Posted on

STATE NEWS – Louisiana Medicaid Increased Physician Reimbursement Rates Beginning July 1, 2025

STATE NEWS – Louisiana Medicaid Increased Physician Reimbursement Rates Beginning July 1, 2025


Alternative Headline:  Louisiana Boosts Medicaid Pay


[MM Curator Summary]: Louisiana will raise Medicaid physician reimbursement rates to 85% of Medicare levels starting July 2025.

==============================


– The Louisiana Department of Health (LDH) announced an increase in Medicaid reimbursement rates for physicians through funding authorized by Act 306 of the 2024 Regular Legislative Session and appropriated in House Bill 1 of the 2025 Session.

Effective July 1, 2025, Medicaid physician reimbursement rates will increase to 85% of the March 2024 Region 99 Medicare rates for applicable services. Reimbursements at or above this threshold will remain the same.

To implement the new rates, LDH has initiated the formal rulemaking process and submitted a state plan amendment to the Centers for Medicare and Medicaid Services (CMS). An emergency rule was published in the July 2025 edition of the Louisiana Register with the effective date of July 1, 2025, allowing the rate increase to take effect while the final rule is being finalized.

What Providers Need to Know:

  • No action is required from providers. All eligible Medicaid claims with service dates on or after July 1, 2025, will be automatically recycled by LDH and the managed care organizations (MCO) to reflect the updated reimbursement amounts.
  • revised Medicaid fee schedule will be posted on LDH’s website by September 30, 2025.
  • Once the fee schedule is published, MCOs will have 30 calendar days to implement the new rates.
  • LDH will issue an informational bulletin with additional details before the online posting of the revised fee schedule.

For updates and more information, providers are encouraged to monitor LDH communications.

https://ldh.la.gov/news/7537


COLOR CODE: 


General item, but important. Gets at main point of article= YELLOW

Has a dollar amount or number = GREEN

A specific topic that seems to be different than other topics = BLUE


Posted on

STATE NEWS – Louisiana paid nearly $10 million for health care dead Medicaid beneficiaries didn’t receive: audit

STATE NEWS – Louisiana paid nearly $10 million for health care dead Medicaid beneficiaries didn’t receive: audit


Alternative Headline: Louisiana Paid Millions for Dead Medicaid Enrollees

[MM Curator Summary]: Louisiana mistakenly paid nearly $10 million over 6 years in Medicaid benefits for over 1,000 dead people, auditors found.

====================================


A review of how Louisiana keeps its Medicaid rolls up to date found the state paid out benefits for more than 1,000 people over the past six years after they died. Nearly $10 million was paid to managed care organizations over that period, even though no health care services were actually provided.

The Louisiana Legislative Auditor conducted its study as part of Gov. Jeff Landry’s Fiscal Responsibility Program, which he has branded LA DOGE. It looked specifically at how state health officials keep track of when Medicaid beneficiaries die and whether outside data sources could help that process. 

When auditors used those additional sources, they found 1,072 beneficiaries who died between February 2019 and March 2025 and approximately $9.6 million spent collectively on their Medicaid coverage. Auditors said the actual spending figure is higher because their calculations only included dental coverage payments – and not health coverage – for the final eight months reviewed.  

According to the audit reportthe Louisiana Department of Health relies on federal and state data sources to identify dead Medicaid beneficiaries. They include Louisiana Vital Records, the Social Security Administration, the Centers for Medicare and Medicaid Services, the state Department of Children and Family Services and the managed care organizations the state pays to deliver Medicaid offerings.

For its analysis, the Louisiana Legislative Auditor’s staff also used obituaries and identified 511 dead Medicaid beneficiaries the state missed in its reviews. Payouts to managed care organizations for this group totaled $5.22 million over the six-year period, and the median time between the beneficiary’s death and the most recent monthly payout to their managed care provider was more than 20 months.

Auditors found 168 more deceased Medicaid beneficiaries through the Social Security Administration’s Death Master File, a source the state health department has not used. The median time between the beneficiary’s death and the latest payment in this group was almost 800 days, according to the audit.   

The Legislative Auditor recommended the Louisiana Department of Health determine whether it should use third-party data sources as part of its eligibility determination process to identify deceased Medicaid beneficiaries. Out of the $9.6 million Louisiana paid for Medicaid services never provided, the audit identified $7.6 million through third-party sources.    

In his July 30 response to the Legislative Auditor, state Health Secretary Bruce Greenstein agreed with the audit’s recommendation and said his department was “in the process of working with the U.S. Department of Treasury to gain the necessary approvals to receive the Social Security Administration Death Master File.” 

The health department was presented with the auditor’s findings in May. In June, approximately $4 million in state payments to Medicaid managed care organizations were to be withheld to recoup part of the money paid on behalf of dead beneficiaries, the audit report said.

This report was updated to correct the name of the state health secretary.

Our stories may be republished online or in print under Creative Commons license CC BY-NC-ND 4.0. We ask that you edit only for style or to shorten, provide proper attribution and link to our website. AP and Getty images may not be republished. Please see our republishing guidelines for use of any other photos and graphics.

https://lailluminator.com/2025/08/12/dead-medicaid/



COLOR CODE: 


General item, but important. Gets at main point of article= YELLOW

Has a dollar amount or number = GREEN

A specific topic that seems to be different than other topics = BLUE