Ellington

BATON ROUGE, La. (AP) — Louisiana is becoming the first state in the Republican-dominated Deep South to expand its Medicaid program, with more than 233,000 people already enrolled in the government-financed insurance coverage that begins Friday.

Medicaid expansion fulfills one of Democratic Gov. John Bel Edwards' main campaign promises, embracing the health law championed by President Barack Obama after years of GOP stonewalling in Louisiana.

"I understand that this is a Southern state. It's a conservative state, with a majority of the legislators Republican. But I've always said the idea of expanding Medicaid is not right versus left, it's right versus wrong," Edwards said.

Adults ages 19 to 64 with incomes up to 138 percent of the federal poverty level — about $16,400 for a single adult or $33,500 for a family of four — are eligible for the coverage through one of Louisiana's Medicaid plans administered by managed-care companies.

Joyce Brock, a 62-year-old Wendy's cashier, enrolled for the coverage and was looking for a primary care doctor to monitor her asthma and test her for diabetes. Uninsured, she had struggled to cover the costs of inhalers and other medication, whose costs she estimated at $300 a month. Medicaid expansion will help her pay for prescriptions and get routine checkups.

"I've been crying for Medicaid," Brock said, signing up at a Baton Rouge clinic.

Louisiana is the 31st state to expand its Medicaid program.

The Edwards administration estimates 375,000 people will get insurance from the expansion over the next year, 70 percent of them full-time workers in industries such as food service, tourism and construction.

As a state lawmaker and when running for governor, Edwards advocated for Medicaid expansion as a way to improve health outcomes in a state where 13 percent of residents are uninsured and nearly a quarter of the population lives in poverty.

About 6,000 people already have signed up in Edwards' home parish, and the governor tells the story of a woman approaching him at church with her 5-year-old son, saying she had been unable to afford a surgery she needed. Now, the governor said, the single mother with three jobs is enrolled in Medicaid with the surgery scheduled.

"At the end of the day, we're going to have that story being replicated all across the state of Louisiana, in families rich and poor, black and white, Republican and Democrat," he said.

Enrollment for 185,000 people was fast-tracked by shifting them from existing health programs that had less coverage and fewer benefits, including thousands in the New Orleans area served through a community clinic program started after Hurricane Katrina.

Edwards signed the expansion order on his first full day in office in January, reversing the refusal from his Republican predecessor Bobby Jindal, a one-time candidate for president who described the expansion as too costly and as growing an inefficient model of health care.

Republicans in the Louisiana Legislature had blocked expansion efforts in prior years. But GOP legislative opposition largely disappeared once Edwards entered office — and after the program was estimated to save the cash-strapped state $184 million in the new budget year.

The federal government will pick up the full cost of the health services through 2016. After that, Louisiana will pay a share that eventually increases to 10 percent.

But to make the model work, habits of getting coverage primarily through emergency rooms will have to be broken, and doctors and clinics will have to agree to see the large influx of patients being added to the Medicaid rolls.

Health Secretary Rebekah Gee said her department was working on incentive programs to encourage health providers to take the new patients. The governor said payments to Medicaid doctors will have to go up, though he gave no timeline for that to happen.