Louisiana
President Donald Trump’s budget bill cuts Medicaid. Here’s what it means for Louisiana.
WASHINGTON – During his nearly nine-hour floor speech opposing passage of the Republicans’ One Big Beautiful Bill Act, House Minority Leader Hakeem Jefferies used Louisiana to underscore his argument that the measure harms Medicaid.
The legislation, signed into law Friday, includes tax breaks and increased funding for Republican priorities. It pays for them, partially, by cutting spending by $1.1 trillion over the next 10 years for Medicaid and the Affordable Care Act.
That will lead to 17 million Americans losing healthcare coverage, according to the Congressional Budget Office.
“Louisiana is a state that stands to suffer mightily as a result of this all-out assault on Medicaid,” said Jefferies, D-Brooklyn. He pointed out that the Republican supermajority in the Louisiana Legislature passed a resolution asking Congress not to slash Medicaid because the state, one of the poorest in the nation, simply couldn’t afford the extra costs.
Except for New Mexico, Louisiana has the nation’s highest percentage of residents — one third — on Medicaid, which covers the cost of healthcare for low-income adults, children and seniors. The law eventually could cost Louisiana $4 billion and lead to 267,550 losing their coverage over the next 10 years, according to the Kaiser Family Foundation and other nonpartisan experts.
However, in the frenzy of negotiations other the past few weeks, some of the biggest cuts were delayed for several years.
That includes some of the changes that most alarmed Louisiana health care leaders, such as new restrictions on provider taxes and state-directed payments.
Louisiana’s hospital community, while not exuberant, says the bill could have been much worse had the Louisiana congressional delegation not inserted wording that delayed the changes, said Paul A. Salles, president and CEO of the Baton Rouge-based Louisiana Hospital Association.
State Senate President Cameron Henry, R-Metairie, put it more succinctly in a post on X: “The Senate-passed reconciliation bill is much improved, and Louisiana is in good shape.”
Henry had said a previous version of the bill could have caused a big enough budget problem for Louisiana that the Legislature would need to convene for a special session.
With some of the biggest changes still years out, some in Louisiana health care circles hope changes can be made to blunt the impact of the cuts. Many of those changes won’t take effect until after mid-term elections next year, when the makeup of Congress could change significantly.
How Medicaid could change in Louisiana
Of the $16.4 billion annual Medicaid costs for Louisiana, state taxpayers kick in about $3 billion, according to the Legislature. The new law would halt some of the tools Louisiana uses to pay that $3 billion, requiring the state to pour in extra money or let some people go without health insurance.
Republicans cast the changes as needed to shore up the healthcare programs by ensuring services remain available only for those truly in need.
“A lot of the estimations are far overblown … especially in my district,” said House Speaker Mike Johnson, R-Benton. About 40% of his constituents are Medicaid eligible.
But U.S. Rep. Troy Carter, D-New Orleans, said the bill “represents the largest cuts to health care and nutrition assistance in American history. …It strips support from our hospitals and nursing homes,” threatening to close long-term facilities and rural hospitals. About 38% of Carter’s constituents are Medicaid eligible.
Much of the savings in the new law come from fees the state levies on hospitals, clinics and other healthcare providers. These provider taxes help the state put more money into Medicaid.
Provider taxes also have the effect of increasing the portion the federal government must pay. The new law ratchets down the provider tax rate from 6% to 4.5% over several years. But Louisiana’s rate is 4.6%, so the state has a buffer.
Some of the money raised through provider taxes goes directly to hospitals in what are called state directed payments. One state directed payment sends funds to rural hospitals whose patients – almost half in some parishes – have Medicaid, which doesn’t always cover the cost of services provided.
The new law immediately freezes the size of state directed payments and, starting in 2028, lowers that amount by 10% each year.
The provider tax also is used to boost Medicaid payments to nursing home facilities used by seniors who need long-term nursing care but have run out of insurance and savings, which is about 60% of them in Louisiana. The bill will effectively lower payments to nursing facilities and could cause many to limit patients or close their doors.
State directed programs using provider taxes, such as those for rural hospitals and nursing homes, must be approved by U.S. Centers for Medicare & Medicaid Services, called CMS.
Wording inserted by U.S. Sen. Bill Cassidy, R-Baton Rouge, allows CMS to consider Louisiana’s state directed payment applications already in the pipeline.
“It’s a small change with huge consequences,” Cassidy wrote in a memo to state officials.
As part of the deal to persuade senators to accept restrictions on provider taxes and state directed payments, the Senate created a $50 billion fund to help rural hospitals.
Louisiana hospital officials say the fund will help but the amount is insufficient. But delaying until 2028 allows time for the provisions to be amended.
Work requirements
One of the biggest changes is a requirement that most adults under the age of 65 years work, volunteer or go to school at least 80 hours a month. The states will have to verify eligibility twice a year rather than every 12 months beginning in 2027.
KFF Health, a respected San Francisco-based nonpartisan health care thinktank, says relatively few people who receive Medicaid are able to work but choose not to.
KFF found that 69% of Louisiana Medicaid population is working and most of the 31% who are not working are disabled, elderly, or provide care for a sickened family member or are covered under the exemptions included in the law.
The issue with the work requirement, said U.S. Rep. Cleo Fields, is the amount of paperwork and effort required to remain qualified. States that have tried work requirements ended up forcing qualified recipients off Medicaid rolls.
“It sounds good,” said Fields, D-Baton Rouge. But the data shows more people lose their qualifications from being unable to quickly track down the appropriate supporting documents, such as proof of previous jobs.
The Louisiana Department of Health, which will handle the increased vetting, did not respond to inquiries. But LDH officials told hospital and congressional representatives that a more technologically advanced system is being put in place to handle the qualification process more efficiently and will be ready by 2027, when those requirements go into effect
The new law also will charge a small co-pay to some enrollees, particularly those in families of four with incomes between $32,000 to $44,000 annually, for most provider visits except for primary care and some other services.
People who buy private insurance using federal subsidies under the Affordable Care Act will have to sign up during a narrower window from November 1 to December 15.
“For the first two years, we’ll be fine, but at some point that third year is going to come,” Fields said. About 37% of his constituents are Medicaid eligible.
“It doesn’t negate the fact that soon people who use Medicaid are going to lose their healthcare benefits and many of the hospitals, particularly rural hospitals, will close,” he added.
SHREVEPORT, La. — Investigators are looking into how a former National Guardsman identified as the gunman who killed eight children in Louisiana on Sunday got a gun — despite an illegal firearms conviction on his record.
Shreveport Police Chief Wayne Smith said the federal Bureau of Alcohol, Tobacco, Firearms and Explosives is probing how the man obtained the assault-style pistol used in the shooting, which he described as a domestic violence incident.
Shamar Elkins was arrested in 2019 and convicted of illegal use of a firearm. Shreveport Police spokesman Christopher Bordelon said Elkins was likely prohibited from legally owning firearms because of that conviction.
In an interview, Bordelon said Elkins shot most of the children in the head and “probably still in their sleep.” Elkins was the father of seven of the eight children who were killed, Bordelon said; one of the children was a cousin, according to the coroner’s office.
“It is a disgusting and evil scene,” Bordelon told NBC News.
Elkins also shot and seriously injured his wife and another woman believed to be his girlfriend, police said.
He fled the scene and died in front of a home nearby, authorities said. It was not known whether he was fatally shot by law enforcement officers or died by suicide, Smith told reporters at a news conference Monday.
The mass shooting, one of the worst in the U.S. in recent years, sent waves of shock and grief through Shreveport. Shreveport Mayor Tom Arceneaux described it as “maybe the worst tragic situation we’ve ever had” in the city.
In an emotional news conference Monday, city and state officials condemned the bloodshed and called on community members to advocate for victims of domestic violence.
“We cannot afford to treat domestic violence as an afterthought. We must ensure that every victim, every mother, every father, every child has access to safety,” Caddo Parish Sheriff Henry L. Whitehorn Sr. said.
The Caddo Parish Coroner’s Office, citing information provided by the children’s mothers, identified the victims as Jayla Elkins, 3, Shayla Elkins, 5, Kayla Pugh, 6, Layla Pugh, 7, Markaydon Pugh, 10, Sariahh Snow, 11, Khedarrion Snow, 6, and Braylon Snow, 5.
Elkins served in the Louisiana Army National Guard as a signal support system specialist and a fire support specialist from August 2013 to August 2020, the Army said. He never deployed and left the National Guard as a private.
Shreveport police officers responded to the 300 block of West 79th street just after 6 a.m. local time after reports of a domestic disturbance, authorities told reporters.
Elkins first shot a woman on nearby Harrison Street before he went to the West 79th Street home, where he killed the children, authorities said. He then fled and carjacked a person at gunpoint near the intersection of Linwood Avenue and West 79th Street.
Police officers exchanged gunfire with Elkins in neighboring Bossier Parish after a pursuit, Smith told reporters Monday.
Police initially said that officers fatally shot Elkins at that scene, but Smith said Monday that Elkins’ cause of death was still under investigation.
In September 2017, a judge granted Elkins and Sariahh’s mother joint custody following a petition to determine paternity and establish child support, according to court records reviewed by NBC News.
The photo at the top of Elkin’s Facebook profile, which has been verified by NBC News, shows him posing with eight children, including a baby seated on his lap.
On April 9, Elkins reposted a poem addressed to God. “Today I ask You to help me guard my mind and my emotions,” it reads in part. “When negativity arises, remind me to say, ‘It does not belong to me, in the name of Jesus.’”
Ryan Chandler reported from Shreveport, and Daniel Arkin from New York.
If you or someone you know is facing domestic violence, call the National Domestic Violence hotline for help at (800) 799-SAFE (7233), or go to www.thehotline.org for more. States often have domestic violence hotlines as well.
Louisiana
Louisiana shooter Shamar Elkins made chilling remarks about ‘demons’ weeks before killing his 7 kids and their cousin
The deranged Army vet dad who gunned down his seven children and their cousin confessed he was drowning in “dark thoughts” and told his stepdad that some people “don’t come back from their demons” just weeks before the heinous killings, according to a report.
Shamar Elkins, 31, killed eight children — five girls and three boys ages 3 to 11 — and seriously wounded two women believed to be his wife and girlfriend when he went on a shooting rampage through Shreveport following an argument with his spouse around 6 a.m. Sunday.
Just weeks ago, on Easter Sunday, Elkins called his mother, Mahelia Elkins, and his stepfather, Marcus Jackson, and chillingly told them he was drowning in “dark thoughts,” wanted to end his life, and that his wife, Shaneiqua Pugh, wanted a divorce, the New York Times reported.
“I told him, ‘You can beat stuff, man. I don’t care what you’re going through, you can beat it,’” Jackson told the publication. “Then I remember him telling me: ‘Some people don’t come back from their demons.’”
Mahelia Elkins said she was unclear what problems her son and his wife, who were married in 2024 and had four kids together, were dealing with, the Times reported.
But a relative of one of the wounded women said the couple was in the middle of separation proceedings and was due in court on Monday.
They had been arguing about their relationship coming to an end when Elkins — who was later killed by cops — opened fire, Crystal Brown told the Associated Press.
The killer father worked at UPS and served with the Louisiana Army National Guard from August 2013 to August 2020 as a signal support system specialist and fire support specialist, according to the Times.
A UPS coworker described Elkins as a devoted dad, but said he often seemed stressed and would pull his hair out, creating a lasting bald spot, the publication reported.
Elkins’ mother noted that she had reconnected with her son more than a decade ago after leaving him to be raised by a family friend, Betty Walker. She had Elkins when she was a teenager and struggling with a crack cocaine addiction.
Walker said that she did not witness the shootings on Sunday morning but knew that Elkins shot his wife several times in the head and stomach, the paper reported.
She last saw the deranged father when his family came over for dinner just last weekend — but noted he did not appear off at the time.
“I was getting up this morning to make myself some coffee, and I got the call,” Walker recalled. “My babies — my babies are gone.”
Elkins also had two previous convictions, including for driving while intoxicated in 2016 and for the illegal use of weapons in 2019, the outlet said.
In March 2019, a police report detailed that the National Guard vet had pulled a 9 millimeter handgun from his waistband and shot at a vehicle five times after a driver pulled a handgun on him — with one of the bullets being discovered near a school where children were playing.
The victims killed by Elkins have been identified as Jayla Elkins, 3; Shayla Elkins, 5; Kayla Pugh, 6; Layla Pugh, 7; Markaydon Pugh, 10; Sariahh Snow, 11; Khedarrion Snow, 6; and Braylon Snow, 5. Seven of the eight were his own children, and the eighth was their cousin. They were all found dead inside their home in Shreveport.
Most of the victims were shot in the head while they slept, Shreveport Police Department spokesman Christopher Bordelon told NBC News.
One child was killed on the roof while trying to escape, police said.
Elkins, who was later killed by police during an attempted carjacking, also shot and wounded two women — the mothers of his children — during his murderous rage.
He shot his wife in the face at the home with the eight kids, Bordelon told the outlet. The other injured victim is believed to be Elkins’ girlfriend, who was shot in a separate house nearby, the police spokesperson added.
Elkins shared four of the slain children with his wife and three with the other injured woman, according to Brown.
If you or someone you know is affected by any of the issues raised in this story, call the National Domestic Violence Hotline at 1.800.799.SAFE (7233) or text START to 88788.
Yasin Gungor
19 April 2026•Update: 19 April 2026
At least eight children were killed and two others were wounded in a shooting in the US state of Louisiana, local police said Sunday.
Shreveport Police Department spokesperson Christopher Bordelon said officers responded to the shooting just after 6 am (1100GMT), following a domestic disturbance call.
The age of the deceased ranged from one to 14 years, he said, adding that the incident involved at least 10 individuals across four separate locations.
The suspect attempted to flee by carjacking a vehicle and driving to neighboring Bossier City, where police located and shot him dead.
Bordelon said Shreveport police officers pursued the suspect’s vehicle into Bossier, where three officers discharged their firearms, killing him. He said investigators believe the suspect was the only person who opened fire at the locations.
Shreveport Mayor Tom Arceneaux described the attack as “maybe the worst tragic situation we’ve ever had,” adding: “It’s a terrible morning.”
No immediate information was available about the condition of the injured.
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