Convenient Resources
Convenient Resources
Amicus Brief of FEHP, LEHP, and FHA in support of Plaintiff’s MSJ
Louisiana Essential Healthcare Partnerships, along with Florida Essential Healthcare Partnerships, filed an amicus brief in support of the State of Texas’s challenge to CMS’s unlawful interpretation of impermissible hold harmless agreements. LEHP lent its full support in favor of Texas’s arguments that CMS’s interpretation violates the Social Security Act and was an unreasoned change from CMS’s historical position. But, perhaps just as importantly, LEHP highlighted through its brief how CMS is actually enforcing its unlawful position in states that are not parties to the litigation in Texas. CMS is doing so despite the judge in Texas granting preliminary relief, holding that Texas has a substantial likelihood of success in the litigation. In other words, CMS is directly flouting the judge’s ruling in other jurisdictions, and LEHP wanted to make sure that the judge knew it as he considers the scope of the final relief to order.
Frequently Asked Questions
About Payment Programs
There are several supplemental payment programs that provide supplemental funding to Medicaid programs in Louisiana. Below is a brief summary of each program being utilized by the state for SFY25.
HIDER
A Local Provider Participation Fund (LPPF) ordinance allows a local government to impose a uniform, non-ad valorem special assessment on hospitals that have a property interest in the jurisdiction. Funds collected through the LPPF assessments are sent to the state through intergovernmental transfers (IGTs) to support the non-federal share of increased Medicaid managed-care payments for eligible hospitals. This non- federal share receives a federal match.
Currently, 26 Louisiana counties have adopted ordinances establishing LPPFs to help contribute to the non-federal share. They range from Escambia to Miami-Dade and include all 9 Statewide Medicaid Managed Care Regions in the State.
Hospital Directed Payment Program
The Hospital Directed Payment Program (DPP) reimburses hospitals for inpatient, and outpatient medical care and services provided to Medicaid enrollees. The program collects IGTs as the non-federal/state match to draw down federal Medicaid matching dollars—not requiring additional General Revenue from the state’s budget. A DPP is a mechanism authorized by CMS that allows states with Medicaid Managed Care waivers to seek approval from CMS to direct managed care plans to make certain payments.
Physician Directed Payment Program
The Physician Directed Payment Program (DPP) will reimburse providers for professional services provided to Medicaid enrollees. The program will use funds from local hospital assessment payments as the non-federal/state match to draw down federal Medicaid matching dollars As of August of 2025, Louisiana is waiting for CMS to approve the Physician DPP.
About Medicaid
ACCORDIAN HIDER
How is Medicaid Funded?
Medicaid is jointly financed by states and the federal government. The federal government matches state Medicaid spending, but the federal match rate varies by state based on a federal formula called The Federal Medical Assistance Percentage (FMAP). The FMAP ranges from 50% on the dollar to a high of 78% for FY2022.
In 2017, Medicaid was the second-largest item in state budgets. Federal Medicaid matching funds are the largest source of federal revenue (55.1%) in state budgets. Accounting for state and federal funds, Medicaid accounts for 26.5% of total state spending. Nationally, Medicaid pays for 1 in 6 dollars in the healthcare system and 1 in 2 dollars in long-term services and support.
States are obligated to contribute at least 40% of their Medicaid budget from state general revenue. The remaining 60% can come from other permissible sources, provided the sources are compliant with federal law. For example, states have some flexibility to use funding from transfers from local governments (intergovernmental transfers) or revenue collected from provider taxes and fees to help finance the state share of Medicaid. Provider taxes can also be known as assessments, fees, or mandatory payments, and can vary in structure in accordance with state law requirements. However, federal law requires that, whatever the name and local variation, all such collections from providers must be must be broad-based, uniformly applied, and the collecting governmental entity may not take any action to offset the costs of these payments or otherwise hold the providers harmless. All states (except Alaska) have at least one provider tax in place, and many states have more than three.
What is FMAP?
The Federal Medical Assistance Percentage (FMAP) is used to calculate the amount of federal share of state Medicaid program expenditures. The amount of FMAP varies from state to state and is updated annually.
The FMAP formula is based on the ratio of the state per capita income to the national per capital income using the three most recent calendar years for which satisfactory data are available from the Department of Commerce, Bureau of Economic Analysis. The lower the state's average per capita income, the higher the FMAP. The higher the state's average per capita income, the lower the FMAP.
All states receive at least 50% FMAP.
What is an IGT?
An intergovernmental transfer (IGT) is the transfer of funds from a governmental entity, such as counties, municipalities, local health care taxing districts, and providers operated by state or local governments. In Louisiana, IGTs are used to help fund the state’s share of Medicaid financing. The IGTs are combined with other state funds to draw down federal matching funds based on the FMAP.
The Louisiana Department of Health (LDH) is responsible for collecting IGTs and adding those funds to the state’s share of the Medicaid funding in Louisiana.
About LPPFs
ACCORDIAN HIDER
What is an LPPF?
A Local Provider Participation Fund (LPPF) ordinance allows a parish to levy a local hospital assessment payment on nongovernmental hospitals in the parish.
Funds collected through the LPPF assessments are sent to the state through IGTs to support the non-federal share of increased Medicaid managed-care payments for eligible providers. This non-federal share receives a federal match.
Currently, 4 Louisiana parishes have adopted ordinances and resolutions establishing LPPFs to help contribute to the non-federal share. They range from Bossier to Webster.
Click here to view an interactive map and resources of Louisiana's LPPFs.