8) "Secretary" means the secretary of the Department of Health and1
Hospitals.2
§979.3. Legislative findings; purpose3
A. The Legislature of Louisiana does hereby find and declare that, due to4
compelling moral and economic reasons, participation in the expansion of Medicaid5
eligibility as provided in the ACA, or through the creation of any alternative health6
insurance program that maximizes access to health care for Louisiana residents7
whose income is at or below one hundred thirty-eight percent of the federal poverty8
level, is in the best interest of this state.9
B. The purposes of this state in maximizing the efficient use of federal funds10
to provide access to health care for Louisiana residents whose income is at or below11
one hundred thirty-eight percent of the federal poverty level, as required by this12
Chapter, are as follows:13
(1) To maximize the number of Louisianians who are covered by some form14
of health insurance.15
(2) To provide basic health insurance coverage to the citizens of Louisiana16
whose income is at or below one hundred thirty-eight percent of the federal poverty17
level.18
(3) To assure health care providers who serve low to moderate income19
persons of some amount of compensation for the care they provide.20
§979.4. Administration of the Louisiana Health Care Independence Program by the21
Department of Health and Hospitals22
A. The department shall create and administer the Louisiana Health Care23
Independence Program, and shall promulgate rules to implement the provisions of24
this Section in accordance with the Administrative Procedure Act.25
B. On or before September 1, 2014, the department shall submit and apply26
for all of the following:27
(1) Federal waivers necessary to implement the program in a manner28
consistent with this Chapter, including without limitation approval for a29 HLS 14RS-1185 ORIGINAL
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comprehensive waiver under Section 1115 of the Social Security Act, 42 U.S.C.1
1315.2
(2) Medicaid state plan amendments necessary to implement the program in3
a manner consistent with this Chapter.4
C. Implementation of the program shall be conditioned upon the receipt of5
necessary federal approvals.6
D. The program may include premium assistance for eligible individuals to7
enable their enrollment in a qualified health plan through the federal health insurance8
marketplace.9
E. The department is hereby authorized to pay supplemental cost-sharing10
subsidies directly to qualified health plans for enrolled eligible individuals.11
F. The department shall accomplish the following:12
(1) Pursue strategies that promote insurance coverage of children in their13
parents' or caregivers' plan, including children eligible for the LaCHIP, the Louisiana14
Children's Health Insurance Program.15
(2) Provide every Louisiana citizen whose income is at or below one16
hundred thirty-eight percent of federal poverty level Medicaid coverage or access to17
health insurance with health benefits as provided by federal law.18
(3) Develop and implement a strategy to inform Medicaid recipient19
populations whose needs would be reduced or better served through participation in20
the federal health insurance marketplace.21
G. The program authorized by this Chapter shall terminate within one22
hundred twenty days after a reduction in any of the following federal medical23
assistance percentages:24
(1) One hundred percent in 2015 or 2016.25
(2) Ninety-five percent in 2017.26
(3) Ninety-four percent in 2018.27
(4) Ninety-three percent in 2019.28
(5) Ninety percent in 2020 or any year after 2020.29 HLS 14RS-1185 ORIGINAL
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H. The department shall require each adult who enrolls in the program to1
affirmatively acknowledge all of the following:2
(1) The program is neither a perpetual right provided by the federal or state3
government nor a guarantee of assistance.4
(2) The program is subject to cancellation upon appropriate notice.5
(3) The program is not an entitlement program.6
I. The state may implement cost sharing and copays as a condition of7
participation in the program for program participants whose earnings exceed fifty8
percent of the applicable federal poverty level.9
J. The department shall recommend adjustments in program funding to the10
legislature, and the legislature shall make such adjustments as appropriate.11
K. On a quarterly basis, the department shall report to the Joint Legislative12
Committee on the Budget, within two weeks of the end of each quarter, information13
regarding the following aspects of the program:14
(1) Program enrollment.15
(2) Patient experience.16
(3) Economic impact including enrollment distribution.17
(4) Carrier competition.18
(5) Success in avoiding uncompensated care.19
§979.5. Medicaid program outcomes; reporting requirements20
A. On or before July 1, 2015, and annually thereafter, the secretary of the21
department shall provide to the House and Senate committees on health and welfare22
and to the governor a written report covering the most recent one-year period which23
includes at minimum all of the items required hereafter in this Section.24
B. The secretary shall make the report provided for in this Section publicly25
available on its Internet website.26
C. The report shall include but shall not be limited to the following items:27 HLS 14RS-1185 ORIGINAL
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(1) Evaluation of major barriers to access to health care by Medicaid1
enrollees of this state and participants in the Louisiana Health Care Independence2
Program, and recommendations for policy changes to eliminate such barriers.3
(2) Summary of successful initiatives in this state for disease prevention and4
early diagnosis and management of chronic conditions among Medicaid enrollees of5
this state and participants in the program.6
(3) Such other information as the secretary deems appropriate to convey a7
clear and sufficiently complete assessment of the impact of the program.8
§979.6. Termination9
When federal funding is no longer available to fund ninety percent of the10
total cost of operating the program, the legislature shall have the authority to decide11
whether to continue the program.12
Section 2. This Act shall become effective upon signature by the governor or, if not13
signed by the governor, upon expiration of the time for bills to become law without signature14
by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If15
vetoed by the governor and subsequently approved by the legislature, this Act shall become16
effective on the day following such approval.17
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
Smith HB No. 536
Abstract: Provides for expansion of Medicaid through a program of premium assistance
to be known as the "La. Health Care Independence Program".
Proposed law directs the Dept. of Health and Hospitals (DHH) to create and administer a
program to be known as the Louisiana Health Care Independence Program. Provides for
definitions of terms relating to the program.
Proposed law provides for legislative findings declaring that participation in the expansion
of Medicaid eligibility, or the creation of any alternative health insurance program that
maximizes access to health care for Louisiana residents whose income is at or below 138%
of the federal poverty level, is in the best interest of Louisiana.
Proposed law provides that the purposes of the state in maximizing the efficient use of
federal funds to provide access to health care for Louisiana residents whose income is at or
below 138% of the federal poverty level as required by proposed law are as follows: HLS 14RS-1185 ORIGINAL
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(1)To maximize the number of Louisianians who are covered by some form of health
insurance.
(2)To provide basic health insurance coverage to the citizens of Louisiana whose
income is at or below 138% of the federal poverty level.
(3)To assure health care providers who serve low to moderate income persons of some
amount of compensation for the care they provide.
Proposed law requires DHH to promulgate rules in accordance with the APA to implement
proposed law. Further requires that DHH, on or before Sept. 1, 2014, submit and apply for
all of the following:
(1)Federal waivers necessary to implement the program in a manner consistent with
proposed law, including without limitation approval for a comprehensive waiver
under Section 1115 of the Social Security Act, 42 U.S.C. 1315.
(2)Medicaid state plan amendments necessary to implement the program in a manner
consistent with proposed law.
Proposed law provides that implementation of the program shall be conditioned upon the
receipt of necessary federal approvals.
Proposed law provides that the program may include premium assistance for eligible
individuals to enable their enrollment in a qualified health plan through the federal health
insurance marketplace.
Proposed law authorizes DHH to pay supplemental cost-sharing subsidies directly to
qualified health plans for enrolled eligible individuals.
Proposed law directs DHH to pursue strategies that promote insurance coverage of children
in their parents' or caregivers' plan, including children eligible for the La. Children's Health
Insurance Program (LaCHIP).
Proposed law directs DHH to provide every La. citizen whose income is at or below 138%
of the federal poverty level with either Medicaid coverage or access to health insurance with
essential health benefits as provided by federal law. Further directs DHH to develop and
implement a strategy to inform Medicaid recipient populations whose needs would be
reduced or better served through participation in the federal health insurance marketplace.
Proposed law provides the program shall terminate within 120 days after a reduction in any
of the following federal medical assistance percentages:
(1)100% in 2015 or 2016.
(2)95% in 2017.
(3)94% in 2018.
(4)93% in 2019.
(5)90% in 2020 or any year thereafter.
Proposed law requires that each adult who enrolls in the program affirmatively acknowledge
all of the following:
(1)The program is neither a perpetual right provided by the federal or state government
nor a guarantee of assistance. HLS 14RS-1185 ORIGINAL
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(2)The program is subject to cancellation upon appropriate notice.
(3)The program is not an entitlement program.
Proposed law provides the state may implement cost sharing and co-pays, as a condition of
participation, for program participants whose earnings shall exceed 50% of the applicable
federal poverty level.
Proposed law provides that DHH shall recommend adjustments in program funding to the
legislature, and that the legislature shall make such adjustments as appropriate.
Proposed law provides that on a quarterly basis, DHH shall report to the Joint Legislative
Committee on the Budget, within two weeks of the end of each quarter, information
regarding the following aspects of the program:
(1)Program enrollment.
(2)Patient experience.
(3)Economic impact including enrollment distribution.
(4)Carrier competition.
(5)Success in avoiding uncompensated care.
Proposed law requires that on or before July 1, 2015, and annually thereafter, the secretary
of DHH shall provide to the legislative committees on health and welfare and the governor
a written report covering the most recent one-year period which includes at minimum all of
the following items:
(1)Evaluation of major barriers to access to health care by Medicaid enrollees of this
state and participants in the Louisiana Health Care Independence Program, and
recommendations for policy changes to eliminate such barriers.
(2)Summary of successful initiatives in Louisiana for disease prevention and early
diagnosis and management of chronic conditions among Medicaid enrollees of this
state and participants in the program.
(3)Such other information as the secretary deems appropriate to convey a clear and
sufficiently complete assessment of the impact of the program.
Proposed law requires DHH to make the report provided for in proposed law publicly
available on its website.
Proposed law provides that when federal funding is no longer available to fund 90% of the
total cost of operating the program, the legislature shall have the authority to decide whether
to continue the program.
Effective upon signature of governor or lapse of time for gubernatorial action.
(Adds R.S. 46:979.1-979.6)