Thinking of a number between "bullshit" and "tell me how much you want"

Jindal's Medicaid privatization scheme goes into effect today.

The move overhauls much of the traditional fee-for-service system in which the state makes direct payments to health care providers who treat Medicaid patients and puts Louisiana alongside dozens of states that have implemented some kind of managed-care system for Medicaid. As of today, beneficiaries enrolled in the new system will receive their care from providers within their specific network, rather than selecting from among any provider that accepts Medicaid. The networks each won three-year contracts.

When implemented statewide, the system will affect more than 800,000 people and shift $2.2 billion in Medicaid insurance spending — about a third of the total $6.7 million budget that comes mostly from the federal treasury — to the private firms.

The network providers are due to make a significant profit for reasons that will be clear in a minute. But first note that the process by which they were selected was contentious and slightly marred by the fact that Jindal's DHH secretary Bruce Greenstein had awarded a separate claims processing contract to his former employer, CNSI.

In December a PAR study criticized the plan for several reasons including lack of legislative oversight, concern that the private networks may not be subject to open records laws, and this.

Managed-care networks, as the descendants of unpopular health management organizations that proliferated more than decades ago, are sometimes accused of producing those savings through denying needed treatments, rather than by improving care.

David Hood, a former DHH secretary who now leads PAR’s health care policy efforts, noted that Bayou Health will include, generally, the healthiest portion of the existing Medicaid population: the children and non-disabled adults. Among that population, Louisiana has among the lowest per-patient Medicaid spending in state-by-state comparisons. That, Hood said, could leave little room for the network managers to find savings -- and, thus, generate profit -- without denying needed care.

Oh but I'm sure they'll figure something out. And even if they don't, it doesn't mean we can't figure out a way to pay them. At least if I'm reading this correctly.

The network’s profit will be a management fee that is a portion of what the state calculates is saved through reducing unnecessary diagnostic tests, hospitalizations or other treatment.

And so we refer you back to the title of this post.