The Louisiana Department of Health has enrolled more people than projected in Medicaid expansion since Gov. John Bel Edwards kicked off the program in July 2016, and those signing up for the free insurance coverage are older and costlier patients than expected.
"It's more of them, and it was a different mix of people," said Jeff Reynolds, chief financial officer for the health department.
The health department needed permission from lawmakers to accept and spend the additional federal dollars available to Louisiana.
Despite previous complaints from House Republicans about the wisdom of expanding Louisiana's Medicaid program, the Legislature's joint budget committee voted to bump up the federal financing for the coverage without objection Monday evening.
The Medicaid expansion program was slated to deplete its federal financing by Tuesday.
The added dollars will lift the price tag for the program to about $2.3 billion this budget year.
More than 428,000 people have enrolled in the government-financed coverage for the working poor, which began July 1. The Edwards administration says more than 91,000 have received preventive services that in some instances have identified cancer, diabetes and other illnesses.
The Medicaid expansion financing gap had been known since November, when it appeared on a monthly report tracking spending across the entire Medicaid program.
Edwards, a Democrat, said Louisiana is saving more than $180 million this year by tapping into the Medicaid expansion's enhanced federal financing rates for coverage the state already had provided to the poor and uninsured. The higher federal match rate makes the care cheaper for the state. The health department anticipates Louisiana will save money for the next five years.
GOP lawmakers point to congressional debate about revamping the federal health care law.
"If there are alterations in Washington made on the Medicaid expansion, what effect is that going to have long-term on the state?" said Rep. Cameron Henry, the Republican vice chairman of the joint budget committee.
Adults ages 19 to 64 with incomes up to 138 percent of the federal poverty level — about $16,400 for a single adult or $33,600 for a family of four — are eligible for the coverage through one of Louisiana's Medicaid plans administered by private managed-care companies.
The federal government is paying most of the Medicaid expansion cost. Louisiana is paying a share that eventually increases to 10 percent. Lawmakers previously passed items to help cover the state's costs, including a tax hike charged on health maintenance organizations known as HMOs.