(Citizens for a New Louisiana) — In October 2025, Louisiana’s Legislative Auditor released a progress report that should have shaken the state’s health bureaucracy. Nothing registered on the Richter scale, but the findings should have. The report revealed that the Department of Health (LDH) had spent more than $1.2 billion in Medicaid premiums for over 50,000 beneficiaries who, according to state data, had not received a single medical service in as long as seven years.

The report confirmed what auditors first warned in 2024, that LDH still isn’t analyzing its own data to verify who actually uses care or remains eligible for coverage. What emerged was not a story of compassion, but one of complacency. Another recitation of a system that rewards high enrollment, ignores inactivity, and allows both state officials and private contractors to profit from the illusion of care. It’s all just virtue signaling—coverage equals compassion.

Coverage Equals Compassion

For more than a decade, Louisiana’s Department of Health (LDH) has framed its Medicaid expansion as a triumph of compassion and efficiency. The agency’s messaging is straightforward: more coverage means better care. By that measure, Louisiana should be thriving. Enrollment has soared, federal dollars pour in, and state officials routinely cite record participation as evidence of a healthier population.

Yet beneath the surface lies a costly contradiction. The state’s own data reveal tens of thousands of Medicaid enrollees who have not received a single medical service in years. No clinic visits, no prescriptions, and no hospital stays. Despite that, LDH continues to pay private insurance companies monthly premiums to “manage” their nonexistent care.

The illusion is bureaucratic. Success is defined by how many people are covered, not how many are served. That metric alone has produced billions of dollars of waste, yet no significant changes are expected. Why?

The Legislative Auditor Follows the Data

In May 2024, the Legislative Auditor examined LDH’s oversight of its five Medicaid Managed Care Organizations (MCOs). The findings were stark: 49,894 people had been continuously enrolled for 13 to 60 months but received no services, while the state paid $720.5 million to the MCOs on their behalf.

Eighteen months later, in October 2025, a follow-up audit extended the analysis through December 2024 and found 50,299 people enrolled for 36 to 84 months—seven consecutive years—without any record of service use. The additional payments totaled $1.234 billion!

• Never analyzed its own Medicaid data to flag long-term non-users.
• Never required MCOs to share their outreach or case-management results.
• Never used data to verify ongoing eligibility.

When questioned, LDH said that care management was the MCOs’ job. The MCOs responded that eligibility verification was LDH’s job. Between them, no one was accountable for determining whether the beneficiaries existed, were still in the state, or were still alive. The report indicates:

LDH stated that it is the MCOs’ responsibility to manage the care of beneficiaries and to identify those beneficiaries who have not received any services.

Inertia Disguised as Principle

Rather than confront the problem, LDH normalized it. Officials told auditors that paying for both high-use and non-use members is “a fundamental aspect of managed care.” Actuaries, they said, already build non-users into the premium rates; therefore, the system is functioning as intended.

That explanation preserves everyone’s incentives:

• MCOs continue receiving monthly payments for inactive enrollees.
• LDH maintains high enrollment numbers, which secure a larger stream of federal matching funds.
• Elected officials can claim record coverage without addressing whether care is being delivered.

In this arrangement, the appearance of compassion is maintained, budgets remain intact, and no one in authority faces the discomfort of reform. But the taxpayers, you and me, are being swindled!

A Billion Dollars for Nothing

Across seven years, Louisiana’s Medicaid program has spent nearly $2 billion on beneficiaries who generated no medical claims. During that same period, Louisiana’s overall health ranking dropped from 49th to 50th in the nation.

The waste extends beyond dollars:

• LDH’s provider directories were only 49 percent accurate.
• One-third of listed providers filed no Medicaid claims.
• Quality incentive payments were awarded even when MCO performance declined.
• The department lacked a consolidated complaint-tracking system to identify patterns in care failures.

These are not isolated clerical lapses. They are the predictable outcomes of a culture that measures performance by volume rather than value. The system pays to sustain the illusion of care, even as genuine care becomes harder to find. According to the Legislative Auditor:

LDH is not using Medicaid data to determine whether beneficiaries no longer need Medicaid services or to monitor the Managed Care Organizations’ management of Medicaid beneficiary care.

The Call to Wisdom – Measure What Matters

A public-health system cannot be judged by how many people are listed on its rolls. The only honest metric is whether people receive the care they need and whether public funds are spent for that purpose.

If Louisiana wishes to restore trust and fiscal integrity, LDH must:

1. Analyze its own Medicaid data to identify long-term non-users and test eligibility.
2. Require MCOs to document and share their outreach results.
3. Link future payments to verified care and outcomes, not mere enrollment.
4. Publish transparent utilization dashboards so taxpayers can see who is being helped and who is not.

Reform does not demand new technology or new slogans—it only requires moral clarity and accountability. Government must have the courage to see what its own numbers already show, and the discipline to stop paying for what doesn’t exist.

Until that happens, Louisiana will continue spending billions to purchase an illusion of care—and congratulating itself for doing so.