Providers Criticize Medicaid Overhaul Plan

May 18, 2012

Medicaid providers are criticizing the state Human Services Department's plan to overhaul the program that provides health care to children and poor adults.  

From The Albuquerque Journal:

Participants generally praised HSD’s plans to help Medicaid recipients get better care through better patient education and programs to coordinate care among several providers. State officials were not able to provide many of the implementation details audience members were seeking.

New Mexico Hospital Association president Jeff Dye estimated one proposed change could cost Albuquerque’s major hospital systems $48 million a year in lost revenue. The state’s Department of Children, Youth and Families issued a statement opposing the change to what is known as retroactive eligibility because it would interrupt health care over administrative hiccups.

Today, people eligible for Medicaid who haven’t enrolled are allowed to enroll retroactively after they’ve started receiving care. Not allowing them to do so would leave hospitals with unpaid bills. CYFD said recipients are often removed from the rolls because of administrative problems that can be quickly resolved, but recipients, most of them children, lose care in the meantime.Jemez Pueblo Gov. Joshua

Madalena and Roselyn Begay of the Navajo Nation Division of Health both opposed plans to require Indians to receive Medicaid benefits through managed care organizations. Today Medicaid provides feefor-service payments for Indians’ care.Earlier HSD proposals would have allowed Indians to opt out of managed care, but officials said Thursday the waiver application requires tribal Medicaid beneficiaries to be enrolled in managed care programs. 


HSD says the plan would cuts costs by $453 million dollars over five years and increase access.  New Mexico's Medicaid program serves 560,000 people.  Two thirds of the $3.9 billion dollar program is provided by the federal government.