The proposed budget for the Louisiana Department of Health calls for spending about $978 million more than last fiscal year, an increase driven largely by federal dollars for the state's Medicaid program.
Department spending has grown about 82 percent since 2011, with the biggest jump associated with Gov. John Bel Edwards' acceptance of Medicaid expansion, part of the federal Affordable Care Act. The federal government covers 90 percent of the expansion's cost, with fees paid by hospitals covering the state's match.
The number of department employees has declined over that time, from more than 10,000 to just over 6,000 positions in the request for next year.
LDH would spend about $15 billion next year, nearly half of the state's overall budget. The department is requesting about $126 million less in general fund dollars compared to last year, thanks to higher revenue from other sources such as self-generated fees and statutory dedications.
During a hearing about the department's budget Monday, Sen. Sharon Hewitt, R-Slidell, and other lawmakers worried that statutory dedications and fees weren't receiving as much scrutiny as other revenue sources. While economists employed by the governor's administration and the legislature use detailed models to help the Revenue Estimating Conference predict general fund revenue, the REC relies more heavily on department projections of their self-generated and dedicated revenue, she said
"I think that's problematic," Hewitt said.
LDH relies on self-generated and dedicated revenue first before asking to tap the general fund, so projections about the first group heavily influences how much lawmakers appropriate from the general fund.
Sen. Conrad Appel, R-Metairie, acknowledged spending increases are largely driven by federal dollars and mandates, but wondered how the state would pay for its matches if there is a downturn in the economy in the near future.
Cindy Rives, undersecretary with LDH, said the department's ability to project spending is mostly limited to historical trends that can be discerned from their own data. However, officials have engaged LSU in hopes of doing more sophisticated projections that would include broader economic data, such as employment trends, to better understand the state's needs. For example, higher levels of employment could lead to fewer Medicaid enrollees.