In 2018, leadership at the Louisiana Department of Health (LDH) identified the need to update its process for making medical, behavioral health, and dental coverage decisions for fee-for-service (FFS) Medicaid and Medicaid managed care. LDH needed more clear, effective, and evidence-informed processes and policies to enable Louisiana Medicaid to better serve enrollees and the citizens of Louisiana, particularly in a context of limited resources.
The Center has worked with LDH since 2018 to develop and update a framework and process for medical, behavioral health, and dental coverage decisions based on five key components: 1) benefit identification; 2) benefit selection and prioritization; 3) evidence review; 4) policy development; and 5) improved communication. The framework is implemented using procedures that identify and synthesize best practices, internal and external stakeholder needs, and shared principles for coverage decision-making processes. A suite of tools and a series of trainings were developed to support the implementation of the revised decision making process, and the Center continues to provide technical assistance to LDH to support implementation of this work.