KUNM

Medicaid Copay Plan Met With Strong Opposition

Jul 18, 2017

New Mexico is considering a plan to charge Medicaid patients copays as a way to save the state money. The proposal is drawing strong criticism from health care groups, poverty advocates and Medicaid recipients.

Officials with the state Human Services Department (HSD) say changing the Medicaid rules to include copays could help balance the state’s tight budget. It’s not a very popular idea.

But with over 43 percent of New Mexicans now getting their health care through Medicaid, and more expected to sign up in the future, the state is struggling to pay its share of the program’s costs. They have to figure out how to cut costs or raise more cash to keep the program solvent. HSD says charging people between $5 - $50 for doctor appointments and surgeries, as well as small copays for prescriptions, would save the state $1 million a year.

Still, critics of the idea say even modest copays can be a serious problem for people on Medicaid.

"People simply don’t have the money," said Ona Porter, who directs the Albuquerque nonprofit Prosperity Works, "because most low-income people are working in jobs where they have no paid time off. So they have to lose pay in order to go to the doctor. Now they have to go and pay? That’s an additional burden yet. So what people do is not go to the medical system."

Not everyone would have to pay a copay under HSD’s plan. Very low income people, pregnant women and people with intellectual disabilities would be exempt from most copays. So would Native Americans.

But people like Philip Casady, who made just over $12,000 after taxes last year, would have to come up with extra cash to see a doctor or fill prescriptions.

"I have an appointment coming up and I have to literally consider right now that I only have $140 to my name, and I have to pay some bills. It really makes me fearful for my long-term health care needs right now," Casady said. 

Casady is a student at Highlands University and used to have a student insurance plan.  But the copays were sometimes too much and he recently signed up under the Medicaid expansion.

"Any type of copay for me right now would be very troublesome," he said. "Even before, I had a lot of trouble getting the health care I needed. So now I’m looking at this situation and I’m like, I don’t know if I will be able to get the health care that I need at all."

Copays aren’t the only cost cutting changes to Medicaid that Human Services is considering. Other proposals include eliminating free vision and dental services for adults and charging fees for missed appointments.

Those other proposals are massively unpopular too.

"What you’re going to end up seeing is low income New Mexicans suffering because they don’t have access to health care from those changes," said Abuko Estrada with the New Mexico Center on Law and Poverty. They joined with the New Mexico Pediatric Society, the New Mexico Medical Society and around 20 other groups in sending a letter to the state urging officials to abandon the proposal.

Republicans in Congress are proposing massive cuts to Medicaid and with those cuts on the horizon, Estrada says any cuts at the state level could impact low-income New Mexicans especially hard.

"With the larger overhauls at the federal level, when you cut out $800 billion in Medicaid you’re going to further damage the program even more," Estrada said.

We wanted to hear from the state and ask how HSD plans to make sure people wouldn’t lose access to health care under the Medicaid revisions. But the department doesn’t currently have its own spokesperson and the HSD representatives at last week’s public meeting said they couldn’t comment. We sent multiple emails to the governor’s office requesting comment. No one responded.

If the state moves forward with the changes, the new copays will go into effect starting in October.