KUNM

Medicaid

Marisa Demarco / KUNM

A U.S. District Court judge has found the Human Services Department secretary in contempt of court after hearings this summer when state employees testified that they were instructed to falsify food stamps applications.

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UnitedHealthcare is dropping insurance coverage for its Medicaid patients at the University of New Mexico Hospital. The decision comes after months of negotiations.

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For decades, the New Mexico Human Services Department has faced criticism for failing to properly process applications for Medicaid and food assistance, or SNAP benefits. Several former and current Human Service Department workers testified last month that it was department policy to alter the information on emergency SNAP applications so that people wouldn’t be eligible for benefits.

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UNM Hospital and UnitedHealthcare are in negotiations over continuing coverage for the company’s Medicaid patients . The hospital and insurer haven’t come to an agreement yet and are extending their negotiations for 60 more days.

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New Mexico’s attorney general announced on Tuesday that his office cleared the final two behavioral health providers accused of fraud. Those allegations against more than a dozen providers shuttered services that the state is still scrambling to restore.

Marisa Demarco / KUNM

The Legislature found more money for health care this year than it did last year, but it’s still not enough to cover the costs of Medicaid expansion under the Affordable Care Act. A group of advocates and associations from all corners of the health care system met on Friday to grapple with the projected shortfall.

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The state’s Medicaid Advisory Committee is meeting Friday afternoon in Santa Fe to talk about budget shortfalls. One lawmaker called it the tightest budget in memory after the legislative session ended last month. And advocates are warning that Medicaid will be millions short, which could mean higher fees for low-income patients, lower rates for providers and limited job growth in the health care field. About 40 percent of the state’s population is covered by Medicaid after the expansion...

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Health insurance can be complicated and understanding how to get covered can be difficult. Students at a specialized charter school in Albuquerque are producing podcasts to help people navigate the health insurance system.

Marisa Demarco / KUNM

More than 20 organizations joined together Tuesday to call on lawmakers not to cut funding for behavioral health services.

Public Health In The 2015 Session

Mar 24, 2015
Arianna Sena

Psychiatric Meds In School—PASSED If parents refuse to give their child psychiatric medicine, the school can’t prevent the student from participating in programs under Republican Rep. Nora Espinoza’s bill . The student also can’t be put into protective custody just because his or her parents refuse psychotropic drugs, and the school has to get consent from parents to screen a child for psychological issues. (MD) Inmates With Mental Illness Awaiting Trial—PASSED AND SIGNED This legislation is...

Marisa Demarco / KUNM

Advocates have tried since 2011 to pass a bill that would create a new breed of mid-level dental care providers in New Mexico. It passed the state’s House of Representatives on Monday for the first time ever on a bipartisan vote. If the Senate gives it a thumb’s up before the session ends on Saturday at noon, it could mean a big change for dentistry. At Cochiti Pueblo’s dental clinic Dr. Patricio Larragoite congratulated his young patient on the lack of buildup on his teeth. " What we’re...

JZim534 via Flickr / Creative Commons License

Javier Martínez was familiar with home-visiting services when his son Camilo was born in January. Martínez’s 2-year-old daughter Marisela participated in a program, which teaches parenting skills and provides other support for pregnant mothers and new parents and guardians. Such programs improve kids’ performance in school and beyond. And, as New Mexico In Depth and the Las Cruces Sun-News reported in December , home visiting is one way to help reduce fatal child abuse. While preparing to...

A New Mexico legislator is trying to help inmates sign up for Medicaid around the state. Sen. Jerry Ortiz y Pino says his bill, Senate Bill 42, could help stop people from cycling in and out of jails and prisons. For people with addiction or mental health issues, he says, it’s nearly impossible to find affordable services if you’re not signed up for Medicaid. "If you apply the day you got out of jail, it would take a couple of weeks—at the fastest—before Medicaid could certify you as eligible...

Attorney General Hector Balderas released a 339-page audit by Public Consulting Group that caused the suspension of funding for 15 behavioral health providers in New Mexico. Read the released audit here. Arizona firms were hired to provide behavioral health services, and local providers have said they were unable to see or refute the specific fraud allegations against them. Much of the audit has been a mystery since 2013, though heavily redacted portions of it were released. News...

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Roswell Mayor Dennis Kintigh reached into his shoulder bag and pulled out a four-page brochure Monday at the Roundhouse in Santa Fe. The pamphlet the former Republican state lawmaker held begins with this statement in bold lettering: “The behavioral health system in Chaves County is in crisis.” The brochure is the product of an ad hoc committee formed by a state court district judge in Roswell, Kintigh says. The pamphlet goes on to warn of the consequences when a community has too few...

Lawsuit Argues Medicaid Evaluations Hurt Disabled

Aug 25, 2014
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Family members of developmentally disabled New Mexicans suing the state say a Medicaid assessment system puts recipients of services at risk. The Albuquerque Journal reports attorneys for eight families asked a judge Wednesday to halt a new method for evaluating recipients to determine their level of services, which can include 24-hour residential care as well as occupational and speech therapy. The lawsuit was filed in January to restore the services lost by individuals and stop Gov. Susana...

Deborah Martinez

Midnight Monday is the deadline to sign up for healthcare under the Affordable Care Act . Over the weekend in New Mexico people lined up to get covered, either through the insurance marketplace or Medicaid. From those in their 60s to young people under 26 covered under their parents’ plan, hundreds stood in the bright spring sunshine sign up under Medicaid , or with one of four insurance plans. “My name is Elizabeth Rodriguez, I’m 25 and I’ll be 26 this September, and I came here today...

Ken Lund via Flickr

Community health workers can be paid through Medicaid after a measure signed by Gov . Susana Martinez on Sunday, March 9, goes into effect. As things stand, workers’ salaries are primarily funded by grants. The legislation also creates a state certification program and funding for trainings. Bette Jo Ciesielski called the act historic and says it’s the culmination of decades of work. She is the director of the New Mexico Community Health Worker Association , which she helped form in 1995. The...

Deborah Martinez

Thousands of people with developmental disabilities in New Mexico have been waiting to receive the full spectrum of services available through a government program, some for more than 10 years . The Tatz family is inching towards that benchmark, as they and their kids grow older. “I had back surgery," Lesly Tatz announced. Lesly's mom, Jill Tatz, explained, "S he has had medical issues, and had open heart surgery at 18 months.” Her daughter has had numerous surgeries. Lesly and Jill have been...

Wiki Creative Commons

UPDATE Feb. 19, 2014, 11:40 a.m.: The Medicaid fraud definition , the f arm-fresh produce in public schools , the mental health nursing program and the emergency procurement and audits measure are stuck in committee. The marijuana legalization bill died in committee. The ban on sales of e-cigs to minors passed the House and is awaiting a vote in the Senate. The DD Waiver Program 5-year plan is awaiting a vote in the Senate. Lawmakers have introduced a series of public health-related bills...

The director of the state's Behavioral Health Services Division is resigning. Diana McWilliams submitted her resignation letter on Monday, Dec. 16, and her last day is tomorrow. She'll be heading back east to Philadelphia to become the chief operating officer for a nonprofit behavioral health and child welfare organization, she said. Matt Kennicott, spokesperson for the Human Services Department , said a plan is still being formulated for finding McWilliams' replacement, and in the interim, a...

Free App Enrolls New Mexicans in Obamacare

Dec 19, 2013
Cheon Fong Liew via Compfight cc

Medical residents at UNM created a free app to help New Mexicans get hooked into health care. The app, called Get Covered New Mexico, can aid folks in calculating what they're eligible for. It links directly to websites people can use to apply for Medicaid and the health care exchange . It also points the way to the nearest physical location to apply for services in-person. And it works entirely on your cell phone. Healthcare.gov has been heavily criticized for bad mobile design . The local...

Under the Affordable Care Act , around 63,000 New Mexicans will need to buy new health insurance policies by the end of the year. Those plans could cost more and cover more. Come Jan. 1, many health plans offered by insurance companies will be non-compliant with new federal standards. For instance, if the plan doesn't offer mental health services or maternity care, it's non-compliant. That means 23,000 New Mexicans who get their insurance through Presbyterian Healthcare Services will have to...

In June, New Mexico’s Behavioral Health care system was thrown into chaos — the state abruptly froze Medicaid payments to more than a dozen mental health providers in the state after an audit allegedly found widespread fraud . Those providers served nearly 30,000 patients , but neither the public nor those accused have been able to see the actual audit because the state says an investigation continues . Now a partial release of the audit’s findings have raised further questions about New...

Bryant Furlow / New Mexico In Depth

At the end of June, 15 New Mexico behavioral health agencies had their Medicaid funding frozen by the state's Human Services Department due to “credible allegations of fraud.” The agencies provide services to approximately 30,000 patients , many who seek help for mental health issues ranging from substance abuse treatment to schizophrenia. The reason for the freeze, according to HSD, was an audit that was conducted after OptumHealth — the company tasked with managing Medicaid dollars for the...

On June 24, New Mexico's Human Services Department announced that an audit found " credible allegations of fraud " for 15 behavioral health agencies that provide mental health and substance abuse treatment to approximately 30,000 patients . Medicaid funding was immediately suspended, the audit was turned over to the state's Attorney General to conduct a criminal investigation, and five Arizona firms were given emergency, no-bid contracts to take over the New Mexico organizations and their...

Bryant Furlow

When the New Mexico Human Services Department (NMHSD) announced last month it would suspend Medicaid payments to 1 5 behavioral health providers , Joe Frechen was worried. For nearly 20 years, Frechen has worked as psychiatrist in Southern New Mexico with some of the most vulnerable patients in the region. “I know when something’s going wrong,” Frechen said. “I know what’s happening in the family, I know all the various trials and tribulations they’ve been through, I know about the...

Indian Health Service

Around 25-thousand Native Americans in New Mexico will become eligible for Medicaid when the Affordable Care Act goes into effect next year. The change translates to more money for the Indian Health Service. But as KUNM’s Poverty and Public Health Reporter Tristan Ahtone explains: in Albuquerque, Medicaid expansion will also force Native health providers to deal with something they’ve never faced before: competition from non-tribal health programs. TRANSCRIPT: TRISTAN AHTONE: New Mexico has...

Centennial Care Tribal Opt-Out Future Uncertain

Mar 15, 2013

Tribal health advocates say the clock is running out for legislation that would prohibit the state from forcing Native American Medicaid enrollees into mandatory managed care.
House Bill 376 aims to provide New Mexico's Medicaid-eligible tribal population the ability to opt-in to the states mandatory Medicaid managed care program, Centennial Care.
Earlier this month the federal government stepped in and told the state that Native Medicaid enrollees could not be made to enroll in the...

A bill that would remove the mandatory requirement that Native American Medicaid recipients enroll in a state run managed care program is now heading to the Senate. Centennial Care, New Mexico’s planned Medicaid program, would require all Medicaid users to enroll with one of four managed care organizations (MCO) contracted with the state. Under the program, the Indian Health Service, as well as Tribal and urban clinics, would have to bill those same MCO’s for services provided, instead of...

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