AcidicBasicGlitch

cross-posted from: https://lemm.ee/post/59903645

I will put references for all of this info in a comment to save space:

So back in Feb Landry announced he found $11M in savings from Louisiana Department of Health (LDH).

It turns out that a few weeks before that, Louisiana DOGE held secret meetings with Tara LeBlanc, an employee who works for Guidehouse, a consulting firm in the DC area. Before she worked for Guidehouse, she was director of Medicaid at LDH. Since these meetings were held in secret, there is no public record and we don't know what they actually discussed (which is a violation of transparency law).

1 week after Landry said he found $11M in savings, he announces LA DOGE was partnering with the LA Legislative auditor to find savings.

A little under two weeks after that, the LA Legislative auditor releases a report saying that LDH is being audited for misspending funds for Medicaid program MCIP, which was designed to enhance health outcomes for patients on Medicaid. The program was created in 2018 and implemented in 2019.

The audit is blaming the hospitals that were running the programs. However, think back to that secret meeting for a second: A Guidehouse description of Tera Leblanc welcomes the former Medicaid Executive Director for the LA Department of Health, and says she previously "designed and implemented plans to elevate Louisiana’s pioneering public health emergency unwinding strategy and enhance outcomes for Medicaid beneficiaries."

Tera LeBlanc was deputy and then executive director of Medicaid from (2019-2023). This means that LeBlanc was involved in designing and implementing plans to improve outcomes for Medicaid beneficiaries during 4 of the 5 years (2019-2024) that the Louisiana Legislative Auditor claims MCIP funds were misspent on administrative costs such as submitting reports and meetings.

Why do I bring up your LCMC doctors?

Around the time this audit was announced, I learned that several doctors who accept Medicaid were suddenly no longer with LCMC. Nobody seems to understand exactly what is going on. Nurses trying direct people on where to find care are being informed by patients that doctors they are recommending patients contact are no longer with LCMC. There is no reporting on this, which is why I am asking people to help me figure out exactly how widespread this issue is.

According to Landry's team, they found $11M in savings at LDH by eliminating contracts and almost 60 of the health department’s 7,700 employment positions in an effort to reduce spending. I would really like to see exactly what contracts and positions those were.

However, Landry's team also says the overall LDH budget for next year is also increasing due to Medicaid costs being out of their control. This is all apparently coming from federal money, but the day after an article came out clarifying that LDH budget was increasing by $1.5B, another article came out that said the Federal DOGE was suddenly slashing $55M in grant money already given to LDH. Some grants had already expired, but others hadn't.

The most recent estimate of budget elimination when considering expired vs not expired grants is ~$10M. Now LDH is having to figure out how to make up for that $10M in other ways. Which seems like it kind of offsets any "$11M savings" Landry found, but honestly I am very confused by most of this.

I do know that the LA Surgeon General Ralph Abraham, who has long opposed Medicaid expansion, claims that one reason the Medicaid budget is growing is because they have to offer doctors more money as an incentive to get them to accept Medicaid.

You've probably heard the often repeated phrase "no doctors want to accept Medicaid patients." So why were several doctors that accept Medicaid patients abruptly no longer practicing at LCMC?

Seems kind of counter intuitive to claim you need more money to pay doctors to incentivise them, only to have one of your largest contractors suddenly no longer employ doctors who have been accepting Medicaid patients for years, right?

If you get rid of all the doctors that will accept Medicaid, then it becomes pretty easy to prove the point that no doctors want to accept patients on Medicaid. Weird.

I will put references for all of this info in a comment to save space:

So back in Feb Landry announced he found $11M in savings from Louisiana Department of Health (LDH).

It turns out that a few weeks before that, Louisiana DOGE held secret meetings with Tara LeBlanc, an employee who works for Guidehouse, a consulting firm in the DC area. Before she worked for Guidehouse, she was director of Medicaid at LDH. Since these meetings were held in secret, there is no public record and we don't know what they actually discussed (which is a violation of transparency law).

1 week after Landry said he found $11M in savings, he announces LA DOGE was partnering with the LA Legislative auditor to find savings.

A little under two weeks after that, the LA Legislative auditor releases a report saying that LDH is being audited for misspending funds for Medicaid program MCIP, which was designed to enhance health outcomes for patients on Medicaid. The program was created in 2018 and implemented in 2019.

The audit is blaming the hospitals that were running the programs. However, think back to that secret meeting for a second: A Guidehouse description of Tera Leblanc welcomes the former Medicaid Executive Director for the LA Department of Health, and says she previously "designed and implemented plans to elevate Louisiana’s pioneering public health emergency unwinding strategy and enhance outcomes for Medicaid beneficiaries."

Tera LeBlanc was deputy and then executive director of Medicaid from (2019-2023). This means that LeBlanc was involved in designing and implementing plans to improve outcomes for Medicaid beneficiaries during 4 of the 5 years (2019-2024) that the Louisiana Legislative Auditor claims MCIP funds were misspent on administrative costs such as submitting reports and meetings.

Why do I bring up your LCMC doctors?

Around the time this audit was announced, I learned that several doctors who accept Medicaid were suddenly no longer with LCMC. Nobody seems to understand exactly what is going on. Nurses trying direct people on where to find care are being informed by patients that doctors they are recommending patients contact are no longer with LCMC. There is no reporting on this, which is why I am asking people to help me figure out exactly how widespread this issue is.

According to Landry's team, they found $11M in savings at LDH by eliminating contracts and almost 60 of the health department’s 7,700 employment positions in an effort to reduce spending. I would really like to see exactly what contracts and positions those were.

However, Landry's team also says the overall LDH budget for next year is also increasing due to Medicaid costs being out of their control. This is all apparently coming from federal money, but the day after an article came out clarifying that LDH budget was increasing by $1.5B, another article came out that said the Federal DOGE was suddenly slashing $55M in grant money already given to LDH. Some grants had already expired, but others hadn't.

The most recent estimate of budget elimination when considering expired vs not expired grants is ~$10M. Now LDH is having to figure out how to make up for that $10M in other ways. Which seems like it kind of offsets any "$11M savings" Landry found, but honestly I am very confused by most of this.

I do know that the LA Surgeon General Ralph Abraham, who has long opposed Medicaid expansion, claims that one reason the Medicaid budget is growing is because they have to offer doctors more money as an incentive to get them to accept Medicaid.

You've probably heard the often repeated phrase "no doctors want to accept Medicaid patients." So why were several doctors that accept Medicaid patients abruptly no longer practicing at LCMC?

Seems kind of counter intuitive to claim you need more money to pay doctors to incentivise them, only to have one of your largest contractors suddenly no longer employ doctors who have been accepting Medicaid patients for years, right?

If you get rid of all the doctors that will accept Medicaid, then it becomes pretty easy to prove the point that no doctors want to accept patients on Medicaid. Weird.

For the most part Louisiana, pretty much tends to be the epitome of voter apathy.

2/3rds of voters showed up and said fuck fascism. We might not win, but we're not going down without a fight.

If we can do it, anyone can.

Here are the 2023 salaries for the CEO, President, and COO of the largest chain of hospitals in Louisiana, LCMC.

Here is some information about Louisiana and Federal cuts to Medicaid if it's allowed to be released from the freedom loving, patriotic state of Louisiana:

https://pimento-mori.ghost.io/louisiana-doge-secret-meetings-may-have-involved-plans-to-cut-medicaid-2/

Sorry if this posted twice. My Internet is being really weird today.

3/29/25 Update: When I first published this post, the budget cuts I was referring to were based on Governor Landry's own announcement of his proposed 2026 fiscal budget. The governor announced on February 19, that the proposed 2026 budget was based on discovering efficiencies such as $11M in savings from the Louisiana Department of Health (LDH).

https://gov.louisiana.gov/index.cfm/newsroom/detail/4768

One week after the governor's budget announcement, the governor announced his Louisiana DOGE taskforce would be partnering with a Louisiana Legislative auditor to eliminate unnecessary spending.

https://www.nola.com/news/politics/jeff-landrys-louisiana-doge-to-work-with-auditors/article_9fae9dc4-f478-11ef-8d56-332511026662.html

A little under two weeks after the announcement of this partnership, the LDH was accused of misspending Medicaid money between 2019-2024 by the Louisiana legislative auditor.

https://www.nola.com/news/healthcare_hospitals/louisiana-health-department-failed-to-oversee-parts-of-state-medicaid-program-audit-says/article_c59da822-fdfb-11ef-8015-9f4118cb1f63.html?ref=pimento-mori.ghost.io

Although I did not include this information in my original post, one of the largest hospital systems in Louisiana (LCMC), which includes several of the hospitals named in the above article, abruptly lost several physicians around the time this audit was announced.

I did not include this piece of information in my original post because there has been no official reporting regarding this information. However, the sudden loss of my own provider as well as learning several others in Louisiana also abruptly lost established providers after being given the same vague information that their doctors were just no longer practicing at LCMC, is a large part of what motivated me to write this post in the first place. I still do not know why so many physicians have suddenly left LCMC, but I mention that information here for a reason I will explain in this update.

The same week the LDH audit was announced, Louisiana think tank, the Pelican institute, praised Landry's DOGE program. An article released from the think tank claimed the move was necessary to prevent millions of dollars wasted on inefficient Medicaid payments and bloated administrative costs.

It might be worth noting that the Pelican Institute is an affiliate of the State Policy Network (SPN), a network of think tanks across the United States that promote conservative policy at the state level. SPN was founded by an early funder of the Heritage Foundation, who served on the Heritage board of directors for two decades. SPN has previously been accused of influencing state legislation to benefit powerful corporations and groups such as the Heritage Foundation, while disguising that influence as representative of indigenous state level policy.

https://www.motherjones.com/politics/2011/04/state-policy-network-union-bargaining/

After I published my original post with all of this information, someone pointed out to me on March 25th that the LDH budget was actually increasing by $1.5B, mostly due to federal money. Allegedly, the $11M Landry found in savings was being offset by that $1.5B increase.

I was unable to find any sources that mentioned that $1.5B increase, but then on March 26th, this article was released:

https://lailluminator.com/2025/03/26/louisiana-medicaid-set-to-grow-under-landry-even-as-d-c-republicans-may-force-cuts/

"Landry’s $1.5 billion jump comes at a time when Republicans in Congress and Trump may force unprecedented cuts to Medicaid spending.

Louisiana is also running approximately $100 million over its Medicaid budget for the current budget cycle that ends June 30, according to a letter Louisiana’s interim health secretary Drew Maranto sent to legislators... The Landry administration attributes much of his proposed health care increase to costs it can’t control."

I actually mentioned Secretary Maranto in my original post. This is because one week after the announcement of the LDH audit, the Secretary of the LDH announced he was retiring. Landry then named Maranto as interim secretary.

During the announcement, Landry said that Secretary, Michael Harrington had always planned to step down from the position by Spring. Harrington took over the position of secretary after Landry created the position of surgeon general this past June.

This newly created position, shifted the previous secretary, Ralph Abraham to Louisiana Surgeon General. As Surgeon General, Abraham is responsible for state health policy and public health, while the Secretary would handle financial duties.

Before joining the LDH, Abraham had served as a Louisiana state Representative and publicly opposed Medicaid expansion. Maranto formerly served as a deputy chief of staff for Abraham before being promoted to LDH undersecretary when Harrington was hired in June.

As Surgeon General, Abraham made national news for announcing that the state of Louisiana would no longer support mass vaccinations shortly after RFK Jr. was confirmed by the Senate as secretary of Health and Human Services.

The article released on the 26th, lists several explanations provided by Maranto and Abraham for the increased Medicaid budget. These reasons include worse than expected health of Louisiana patients which requires more expensive care, increasing cost of prescriptions, increasing Physician compensation from Medicaid to incentivise more physicians to accept Medicaid patients, and the general increase of Medicaid costs experienced by most states across the country.

While these points are fairly common explanations heard across the country regarding rising Mediciad costs, the article also mentions a required cost that is unique to Louisiana which is driving increased Mediciad prices. A constitutional amendment approved 11 years ago, requires nursing homes to receive a Medicaid rate increase at least every other year, and as the article points out, nursing home owners in Louisiana are also large political donors.

The article also mentions that the governor increased Medicaid reimbursement rates by $22 million per year for hospitals in rural areas. According to the article, four of the seven hospitals that received funding were owned by Rock Bordelon, a Landry campaign donor and hunting buddy of Donald Trump Jr, while Landry increased similar rates by over $40 million per year to University Medical Center in New Orleans.

These all seem to be making strong arguments that actually favor Republican wishes to cut Medicaid funding.

While these points certainly may be something to re-evaluate, when determining Medicaid spending and questions about how that money is actually being spent, it does seem important to keep in mind a few things before throwing the baby out with the bathwater:

1. An increase every other year going towards nursing homes may be a legitimate necessity that reflects an increasing population of Louisiana residents aging and requiring nursing home care.

2. Rural hospitals in Louisiana provide care to some of the most medically underserved populations in the United States.

3. University Medical Center in New Orleans, despite not being a rural environment, also serves a large population that fits the definition of a medically underserved population.

Keeping all of these points in mind, should we be making sure Mediciad funds are actually being spent as intended?

Without a doubt.

However, simply eliminating that spending through slash and burn policies is a guarantee of harm to some of the most vulnerable citizens of Louisiana.

Increased costs for medical care may certainly be making public support of those programs unsustainable. However, one point that is not addressed in this article, or typically addresses by most politicians regardless of political party, is sort of the elephant in the room when it comes to medical costs in the United States.

What is one thing that most Americans agree is out of control and needs to be addressed when it comes to the cost of healthcare? The astoundingly large salaries of many hospital administrators across the country. So why is nobody touching it with a ten foot pole?

The article provides an explanation for Landry's claim that he found $11M in savings at LDH.

Landry allegedly eliminated $11 million worth of contracts and almost 60 of the health department’s 7,700 employment positions in an effort to reduce spending. A representative of the Louisiana Department of Administration is quoted in the article as saying this was done to get a handle on spending, but does not to provide any information about what those contracts and positions were.

The governor’s administration has also allegedly asked the federal government for permission to raise another physician payment to incentivise doctors to take on Medicaid patients, but as the article points out this would add millions more to Landry's existing Medicaid spending.

As I mentioned, several physicians, including my own, were suddenly no longer with LCMC right around the time the news was released of an audit into LDH Medicaid spending by a group of Louisiana hospitals.

There seems to be no information about why these physicians are no longer with LCMC, but the timing seems especially odd. I cannot speak regarding how many physicians were actually lost, but I do personally know that at least 3 were well known for providing excellent care to Medicaid patients in Louisiana.

Given that there are allegedly so few doctors willing to take on Medicaid patients at the current pay rate, eliminating the few physicians that do, would seem to be an odd decision to make. So could we maybe address that elephant in the room now?

I'll just leave this here for anyone who is interested. It provides the 2023 salaries for LCMC's CEO, president, and COO:

https://projects.propublica.org/nonprofits/organizations/943480131

As the article also mentions, Republicans at the federal level have been looking for opportunities to reduce federal funding and Medicaid has been in their crosshairs.

Slashing federal spending is necessary for Republicans to offer a planned tax cut to corporations and wealthy individuals. However, it's important to note that as much as 80% of the $880 billion Medicaid program is funded by federal taxpayers.

https://apnews.com/article/medicaid-cuts-work-requirements-congress-republicans-90ec1119f1d95de067c76f79eec7fa87?ref=pimento-mori.ghost.io

While the rising cost of Medicaid is being blamed on poor people, sicker patients, and having to pay doctors more money, perhaps we could ask politicians to put on their thinking caps and consider what other possible ways we could be lowering healthcare costs. Perhaps there's a bipartisan elephant in the room that needs to be addressed.

The day after the article on the alleged $1.5B increase to LDH was released, a different article reported that as of 3 p.m. Thursday, March 27, 2025, the Federal DOGE website run by Elon Musk shows $55M in cuts to Louisiana Department of Health.

https://www.wwno.org/public-health/2025-03-27/doge-website-shows-55m-in-cuts-to-louisiana-department-of-health

The cuts target mental health and substance use programs, including crisis services, according to Louisiana health officials.

"The apparent cuts range from more than $18 million slashed from one grant to $333,011 sliced from another. In total, a WWNO/WRKF review of the DOGE website found $55,844,936 in cuts across 11 federal grants to Louisiana’s health department, though the site has previously posted inaccurate and inflated data."

An assistant secretary at the LDH indicated the full impacts were still being determined, and said that notification of the cuts was received on Monday in a "series of emails that were slightly difficult to interpret.”

A Louisiana Senate Finance Committee hearing was scheduled to go over the health department's overall finances and budget for 2026. During the committee hearing, Deputy Secretary Dr. Pete Croughan estimated that the cuts were around $10 million.

It is unclear if these cuts are related to or in addition to Landry's own claimed savings of $11 million eliminated from jobs and contracts. It is also unclear if the $1.5B coming from the federal government to offset Landry's cuts, also somehow offsets their own cuts.

Regardless, one cannot help but question who's best interests our state and federal politicians are really looking out for.

Interestingly, on Friday, LDH Surgeon General made headline news again. In contrast to the national headline recognition he received following RFK Jr.'s confirmation, Friday's news seemed to only reach locals.

https://www.wwno.org/public-health/2025-03-28/louisiana-surgeon-general-shares-vaccine-info-after-2-babies-die-from-whooping-cough

On Thursday, LDH confirmed that amid an ongoing state outbreak of whooping cough, two infants have died in the last six months. The two infants are the first Louisiana whooping cough deaths reported since 2018.

Abraham, who is also a physician, seemed to reverse his previous stance on vaccine promotion, stating:

“Anyone who is up-to-date with their pertussis vaccine is well-protected against the virus... Vaccines are the best way to protect against the disease, especially for babies."

I'm glad to see the Louisiana Surgeon General apparently coming around to the idea of vaccines. All it took to change his mind were the completely unnecessary deaths of two infants who were robbed of a future, along with their families.

So, I will just be frank and ask, who's interests are being looked out for?

If you're in Louisiana don't forget to vote today:

https://www.shreveporttimes.com/story/news/2025/03/28/explaining-the-proposed-amendments-to-the-louisiana-constitution-on-the-march-election-ballot/82709803007/

https://parlouisiana.org/wp-content/uploads/2025/02/PAR-Guide-to-the-2025-Constitutional-Amendments.pdf

https://powercoalition.org/amendments/

Glad to see the former physician seems to be coming around to the idea of vaccines maybe not being just a "political weapon."

And to think, all it took to change his mind was the completely unnecessary death of two infants.

https://www.foxnews.com/politics/louisiana-surgeon-general-depoliticize-medicine-statewide-mass-vaccinations

cross-posted from: https://lemm.ee/post/59816920

I published this story last week, but believe it or not, things have gotten even weirder since, and I haven't even checked the news today.

If you're in Louisiana, don't forget today is the last day to vote on 4 proposed constitutional amendments.

As is tradition in Louisiana, the amendments are vaguely worded and difficult to understand. Even legal experts seem to be confused about what exactly will be accomplished by these amendments.

I'll be honest and admit that I also don't fully understand, but I plan to vote No on all four. Given my recent discovery that a vaguely worded executive order was used to grant the Louisiana National Guard authority over a state of emergency related to cybersecurity, I feel secure in the decision to deny the government another chance to amend the state constitution: https://pimento-mori.ghost.io/comparing-edwards-original-state-of-emergency-cybersecurity-incident-with-landrys-renewal-2/

Your vote is your own choice to make, and I hope you do vote regardless of what you choose to vote for. Here are a few resources about the amendments if you would like more information:

https://www.shreveporttimes.com/story/news/2025/03/28/explaining-the-proposed-amendments-to-the-louisiana-constitution-on-the-march-election-ballot/82709803007/

https://powercoalition.org/amendments/

https://parlouisiana.org/wp-content/uploads/2025/02/PAR-Guide-to-the-2025-Constitutional-Amendments.pdf

cross-posted from: https://lemm.ee/post/59816920

I published this story last week, but believe it or not, things have gotten even weirder since, and I haven't even checked the news today.

If you're in Louisiana, don't forget today is the last day to vote on 4 proposed constitutional amendments.

As is tradition in Louisiana, the amendments are vaguely worded and difficult to understand. Even legal experts seem to be confused about what exactly will be accomplished by these amendments.

I'll be honest and admit that I also don't fully understand, but I plan to vote No on all four. Given my recent discovery that a vaguely worded executive order was used to grant the Louisiana National Guard authority over a state of emergency related to cybersecurity, I feel secure in the decision to deny the government another chance to amend the state constitution: https://pimento-mori.ghost.io/comparing-edwards-original-state-of-emergency-cybersecurity-incident-with-landrys-renewal-2/

Your vote is your own choice to make, and I hope you do vote regardless of what you choose to vote for. Here are a few resources about the amendments if you would like more information:

https://www.shreveporttimes.com/story/news/2025/03/28/explaining-the-proposed-amendments-to-the-louisiana-constitution-on-the-march-election-ballot/82709803007/

https://powercoalition.org/amendments/

https://parlouisiana.org/wp-content/uploads/2025/02/PAR-Guide-to-the-2025-Constitutional-Amendments.pdf