HJBR Sep/Oct 2025

MEDICAID CHANGES 26 SEP / OCT 2025 I  HEALTHCARE JOURNAL OF BATON ROUGE   their operations, run their outpatient clin- ics and provide services to everybody in the community. In a lot of these rural communities, where these rural hospitals serve, they are sort of the cornerstone of those communities. It is a big economic driver, big economic engine for those rural communities. Why do you think it’s important to have rural healthcare? If you were a businessman and you’re looking to open a new business or some- thing, you’re gonna want to know, where are my employees gonna get healthcare? If [a community] does not have a rural hospital, then you’re going to probably look at a community that does have a hospital, does have a robust healthcare system so your employees can get healthcare. If a community loses its rural hospital, it sort of begins the death spiral of that community because that is that economic driver, that attraction to that community goes away. [The Big Beautiful Bill] requires some co- payments for certain types of doctor visits for Medicaid recipients. When you worked for the Louisiana Department of Health, I believe they implemented a co-payment program for Medicaid recipients under Gov. Bobby Jindal. Can you talk about the state’s experience with that policy? Provider fees are in the Big Beautiful Bill, and right now it requires a $35 copay. That would start Oct. 1, 2028. It would only apply to the [Medicaid] expansion adults that have income from 100% to 138% of federal pov- erty [level]. A single adult [that meets those qualifi- cations] makes $15,000 a year to $21,000 a year. We implemented co-pays in the Medic- aid program [during the Jindal administra- tion], and the healthcare providers really hate them. If you’re a specialist doctor doing a knee replacement and you get a thousand dol- lars from Medicaid to provide that service, they’re gonna cut your rate from a thousand dollars down to $965. So they reduce your rate by that $35. So it’s a rate cut to that provider, and then those providers are expected to collect that $35 from the client. If your client is making $20,000 a year, it’s gonna be – I’mnot gonna say none of them are gonna pay – but there’s gonna be a large percentage of them that simply say they do not have the resources to make that copayment. And the providers end up having to eat that cost. So in essence, copays become a rate cut to the providers, and I saw that numerous times under the Jindal administration. Prior to the vote on the Big Beautiful Bill, there were concerns that we were going to see rural hospitals and maybe rural healthcare providers close or shut down. Can you explain whether that’s something we should still be concerned about? As I said earlier, we are fully funded for 2026. I do not see any reductions or any- thing that would cause a rural hospital to shut down here in 2026, and I really don’t see that occurring in 2027 or 2028 either. Once we get past 2030, we are gonna need some help in order to avoid any, you know, issues with reduction of services and those types of things. When you get five years out, I’m very hes- itant to predict what will happen because I know there will be a lot of changes. So that is why, right now I’m saying between now and 2030, I do not foresee any rural hospi- tals closing because of the Big, Beautiful Bill. Do you expect the healthcare community in Louisiana to try to lobby for changes between now and 2027 when some of the [reductions] start taking effect? I do. I think part of my job is to make sure our elected officials understand the impact of this piece of legislation and what will happen. I think everybody, at least from the rural provider community in Louisiana, would absolutely be working with their elected officials to see what changes or tweaks could happen between now and 2029. It is a case where we do have some time to work with everybody, and I’m optimis- tic that we’ll get there and get this resolved, and keep providing those services that are so important to our citizens. n © 2025 Louisiana Illuminator. Reprinted with permission under the terms of Creative Commons license CC BY-NC-ND 4.0. O’Donoghue, Julie. “Medicaid Changes: Q&A with Jeff Reynolds, Rural Hospital Coalition of Louisiana.” Louisiana Illuminator, July 18, 2025. https://lailluminator.com/2025/07/18/ medicaid-changes-qa-with-jeff-reynolds-rural- hospital-coalition-of-louisiana/. “If a community loses its rural hospital, it sort of begins the death spiral of that community because that is that economic driver, that attraction to that community goes away.”