Louisiana Medicaid Expansion Evaluation (2017-2019)
$1,883,932 Total | Louisiana Department of Health

Scope

Comprehensive four-domain evaluation of Louisiana's Medicaid expansion impact on 475,000+ newly enrolled beneficiaries. The evaluation examined access to care, economic impact, health outcomes, and beneficiary/provider perspectives using quantitative claims data, national surveys, hospital financial data, and qualitative interviews.

Key Findings

Access to Care

• Cost barriers reduced: 26.6% fewer adults unable to see doctor due to cost; 66.4% reduction in medication non-adherence due to cost

• Distance to care improved: 1-4 mile average reduction in travel distance

• Provider participation increased: 1,305 additional providers began accepting Medicaid; primary care physicians increased by 1,162

Cost and Economic Impact

• Medical debt reduced: 13.5% reduction in beneficiaries with outstanding medical debt collections

• Uncompensated care costs cut by 35% for Louisiana hospitals vs. non-expansion states

• $367 million total reduction in uncompensated care costs (from $664M to $297M)

• Rural hospitals saw 59% reduction in uncompensated care as share of operating expenses

• 18,298 new jobs in hospital sector; shift from lower-wage to higher-wage positions

Health Outcomes

• Self-reported health improved 5-8.5% among low-income residents

• 3% mortality reduction (approximately 300 fewer deaths in first 18 months)

• Larger improvements for underserved populations—much larger mortality gains for less educated individuals

• Cancer mortality showed largest declines

• Chronic disease management improved across diabetes, hypertension, asthma, depression

Provider and Beneficiary Perspectives

• 80%+ of providers accepting new Medicaid patients

• Improved access: better usual source of care, shorter wait times

• Cost barriers reduced: beneficiaries reported significant affordability improvements

• Chronic condition management improved

• High patient satisfaction with primary care

• Remaining gaps: limited specialist access, rural service gaps, limited service coverage

Impact

The access findings were significant enough to warrant a statewide press conference with the Governor and Secretary of Health. The evaluation provided evidence for Louisiana's continued Medicaid expansion and informed policy discussions around healthcare access and economic impact.

Reports

→ Download Access to Care Report

→ Download Cost and Economic Impact Report

→ Download Health Outcomes Report

→ Download Provider and Beneficiary Perspectives Report

Louisiana Health Information Exchange Evaluation (2012-2014)
$210,350 | Louisiana Health Care Quality Forum

Scope

Evaluation of Louisiana's statewide health information exchange system, examining provider participation, infrastructure development, e-prescribing adoption, and utilization patterns across pharmacies and hospitals.

Key Findings

• E-prescribing pharmacy network participation grew from 79.6% to 92.7% (16.5% growth)

• 26 acute-care general hospitals participating with ADT (Admission-Discharge-Transfer) capabilities

• Patient records in system grew from 246,401 to 690,858 (nearly 3x increase)

• 1,105 unique physician and nurse user IDs with HIE access

• Geographic concentration in southern Louisiana; gaps in central/northwest regions

• Critical finding: Despite strong infrastructure growth, actual system usage remained low and did not increase over the evaluation period

• Identified barriers to adoption including provider training needs, value demonstration, and consumer opt-in restrictions

Impact

Identified key barriers to HIE utilization and provided recommendations for increasing provider engagement and system value to drive higher adoption rates.

Louisiana 1115 Substance Use Disorder Waiver Evaluation (2018-2023)
$226,991 | Louisiana Department of Health

Scope

Five-year evaluation of Louisiana's Section 1115 Demonstration waiver addressing the opioid use disorder epidemic. Examined access to evidence-based SUD care, medication-assisted treatment (MAT) expansion, care coordination, and health outcomes for 4.7% of Louisiana Medicaid members with diagnosed SUD.

Key Findings

Access to Evidence-Based Care

• IMD (Institutions for Mental Disease) treatment increased 37%

• Average IMD length of stay increased from 10 days to approximately 15 days

• ASAM Level 1 (outpatient) services increased from <10% to >15% of SUD members

• ASAM Level 3 (residential/inpatient) services increased nearly 20%

• Withdrawal management services expanded slightly

Medication-Assisted Treatment (MAT)

• MAT use nearly doubled: from ~8% to nearly 17% of SUD members

• MAT providers per 1,000 SUD members increased from ~6 to ~10

• Methadone added to Medicaid in January 2020 for OUD treatment

• COVID-related telemedicine restrictions for MAT relaxed and largely maintained post-COVID

• ECHO Project (Extension for Community Health Outcomes) implemented statewide provider training on MAT

Reduced Emergency/Hospital Utilization

• ED visits for SUD fell from ~3 per 1,000 members to ~2 per 1,000 members

• Inpatient stays for SUD declined post-2019

• Readmission rates stabilized (slowed growth after initial rise)

Care Coordination and Treatment Engagement

• Follow-up after ED visits improved (7- and 30-day measures)

• Treatment initiation rates increased and exceeded 95th national percentile

• Treatment engagement rates improved and exceeded 90th national percentile

• Louisiana Medicaid achieved some of highest treatment initiation/engagement rates in country

Provider Capacity

• Overall SUD provider capacity increased over demonstration period

• Growth rate slowed after 2019

Challenges

• Drug overdose deaths nearly doubled over demonstration period, driven primarily by fentanyl proliferation and COVID-19 pandemic

• Hurricane Laura (August 2020) caused significant care disruptions; estimated 200+ patients lost to follow-up

Impact

Demonstrated significant progress in expanding access to evidence-based SUD care and substantially increasing MAT utilization. Louisiana Medicaid achieved national best practice performance on treatment initiation and engagement metrics. Findings supported continuation and expansion of waiver demonstration initiatives.

Crescent City Beacon Program

Louisiana Public Health Institute | Office of the National Coordinator for Health IT

Advisory consultant on ONC's Crescent City Beacon Program, a regional health information exchange initiative. Provided strategic and implementation guidance on health IT infrastructure development and provider engagement strategies.

Louisiana Department of Corrections Health Information Exchange Project

Tulane University School of Medicine, Department of Psychiatry and Behavioral Sciences | 2024 - 2025

Advisory consultant on health information exchange project for correctional health services, bridging incarcerated populations and community health systems.

Grant writing and health IT strategy work

• Office of the National Coordinator (ONC) Regional Extension Center and Health Information Exchange Programs
  Principal grant writer ($11 million awarded)

• Centers for Medicare & Medicaid Services (CMS) Electronic Health Record Demonstration Program
  Principal writer (demonstration awarded)

• ONC Advance Interoperable Health Information Technology Services
  Principal grant writer (not funded)