More than three years after the health care expansion, 43 percent of New Mexico’s total population is signed up for Medicaid. But budgets are tight, and the Human Services Department is trying to figure out how to make it all work. Some of the proposals presented at a public meeting in Albuquerque were contentious.
The future is uncertain for federal heath care funding, and the state’s coping with budget woes, even though its Medicaid bill is getting bigger fast. HSD got about $32 million less than it asked for from the state Legislature for next year, according to Secretary Brent Earnest.
“We also have think about how to make it sustainable, too,” Earnest said. “So we’ll talk about the budget situation we face today.”
The department has to submit an application to the federal government at the end of the year about what the next generation of the program could look like. A subcommittee met for about six months and came up with some ideas, like:
• Eliminating free vision and dental services for adults
• More frequent income checks on the 900,000 New Mexicans who use Medicaid
• Fees for people who miss appointments more than three times
• No longer allowing Medicaid to retroactively cover recent medical debt
At the public meeting, one person in the crowd told HSD that those aren’t sustainable fixes.
“The long-term consequences I think are more costly,” she said. “And just keep on putting a Band-Aid on it is not effective.”
People said some of the proposals would really end up preventing folks from going to the doctor when they need to, which means more emergency room visits in the long run. And that kind of thing often hits public budgets pretty hard.
Probably the most controversial suggestion? Charging some New Mexicans on Medicaid a premium. For a household making $12,000 a year, it’d be about $20 each month.
She talked about the problems she sees with these proposals in the hall outside the meeting.
“Now think about it. We’re going to pay a monthly fee, even though we don’t need the doctor necessarily, right?” Porter said. “So what this really does is discourage people from signing up at all.”
We’ve made such great strides with health care in New Mexico, she said. The health care expansion cut in half the number of people who were uninsured.
“To go backwards now is crazy in this economic environment, where people—working as hard as they can—can’t move ahead,” Porter said. “And having basic health services is critical to their well-being, and also to their pocketbook.”
"I think both for the individuals and for us as a society, we’re going to see a lot of negative impacts of that,” he said. “If the department goes ahead with this plan, I am afraid—and a lot of my colleagues share this concern—that a lot of people are going to lose that benefit. And as a result, well they’re just going to go without services.”
David Roddy is executive director of the New Mexico Primary Care Association, which he said has experience treating people with low incomes. And he doesn’t take issue with many of the suggestions on the table, including co-pays.
“People are able to make a small co-pay,” Roddy said. “However, you know in the case of a premium, if you don’t pay it, you lose coverage. That’s drastic.”
Spokesperson Kyler Nerison said in an emailed statement that the next phase of Medicaid will build on what the expansion started: making sure patients get the right care at the right time.
Any changes that go through would take effect in 2019 and last for five years. Jason Sanchez is a deputy director with the Medical Assistance Division of HSD. He said hearing criticism from advocates and people enrolled in the program is necessary.
“That’s what this whole process is for,” Sanchez said. “We want to hear feedback. We want to hear input. We want to know reaction to the proposals that we put out there. That’s part of the whole process.”
A revised version of these ideas is slated for public comment again in September.
• Monday, June 19, Silver City, 4 p.m. to 6 p.m.
WNMU GRC Auditorium (1000 W. College Ave., 88061)
• Wednesday, June 21, Farmington, 4:30 p.m. to 6:30 p.m.
Bonnie Dallas Senior Center (109 E. La Plata St., 87401)
• Friday, June 23, Tribal Consultation Hearing, Albuquerque, 9 a.m. to noon
Indian Pueblo Cultural Center (2401 12th Street NW, 87104)
• Monday, June 26, Roswell, 4:30 p.m. to 6:30 p.m.
Roswell Public Library (301 N. Pennsylvania Ave., 88201)