Nearly 200,000 people have left the Medicaid rolls in Louisiana over the past 12 months, raising this question: Are they better off because they are now covered by private insurance? Or are they now without health insurance at all?

Having more people covered by health insurance — either by Medicaid or an employer-sponsored plan — means more people are getting treatment from doctors and nurses for preventive care and chronic illnesses. That matters, especially in Louisiana, since the state typically ranks as the unhealthiest in the country.

But whether the drop in enrollment is viewed positively seems to depend on a person’s philosophical views.

Gov. Jeff Landry, Health Department Secretary Bruce Greenstein and key Republican state legislators count the reduction as a success, saying it’s a sign that fewer people in Louisiana are dependent on government.

“People who are eligible are getting the services they need, and people who are not eligible are not costing the taxpayers any more dollars,” said state Sen. Patrick McMath, R-Covington, who chairs the Senate Health and Welfare Committee.

Others believe, however, that too many people falling off the Medicaid rolls are now without health insurance, and that is causing havoc for them.

“Some of the individuals who were dropped — they didn’t know until they went to the doctor and called my office,” said state Sen. Regina Barrow, D-Baton Rouge. “Most of them have been placed back on immediately. But some don’t know to call their member to get their services back.”

Landry said Wednesday that 100,000 fewer people in Louisiana need Medicaid today because they have gotten jobs with insurance, but his staff could not provide documentation to back that claim.

While nearly 200,000 fewer people receive Medicaid compared to a year ago, Louisiana has only 13,000 more nonfarm jobs over that time, according to the U.S. Bureau of Labor Statistics. The state unemployment rate has ticked up from 4.3% to 4.4% over the past year.

“The economy is not necessarily explaining this drop in Medicaid,” said Courtney Foster, a senior policy adviser at Invest in Louisiana, a progressive nonprofit in Baton Rouge. “My worry is that people are going without insurance.”

Only two other states have seen a bigger drop in Medicaid enrollment since President Donald Trump returned to office in January 2025, according to the Georgetown University Center for Children and Families.

High healthcare stakes

The starting point for the debate is Gov. John Bel Edwards’ decision when he took office in 2016 to have Louisiana accept the Medicaid expansion under the Affordable Care Act, also known as Obamacare. That decision essentially meant that people who had low-paying jobs without health insurance would now receive it through Medicaid thanks to federal government subsidies.

“Seven years ago, I made the easiest big decision I’ll ever make by expanding Medicaid to working families across our state,” Edwards said in 2023. “That decision to bring our federal tax dollars home to Louisiana has given more than 500,000 people access to care and is helping to keep our rural hospitals open.”

Conservatives nationally have decried Obamacare, and Republicans in Congress have made repeated attempts to repeal the program.

Landry followed Edwards in office in January 2024 with a mission to reduce government spending on entitlement programs.

Over the past 12 months, the number of people on Medicaid has dropped from 1,610,066 to 1,411,267, according to the Louisiana Department of Health. That’s a reduction of 198,799, or about 12%.

As part of that decrease, those enrolled through Edwards’ Medicaid expansion had dropped to 398,215 through April, accounting for about 70% of the overall decline.

Also as part of the overall drop, nearly 50,000 children are no longer eligible for Medicaid in Louisiana.

Past history shows that many of them will now be without insurance, said Joan Alker, executive director at Georgetown’s Center for Children and Families.

“Even a short-term loss of healthcare exposes that family to potentially expensive costs — let’s say from a child breaking an arm on the playground — that could bankrupt them,” Alker said.

A hard look at who gets Medicaid

Answering questions in an interview and through email, Greenstein said his department has instituted a more rigorous review of eligibility that has caused over 100,000 people to fall off the Medicaid rolls.

The Louisiana Department of Health is working with the Office of Motor Vehicles to determine if people enrolled in Medicaid in Louisiana now live out of the state, Greenstein said.

The department has also reviewed records to determine whether people on Medicaid who have not filed any type of claim over the past 30 months should continue to be eligible, Greenstein said.

The department is working through Louisiana Works to ask Medicaid recipients on a quarterly basis whether their wage exceeds the federal income limit to remain eligible, Greenstein said.

In each case, the department asks the person on Medicaid to verify that they are still eligible. People who don’t respond or who do respond but cannot show they remain eligible are dropped from Medicaid.

“We reach out to members in whichever way they have opted to receive information from LDH: mail, email or text message,” Greenstein said.

Asked whether the Landry administration is making less of an effort than the Edwards administration did to contact people before dropping them, Greenstein said, “We’ve streamlined it, and we also do more outreaches.”

Concern or celebration?

Barrow said legislators need to hold hearings to review what’s behind the drop in nearly 200,000 from Medicaid and the possible implications.

“It will put more of a strain on the healthcare system and hospitals to deliver services,” she said, as uninsured people seek treatment in emergency rooms. This costs the state more money.

McMath, however, said any legislative hearing ought “to celebrate the accomplishments that the Louisiana Department of Health is having.”

He added, “The underlying goal of Medicaid is to provide quality health care services at an efficient cost to the state. But the overarching goal should be to implement policies across the board that move people from dependence to independence.”

Foster, however, fears that the number of people without insurance is rising, but that policymakers haven’t grasped this fact because the latest figures are not up to date.

According to KFF, a leading health policy nonprofit based in San Francisco, the most recent numbers are from 2024 and show that Louisiana’s uninsured rate was 7.6%, lower than the national rate of 8.2%, thanks to Edwards instituting the Medicaid expansion. Neighboring states governed by Republicans — Mississippi, Texas, Arkansas and Alabama — all had higher uninsured rates than did Louisiana.

Jim Richardson, a retired LSU economics professor who has tracked state spending for decades, said having more uninsured people could cause problems because treating them in emergency rooms means higher costs for Louisiana taxpayers.

“That’s always an issue, if people are not on Medicaid get sick and then become a medical necessity,” he said. “You can’t turn them away. There has to be a way to pay for that.”

Jeff Reynolds, who served as deputy secretary of health under then-Gov. Bobby Jindal and Edwards, noted that the Medicaid expansion under Edwards kept all of Louisiana’s 49 rural hospitals open, in contrast to Mississippi, which didn’t expand Medicaid and saw rural hospitals close.

Reynolds, who now serves as executive director of the Louisiana Rural Hospital Coalition, said the reduction in Medicaid enrollment is beginning to hurt his clients.

“Having fewer uninsured people allows the hospitals to generate additional revenue and keep the doors open, not only for the poor people but also for people on Medicare and private insurance,” Reynolds said.

Greenstein sees the overall drop in enrollment as a positive, at least for now.

“Anecdotally, we’ve heard from employers that they’re continuing to hire new employees who are now receiving health insurance, and we are not hearing of increased rates of uncompensated care occurring in Louisiana hospitals,” he said.

Unlike Barrow, McMath said he’s not receiving concerns from people no longer on Medicaid, who tend to operate on the margins of society.

“I hear from my constituents on a daily basis about their problems, as do my other colleagues,” he said. “Not once has this eligibility issue come up with a phone call, a text or an email.”