The end of pandemic-era protections for people with Medicaid coverage has already caused hundreds of thousands of people – many of them children – to be kicked out of the program. The New York Times’ Noah Weiland reports that many of them are seeing their coverage wane for procedural reasons, such as failing to respond to paperwork requests or because state Medicaid agencies could not locate them. 

From the outset of the pandemic until this spring, states were barred from kicking people off Medicaid under a provision in a coronavirus relief package passed by Congress in 2020. The guarantee of continuous coverage spared people from regular eligibility checks during the public health crisis and caused enrollment in Medicaid to soar to record levels. But the policy expired at the end of March, setting in motion a vast bureaucratic undertaking across the country to verify who remains eligible for coverage. In recent weeks, states have begun releasing data on who has lost coverage and why, offering a first glimpse of the punishing toll that the so-called unwinding is taking on some of the poorest and most vulnerable Americans.

In Louisiana, the Department of Health expects about 350,000 Medicaid recipients to lose coverage over the next 12 months, but many of them will return to the rolls through “churn” as they (or their healthcare provider) realize they’ve been dropped. State House Republicans want to shorten the “unwinding” period from 12 months to 9 months, which could lead to federal financial penalties and more people losing coverage for paperwork reasons even though they remain eligible. 

Capitol cap chronicles continue
The big question hanging over the Legislature’s budget debate – which must wrap up by next Thursday at 6 p.m. – is whether the House of Representatives can muster the two-thirds vote needed to exceed the state expenditure cap. The cap is an artificial restraint on the state’s ability to allocate tax revenue among many important needs, and on Monday the Senate voted unanimously on to raise the cap for the next 13 months.. As the Louisiana Illuminator’s Julie O’Donoghue reports, failure of the House to follow suit could require the state to mothball several important projects.

If they do not raise the cap, legislators will also have to pull back on road, bridge and coastal restoration projects already in the works because they will no longer have access to cash to fund those initiatives. “It will slow down projects that are currently in [the state construction plan], and you will be borrowing money in a 5 to 7% [interest rate] environment and paying off that interest over the next 30 to 40 years,” (Senate President Page) Cortez said. “You would never go and borrow a 30-year note to fix the hole in your roof if you had the cash in the bank.”

The cap vote clears the way for the Senate Finance Committee to rework the House version of the budget bills, which is expected on Friday.  

Maternity’s most dangerous time
New Centers for Disease Control and Prevention research shows that the deadliest time for newborn mothers can often be after the baby is born, with one-third of pregnancy-related deaths occurring between birth and six weeks old and another 30% before the baby’s first birthday. This data demonstrates a need for more support for new mothers and more extensive follow-up care, including doctor’s visits within three weeks of childbirth instead of the standard six-week checkup. Black mothers are at significantly higher risk of complications post-delivery and 3.5 times more at risk for late maternal deaths. The New York Times’ Roni Caryn Rabin explains the CDC’s findings. 

Based on data provided by 36 states on 1,018 pregnancy-related deaths from 2017 to 2019, the C.D.C. concluded that about a third of them occurred during pregnancy or on the day of delivery, and roughly another third before the baby turned six weeks old. A full 30 percent occurred from that point until the baby’s first birthday, a period that had not been a focus of maternal mortality research. The data have led to calls for closer follow-up care and more support for new mothers during what has been called the “fourth trimester,” with special attention given to vulnerable women.

A race against time
Louisiana’s ambitious efforts to fortify its eroding coastline have been buoyed in recent decades by a large influx of federal funding and the legal settlement over the Deepwater Horizon oil spill. But the financial largesse is set to expire in the next decade, meaning there is no guarantee that the state will have enough money on hand to protect coastal communities that are most vulnerable to climate change and natural disasters. As funding erodes,  The Grist’s Jake Bittle reports that the state might be forced to embrace a “managed retreat” from the most vulnerable areas. 

As the limits of the state’s coastal program begin to show, (researcher Jessica) Simms (of the National Academies of Science) told Grist that there’s another strategy that could serve as a better model. Instead of trying to leverage billions of dollars to slow down land loss and displacement, states could use federal money to ensure that the inevitable retreat can be easier. In 2016, after Louisiana won a grant from the Obama administration, it undertook a series of local adaptation projects based on grassroots input from hundreds of coastal residents. These projects included affordable housing for residents moving back from the water and a mental health program to help residents of eroding Plaquemines Parish cope with the loss of a familiar environment. 

Number of the Day

19 – Percentage of state residents who tried to get a homeowners insurance policy last year. More than half (55%)  – about 11% of all adults – reported that they had difficulty getting one. (Source: 2023 Louisiana Survey, LSU Reilly Center for Media and Public Affairs)