Two former Louisiana state Department of Health and Hospitals (DHH) secretaries have a message for Gov. Bobby Jindal (R): accept federal funding for taking part in Obamacare’s Medicaid expansion, or see taxpayer money go to funding other states’ expansions while low-income Louisianans suffer.

Fred Cerise and David Hood, the latter of whom is a Republican who actually succeeded Jindal — a former DHH head himself — after Jindal left to become president of the University of Louisiana public schools system in 1998, urged the governor to join the growing ranks of Republican state officials who have embraced Medicaid expansion in a Baton Rouge Advocate newspaper ad. The advertisement states, “Medicaid expansion offers a path to regular access to health care for working adults.”

The ad goes on to note that forgoing the expansion won’t just deprive low-income Louisiana residents of crucial health coverage, but is fiscally irresponsible, too: “If Louisiana refuses to participate, our share of the money that pays for this program will be used to support the Medicaid expansion in other states and our low-income residents will continue to lack access to care.” Multiple studies, including a comprehensive Kaiser Family Foundation analysis, have shown that states expanding Medicaid will receive massive federal funding for very little state input.

Jindal has a decidedly poor record when it comes to safety net health care entitlements, instituting massive cuts to state programs that assist vulnerable groups such as poor first-time moms and low-income HIV patients. Jindal has also been a staunch Obamacare critic and has so far explicitly ruled out expanding Medicaid — however, there have been recent reports that he and other skeptical GOP state leaders might be open to a modified expansion along the lines of the unique deal struck between Arkansas Gov. Mike Beebe (D) and the Obama Administration.

Advocates for the poor and hospital associations have been pressing Republican leaders to accept unusually generous federal funding to expand Medicaid, warning officials that providers might buckle under the weight of uncompensated care costs without a larger pool of insured low-income Americans who can actually afford to pay their medical bills. Expanding Medicaid faces an uphill battle even in states where GOP governors have embraced it, as they must still convince skeptical lawmakers in their own party to go along with the plan.

Last week, Louisiana’s poor and terminally ill residents won a surprising victory when Gov. Bobby Jindal (R) announced that his state would not stop providing hospice care to its Medicaid beneficiaries. Unfortunately, that’s about the only piece of good news for low-income Louisianans’ health coverage, as the state is still set to implement massive cuts for Medicaid programs that “provide behavioral health services for at-risk children, offer case management visits for low-income HIV patients and pay for at-home visits by nurses who teach poor, first-time mothers how to care for their newborns” this Friday.

While Jindal administration officials argue that the cuts could be mitigated by Medicare and private managed care programs, the reality is that many of these specialty services are simply unavailable — or unaffordable — outside of Medicaid:

Health and Hospitals Secretary Bruce Greenstein said he targeted programs that were duplicative, costly and optional under the state’s participation in the state-federal Medicaid program.

Greenstein said in many instances, people can get the care they’re losing through other government-funded programs. But he acknowledged that won’t happen in every case, meaning some people will simply lose the services or receive reduced services. [...]

Jan Moller heads the Louisiana Budget Project, which advocates for low- to moderate-income families. Moller said he’s most distressed by the cut to the Nurse-Family Partnership Program.

The health department is eliminating the portion of the program that offers at-home visits to low-income women who are pregnant with their first child. Registered nurses visit the women early in their pregnancy and until their children’s second birthday, offering advice on preventive health care, diet and nutrition, smoking cessation and other child developmental issues. [...]

“What the Nurse-Family Partnership does goes above and beyond what a good obstetrician does,” Moller said. “It’s really about teaching life-skills to at-risk moms to make them better parents and make them better able to care for their children, and it’s been proven to work.”

Speech therapy programs for low-income children are also on the chopping block. The cuts — as well as Jindal’s proposals to raise taxes on the poor while slashing public education and other health care funding — are meant to plug a midyear budget deficit. But they are more likely to raise health care costs and poverty levels in a state that already ranks among America’s least-insured and poorest locales by pushing people poor people into finding services that they will no longer be able to afford.

While Jindal has spoken at length on the Republican Party’s existential need to stop being “the stupid party,” the “austerity” policies that he has pursued for his state are some of the most regressive in the entire country.

In a victory for disabled, terminally ill, and poor Louisianans, Gov. Bobby Jindal (R-LA) has reversed course and decided not to go through with his plan to eliminate hospice care benefits for low-income residents through the state’s Medicaid program, the Associated Press reports.

The Jindal Administration’s reversal comes in the wake of public outrage and candlelight vigils over a budget “austerity” proposal that one hospice care provider equated to “throwing away poor people.” If enacted, Jindal’s plan would have thrown as many as 5,000 terminally ill and disabled Americans receiving hospice care benefits off of public insurance rolls, raising health care costs by forcing sick patients into expensive emergency room care while saving the state a meager $8 million in 2014.

Instead, the Louisiana Department of Health and Hospitals will continue funding the benefits through federal grant money, giving sick, low-income Louisianans some much-needed peace of mind. “The good Lord took care of us today, so we got a fix,” said state Sen. Fred Mills, a Breaux Bridge Republican who vice chairs the Louisiana state Senate Health and Welfare Committee.

But while the Jindal Administration’s decision today is an uncontested victory for Americans at risk of falling through the safety net, Louisiana’s poor are not out of harm’s way just yet. Jindal has proposed one of the country’s most regressive tax proposals, and has slated massive budget cuts to public education and health care program funding.

This week, potential Republican presidential contender Gov. Bobby Jindal (R-LA) rolled out one of the country’s most regressive tax proposals, a plan that would shift Louisiana’s tax burden away from the wealthy by raising taxes on the bottom 80 percent of state residents. Apparently, the “austerity” measures don’t stop there.

According to New Orleans CBS affiliate WWLTV, Louisiana residents over the age of 21 who are on Medicaid — the public insurance program for disabled and poor Americans — will stop receiving hospice care benefits at the end of this month. That means that low-income Louisianans with terminal illnesses, debilitating disabilities, and chronic long-term medical problems will no longer have access to the essential home and medical care that they need.

And while the cuts are intended to help the state balance its budget, critics point out that it is more likely to increase health care costs by pushing previously-insured Americans with costly medical conditions into private hospitals and emergency rooms where they will not be able to afford their treatments:

The Louisiana Department of Health and Hospitals say the elimination of hospice care for Medicaid patients will mean nearly $3.3 million in savings this year alone. In 2014, it’ll mean $8.3 million in savings.

However, Burns believes the state will end up paying much more with terminally ill patients forced to turn to local hospitals.

“They’ll just go in and out of the hospitals, maybe go to ICUs, and they won’t be able to have their family around them with hospice care,” said Burns. [...]

DHH says there were 5,819 recipients of hospice services through Louisiana Medicaid in the previous fiscal year.

By the Louisiana DHH’s own estimates, the cuts to Medicaid hospice-care beneficiaries are only expected to reduce the state’s projected $900 million budget deficit by 0.92 percent in 2014. These cuts will be imposed on top of the already draconian cutbacks to public education and health care programs that Jindal has in the pipeline.

Battles over Medicaid funding, particularly for those in need of long-term, specialized care, are nothing new. State budget cuts to the Medicaid program have long left disabled and special-needs Americans by the wayside, even in progressive states such as California. But one of the easiest ways for states to address their perennial public health funding issues is for them to participate in Obamacare’s Medicaid expansion, which the federal government will fund for the first several years.

Jindal, however, has refused to participate in the expansion, calling it a “bad idea” that is “expensive for taxpayers.” Ironically, Louisiana already takes in considerably more tax revenue from the federal government than it pays out, and Jindal’s Medicaid cuts — coupled with his refusal to expand Medicaid — will likely exacerbate that dynamic by forcing Americans across the country to subsidize care for Louisianans who have fallen through the safety net.