DHH officials field questions about medications and Bayou Health Program
2nd July 2012 · 0 Comments
By Zoe Sullivan
Roughly 40 people sat scattered around the Jefferson Parish Council Chamber on June 26. They had come out on a warm Tuesday evening to hear representatives from the state’s Department of Health and Hospital talk about the new Bayou Health system and to ask questions about how the revamped Medicaid program would affect access to medications. Roughly half a dozen independent pharmacists attended, and along with advocates for those living with HIV, they raised the bulk of the questions about the new system.
Dr. Rodney Wise, Louisiana’s Director of Medicaid services, gave an introductory overview to the 5 different healthcare plans that have been introduced. “The recipient is the one who makes the choice of what plan they enter,” Wise told the audience. “We set the minimum of what must be offered, but they can offer additional services,” he explained. Wise assured those present that there are complaint and grievance systems in place for these privately-managed plans, and that the state will be monitoring implementation of the care they provide as well as complaints.
According to Wise, roughly 830,000 people of the state’s 1.2 million Medicaid recipients are enrolled in the Bayou Health program. Calder Lynch, the Project Lead for Pharmacy Reform, also said that the pharmaceutical line item in the state’s Medicaid budget amounts to roughly $950 million and is the second largest item in that budget.
One social worker in the audience told the state officials that when Bayou Health letters were sent out in February telling Medicaid recipients that they had to choose a new plan, some problems arose. She gave the example of patients who needed transportation to get to dialysis treatment, but because the letter threatened dropping those who didn’t select a new program, the firm contracted to bring the patients didn’t do so because they thought the service wouldn’t be covered.
Enrique Moresco of the New Orleans AIDS Task Force told the assembly that he appreciated the state’s efforts to modernize the Medicaid system. He also pointed out that Medicaid “is the largest …payer of services for people living with HIV,” and that there are currently 17,000 people living with HIV in Louisiana. However, he noted that in order to qualify for Medicaid, one needs a disability or an AIDS diagnosis. AIDS is the stage of disease that follows HIV, but with proper treatment, its onset can be delayed or even prevented.
Moresco asked what the prospects are for expanding services to people with HIV. He also warned, “it’s the tip of the iceberg that we’re dealing with” since “it’s suspected that for every five people that we do know who are living with HIV, there’s at least one person that we don’t know about.”
Wise responded that HIV positive individuals would have access to Bayou Health if the Affordable Care Act remains in place. The Supreme Court ruled on June 28 that the law is constitutional and so will remain in force.
One of the pharmacists in the room asked whether the rules had been set around drug reimbursements. Peter Wolfe, an independent pharmacist in Chauvin pointed out that he has found himself having to decide whether to fill a prescription for a patient when the cost of doing so is not fully met by his reimbursement. State officials acknowledged this concern and expressed their willingness to do what they can to ensure that smaller, independent pharmacists are treated fairly.
Wise also described the Louisiana Behavioral Health Partnership, an initiative designed to reach more people in need of mental health services through community and preventive programs, among other things.
This article was originally published in the July 2, 2012 print edition of The Louisiana Weekly newspaper