The Louisiana Department of Health on Nov. 20 asked the Joint Legislative Committee on the Budget to move favorable on 12‑month extensions for six Medicaid managed‑care organization (MCO) contracts while tightening oversight and quality incentives.

"This is the fourth year of an expected five‑year contract," Secretary Bruce Greenstein said, describing the package as a "hard reset" that increases the performance withhold from 1 percent to 3 percent of top‑line revenue and ties that money to measurable quality and access benchmarks. He said the changes aim to "move the needle" on outcomes by giving the department stronger authority to monitor and, where needed, withhold funds until plans meet metrics.

Why it matters: the six contracts are among the state's largest and touch roughly 1.5 million Medicaid enrollees. LDH officials said the proposed contract authority for the coming year is about $17 billion, driven by higher capitation rates, pharmacy costs, and supplemental payment programs.

Lawmakers pressed LDH on several operational weak points during a multi‑hour hearing. Senator Boudreau and others focused on nonemergency medical transportation (NEMT), which providers and legislators described as unreliable and underfunded. "We don't have enough communication, collaboration, or understanding," Greenstein acknowledged, and he promised standing forums and data sharing with the Legislature to improve performance.

Kim Sullivan, senior adviser for Medicaid, said transportation network companies such as Uber and Lyft would follow federal TNC rules but would not be required to meet some state NEMT signage standards; CMS approval is still pending before any TNC rollout. NEMT operators asked the committee to consider higher per‑trip reimbursement and urged the department to address broker and software issues that they said produce missed or fraudulent trips.

Other accountability steps LDH described include monthly operational reviews (MORs) with plans, a secret‑shopper program to verify provider directories and appointment access, and quarterly business reviews to probe claims data and access gaps — particularly in specialties such as optometry. Drew Maranto and other LDH officials said the department will overlay claims with provider directories to confirm who is actually delivering services.

MCO executives at the hearing said they are willing to share best practices and collaborate with LDH, noting examples from other states. Several legislators pressed for prompt, public reporting: under the new contract LDH will withhold funds until performance data justify release.

Committee action: the committee moved favorable on the contract extension request after the public and legislators had opportunities to question LDH officials. LDH said it will return with implementation details and that the Secretary and the new Medicaid director will provide additional briefings and data to the Legislature in the coming months.

What’s next: LDH staff said they will provide legislators with the full list of proposed quality measures, continue quarterly reviews, and convene a working group on NEMT operations, reimbursement, and fraud control. The committee’s favorable motion advances the department’s amendments for final consideration.