Louisiana Medical Assistance Trust Fund, Amendment 1 (2014)
- 1 Text of measure
- 2 Background
- 3 Support
- 4 Opposition
- 5 Path to the ballot
- 6 Related measures
- 7 See also
- 8 External links
- 9 References
The Louisiana Medical Assistance Trust Fund, Amendment 1 is on the November 4, 2014 ballot in Louisiana as a legislatively-referred constitutional amendment. The measure, upon voter approval, would give constitutional protection to the Medical Assistance Trust Fund. It would forbid the legislature from raiding the trust fund to use funds for other budgetary purposes. The measure would also set a baseline compensation rate for nursing homes, pharmacies and intermediate-care facilities that pay provider fees.
Amendment 1 does not establish any new provider fees.
Text of measure
- Note: While the ballot question says, "to create," there is already a statutorily defined trust fund. The amendment will make this fund constitutionally defined.
The official ballot text reads as follows:
|“||Do you support an amendment to authorize the legislature to create the Louisiana Medical Assistance Trust Fund, for the payment of Medicaid reimbursement to the health care provider groups paying fees into the fund?
(Adds Article VII, Section 10.14)
- See also: Article VII, Louisiana Constitution
|§10.14. Louisiana Medical Assistance Trust Fund
(A) There is hereby established as a special fund in the state treasury the Louisiana Medical Assistance Trust Fund, hereinafter referred to as "the fund", which shall consist of monies generated by fees as provided for in law. Subject to the exceptions contained in Article VII, Section 9(A) of this constitution, and after compliance with the requirements of Article VII, Section 9(B) of this constitution relative to the Bond Security and Redemption Fund, the treasurer shall deposit all proceeds from the fees collected as provided for in laws relative to the Louisiana Medical Assistance Trust Fund into the fund. The monies in the fund shall be invested by the state treasurer in the same manner as monies in the state general fund. All interest earned from the investment of monies in the fund shall be deposited in and remain to the credit of the fund. All unexpended and unencumbered monies remaining in the fund at the close of each fiscal year shall remain in the fund.
(B) The treasurer is hereby authorized to establish a separate account within the fund for each health care provider group in which fees are collected according to law. Monies collected from each provider group, and the interest earned on those monies, shall be deposited into the account created for that provider group. Any monies deposited into the fund from sources not required by law, and the interest earned on those monies, shall be deposited into a separate account within the fund, hereafter referred to as "the general account".
(C) The legislature is authorized to appropriate monies from the fund only if the appropriation is eligible for federal financial participation under Title XIX of the Social Security Act, or its successor. The balance of each account shall be appropriated for reimbursement of services to the provider group which paid the fee into the account in any fiscal year, except monies deposited into the general account may be appropriated for any Medicaid Program expenditure.
(D) The monies appropriated from the provider accounts in the fund shall not be used to displace, replace, or supplant appropriations from the state general fund for the Medicaid Program below the amount of state general fund appropriations to the Medicaid Program for Fiscal Year 2013-2014.
Medical Assistance Trust Fund
Currently, nursing homes, community pharmacies and intermediate-care facilities are assessed a fee, which is deposited into the Louisiana Medical Assistance Trust Fund. Money in the fund is used to "draw down" federal dollars through the Federal Medicaid Matching Rate. These Medicaid dollars are used to compensate medical care facilities that provide care to low-income patients. The nursing homes, community pharmacies and intermediate-care facilities that paid a fee are, in return, given back more money due to the federal funds and at no extra cost to taxpayers.
The federal money, however, has been used for other healthcare needs, rather than for the healthcare facilities who paid the provider fees.
The measure was introduced into the legislature by Rep. Charles Kleckley (R-36).
- Sen. Ronnie Johns (R-27)
- Sen. Fred Mills, Jr. (R-22)
- Sen. Gregory Tarver (D-39)
- Rep. Charles Kleckley (R-36)
- Rep. Walt Leger III (D-91)
- Louisiana Hospital Association
The Public Affairs Research Council provided arguments for and against the constitutional amendment. The following is the council's argument in support:
|“||Quality institutional healthcare for the elderly and disabled should be among the state’s highest priorities. Funding for these services should receive the maximum possible financial protection. This amendment would provide protections for these health care providers by constitutionally dedicating funds that result from the provider fees paid by these groups.
Many other states have a provider fee program for nursing homes and intermediate care facili- ties. The amendment would not increase a fee or create a new one but would simply revise and protect how the current fee is used. The newly required minimum financing system would guarantee that the healthcare providers would get a fair deal in return for their fee investment. The minimum reimbursement rate for providers could change the incentive structure to per- suade more providers to offer medical services. Increasing the number of providers can bring greater competition to the marketplace. 
—Public Affairs Research Council
The Public Affairs Research Council provided arguments for and against the constitutional amendment. The following is the council's argument against:
|“||This amendment would reduce the state’s budget flexibility. Higher education could be at greater risk for budget reductions. Constitutional provisions that limit the budgetary options of policymakers should be avoided. This change would make management of the Medicaid program more difficult.
Some advocates of home and community based long-term health care are critical of this amendment. They say it fosters a system that will weigh against individuals with disabilities who want to remain in their homes and communities but will have less opportunity for home care compared with institutionalized care in nursing homes. Such disparate treatment has triggered court cases in the past and could lead to additional litigation. 
—Public Affairs Research Council
Path to the ballot
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- See also: Amending the Louisiana Constitution
State Representative Charles Kleckley (R-36) introduced the amendment into the legislature on March 29, 2013. The measure was approved through a two-thirds vote in both legislative chambers. HB 533 was approved by the Louisiana Senate on May 28, 2013. The amendment was approved by the Louisiana House of Representatives on June 2, 2013.
May 28, 2013 Senate vote
|Louisiana HB 533 Senate Vote|
June 2, 2013 House vote
|Louisiana HB 533 House Vote|
- Louisiana Legislature, "House Bill No. 533," accessed January 16, 2014
- Public Affairs Research Council, "Guide to the 2014 Constitutional Amendments," accessed September 12, 2014
- Note: This text is quoted verbatim from the original source. Any inconsistencies are attributed to the original source.
<ref>tag; no text was provided for refs named
Cite error: Invalid
- Louisiana Hospital Association, "HB 532 and HB 533: Louisiana Hospital Stabilization Formula & Fund and Other Provider Protections," accessed January 16, 2014
- Louisiana Legislature, "Bill Info - HB 533," accessed January 16, 2014
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