Medical homes get boost in Louisiana Medicaid reform effort

By Doug Trapp, AMNews staff. Dec. 15, 2008 -- The feasibility of the plan hinges on federal approval of a waiver and the release of hurricane disaster funds. Physician organizations and Louisiana Gov. Bobby Jindal agree that a medical-home model could help Medicaid provide better value to patients with low incomes or disabilities. But they disagree on whether managed care organizations should be the ones overseeing those homes. On Nov. 14, Jindal released a concept paper for Louisiana Health First, his proposal to transform the state's Medicaid program from a disjointed fee-for-service system largely dependent on hospital charity care to a program in which enrollees have their care coordinated by a primary care physician. The proposal also would expand Medicaid to cover approximately 85,000 additional children, parents and caregivers and calls for the construction of a new academic medical center in New Orleans. The Louisiana Chapter of the American Academy of Pediatrics opposes an option in the plan to allow private, for-profit managed care organizations to run the Coordinated Care Networks that would contract with physicians to provide medical homes. Managed care organizations have no track record using the medical-home model for Medicaid enrollees, said Steven B. Spedale, MD, chair of the chapter's Medicaid policy committee.