Medicaid

Table of Contents:

Updates:

  • Kidswell Briefing in Albuquerque, NM! Executive Director Kim Posich and Staff Attorney Quela Robinson speak at the Kidswell Briefing about the Affordable Care Act. Watch the video here. (March, 2013)
  • New Mexico says yes to the Medicaid Opportunity! Beginning in January 2014, Medicaid will be available to 170,000 more low-income New Mexicans. Click here to learn more and find out how you can get involved! (Jan 2013)
  • Medicaid Rocks! Celebrate the Medicaid Expansion victory by watching our music video! (Jan 2013)
  • Medicaid expansion will save New Mexico over $500 million in the next seven years according to UNM economists. Read the new report by the UNM Bureau for Business and Economic Research. These estimates are similar to findings by NM’s Legislative Finance Committee during its September hearing. (Oct 2012)
  • Center holds Native American convening on the Medicaid Opportunity. See our presentation given to tribal governors, healthcare providers and experts about the importance of Medicaid for Native communities. (Oct 2012)
  • Op-Ed: Medicaid Deal Too Important to Pass Up. Read the op-ed by the Center’s Staff Attorney Kelsey Heilman after the Albuquerque Journal endorsed Medicaid expansion. (Oct 2012)
  • New factsheets on the Medicaid opportunity. Check out our updated factsheet about how expanding Medicaid will close the healthcare gap and bring economic growth to New Mexico, a factsheet on the Top 5 reasons to support the Medicaid opportunity, and an FAQ about Medicaid expansion. (Oct 2012)
  • Center weighs in with CMS on redesigning the Medicaid program in New Mexico. We recently spoke with officials at CMS and submitted comments asking for the federal agency to reject proposals that will harm low-income New Mexicans. (Oct 2012)
  • New Mexico’s Human Services Department announces that it has retracted its application to redesign the state’s Medicaid program. HSD will seek additional public input. Read our Op-Ed in the Albuquerque Journal about how HSD submitted its waiver application to the federal government to make major changes to Medicaid and avoided federal rules for transparency. (June 2012)
 top

About Medicaid and How to Apply

Do you want to learn more about Medicaid in New Mexico, who can get healthcare coverage, and how to apply? Click here

 top

Our Advocacy on Medicaid

Our team of attorneys and community organizers work to ensure that every low-income New Mexican can access healthcare coverage through Medicaid. We focus on a wide range of issues that include (please click on the link to automatically scroll down to the issue area):

 top

Medicaid Expansion in 2014

In January, Governor Susana Martinez announced an historic decision for New Mexico: the state will extend healthcare coverage to over 170,000 more uninsured New Mexicans through Medicaid. Starting on January 1, 2014, the state will expand Medicaid to most adults with incomes below 138% of the poverty level – about $15,000 for an individual and $32,000 for a family of four. This new healthcare coverage will help our state combat poverty and provide economic stability to tens of thousands of families. Businesses and our healthcare system will benefit from billions of federal dollars that will be invested in New Mexico – creating between 6,000 to 8,000 new jobs.

While Governor Martinez initially expressed concerns over the costs of expansion, new analysis by experts including the state’s own Legislative Finance Committee show that the state will save over $500 million dollars by the year 2020 and costs will be completely covered after that. Most of the Medicaid costs will be paid by the federal government, resulting in new revenues for the state as federal funds flow through our economy. The state will save money by moving adults from the State Coverage Insurance (SCI) program and the state’s high risk pool into Medicaid. By saying yes to the Medicaid opportunity, we keep the benefits of our own federal tax dollars here in New Mexico.

The Center on Law and Poverty engaged in a sustained campaign to ensure that New Mexico took the Medicaid Opportunity. We provided research and information to lawmakers and legislative committees, worked with experts on developing cost analyses, worked in coalition with local organizations to reach the Governor and media, and gave numerous trainings and presentations to community members and our allies so that we can work together to let our policymakers know how important this issue is to New Mexico. Thanks to the efforts of thousands of New Mexicans who reached out to the Governor to make their voices heard, we can now celebrate a historic victory for New Mexico!

Get Involved! Now that the state has made the important Expansion decision, it’s time to roll up our sleeves and get the word out. We’re committed to ensuring that every New Mexican knows about this new opportunity to obtain healthcare coverage! Join our efforts by calling (505) 255-2840 or emailing (contact@nmpovertylaw.org) to speak with a staff person from our healthcare project or to join our email listserv.

Factsheets/Presentations/Reports

 Letters/Comments

 Media

 top

ENROLL KIDS AND FAMILIES MISSING FROM MEDICAID

There are over 40,000 children who are missing from Medicaid – they are qualified for healthcare coverage through Medicaid but they are not enrolled. These uninsured children are concentrated in McKinley, Cibola, San Juan, Dona Ana, and Bernalillo counties – and they are mostly from Native American and Latino families. The serious disparities in enrollment are not surprising given that the Human Services Department has stopped most of its outreach efforts due to budget constraints over the last couple of years, and still has not addressed enrollment barriers that continue to prevent people from applying for Medicaid. For example, the Center recently obtained data that shows over half of newborn children get dis-enrolled from Medicaid after their first birthday because of unnecessarily complex renewal procedures.

The Center consistently urges New Mexico’s Human Services Department to improve its enrollment processes, and we met with Governor Martinez last year to ask her to continue fully funding Medicaid and to simplify enrollment procedures so that every child has healthcare. We are currently encouraging the state to address the newborn renewal problem and to conduct targeted outreach that is culturally and linguistically appropriate for Native American and Latino communities. We continue to make positive changes with the Human Services Department in reducing enrollment barriers for eligible immigrant families and children who are citizens and live in “mixed status” immigrant households. In addition, the Center continues to push for enforcement of the consent decree from the Hatten-Gonzalez v. Hyde class action lawsuit that mandates improvements to the application process for all Medicaid applicants.

The Center is also monitoring the state’s progress in updating its computer enrollment systems for Medicaid. In 2012, the House of Representatives passed House Memorial 18, which asks the state to make one unified enrollment system for Medicaid and other healthcare programs that will be implemented under healthcare reform. It calls for a system that is easy to use, meets the needs of low-income people, and provides data that can be used to improve enrollment systems. The Center worked hard to support this memorial during the 2012 Legislative session.

Past Advocacy – The Center’s work on enrollment practices draws upon a long history of advocating for changes in Medicaid. In January 2009, we released a report, “Maximizing Medicaid in New Mexico,” that made recommendations for improving enrollment practices. In April 2009, the Children’s Health Insurance Program Reauthorization Act (CHIPRA) was enacted, providing bonuses and financial incentives to states to improve enrollment procedures in Medicaid and CHIP. We wrote a memo detailing the options available to New Mexico under CHIPRA and collaborated with other advocates to successfully persuade New Mexico to: 1) provide 12-month continuous coverage to children despite fluctuations in their family income, 2) develop a database matching system with the Social Security Administration to verify the citizenship of Medicaid applicants without requiring unnecessary paperwork; and 3) remove the 5 year waiting period for lawfully residing immigrant children and pregnant women to enroll in Medicaid. In 2004, we launched an advocacy campaign to end “autoclosure”, a procedure by which a computer would automatically dis-enroll participants from Medicaid if their renewal paperwork had not been processed, even in cases when the person was still eligible for services. During the first 15 months of autoclosure, more than 120,000 families were dis-enrolled from Medicaid. Approximately 75% of these families were subsequently reinstated, indicating they were eligible for Medicaid all along. While the practice of autoclosure still remains, the Human Services Department has taken significant steps to improve its renewal procedures.

Factsheets/Presentations/Reports

Letters/Comments

Media

Social Media

Other Resources

 top

PREVENT CUTS FROM MEDICAID REDESIGN (“CENTENNIAL CARE”)

The Center closely monitors Medicaid to prevent cuts that harm low-income New Mexicans. The Human Services Department (HSD) is currently proposing a major redesign of the state’s Medicaid program – titled “Centennial Care”. While the proposal takes a step in the right direction to improve care coordination and responds to the wishes of the public in limiting fees and cuts to services, there are also serious problems that continue to garner intense public opposition. HSD intends to cut services for some women who need family planning services or breast or cervical cancer treatment. HSD also intends to reduce coverage for the past medical bills of all Medicaid patients and to increase co-pays on Medicaid patients who go to emergency rooms for conditions that turn out not to be emergencies. These changes will likely send low-income New Mexicans into medical debt and burden hospitals and providers with unpaid bills. HSD is also attempting to move forward with proposals to require Native Americans to enroll in managed care organizations, despite strong and widespread opposition from tribal leaders.

The Center has provided extensive legal research to the Human Services Department (HSD) to document our concerns. We have also worked closely with community members and Native American health leaders and advocates to provide public input throughout the year. Youth interns at the Center captured hundreds of videos that recorded messages from Medicaid recipients opposed to cuts in services, and delivered these to the Governor. See the videos on our Facebook page. Our community organizing team encouraged community members and advocates to attend HSD public meetings about the Medicaid redesign. In November 2011, we worked with our allies to hold a town hall meeting that was attended by over 250 community members. We also wrote several Op-Eds about the harms of co-pays and the lack of transparency in the HSD process.

In order to move forward with its proposals, HSD must obtain a “Section 1115 waiver” from the federal government’s Centers for Medicare and Medicaid Services (CMS). HSD submitted an application to CMS in April 2012, but withdrew the application due to public and tribal opposition to the proposals and concerns about the lack of public input. After holding several public meetings, HSD submitted a final application in August 2012, which included some important positive changes, including a request to adopt “12 month continuous eligibility” in Medicaid for adults so that they don’t lose healthcare coverage during the year even if their income fluctuates. The HSD application also no longer seeks to cut services for some working disabled individuals and pregnant women. However, the final application continues to request cuts for family planning services, breast and cervical cancer treatment, and coverage for past medical bills. HSD still intends to impose more co-pays on Medicaid patients and to transfer all Native American enrollees into managed care organizations despite widespread tribal opposition. In response, the Center has submitted our comments to CMS asking the agency to reject these harmful proposals and detailing the legal grounds for doing so. We have also spoken directly with agency officials about our concerns. There is no deadline for when the agency must make a decision, but HSD has requested a decision before December 31, 2012.

Factsheets/Presentations/Reports

Letters/Comments

Media

Social Media

Other Resources

 top

FULL FUNDING FOR MEDICAID

The Center closely analyzes the Medicaid budgets each year, provides expert testimony to the legislature, and educates the public and lawmakers about the importance of Medicaid and the harms of cutting services. In 2011, we helped commission an independent poll that shows most New Mexicans oppose funding cuts to Medicaid. Although New Mexico has faced tremendous challenges with its budget during the economic recession, especially in the years 2009-2010, Medicaid is one of the only state programs to have its funding mostly preserved, due to the sustained advocacy efforts of the Center, our allies, and key policymakers.

However, the flat budgets for Medicaid have resulted in the Human Services Department cutting most of its outreach efforts. As a result, there are still over 40,000 children who are qualified for Medicaid but who are not enrolled. The Center is advocating for the legislature to set aside outreach funds that can be used to find and enroll these children into Medicaid.

FACTSHEETS:

MEDIA:

 top

 
TRANSPARENCY & ACCOUNTABILITY

The Center has led ongoing advocacy efforts for the Human Services Department (HSD) to increase transparency in Medicaid. In the 2012 legislative session, we advocated for House Bill 17 sponsored by Representative Eleanor Chavez, that would require legislative approval to any changes to the Medicaid program with a fiscal impact over $1 million. We provided extensive research and expert testimony on the bill, but it died in committee. In 2009, we advocated for House Bill 130, sponsored by Rep. Mimi Stewart, which would have required HSD to report upon enrollment and retention data in Medicaid, and the reasons why cases are denied or closed. This information is collected by many other states, and is collected in the HSD computer system, but is not publicly reported. The bill passed unanimously in the legislature, but was vetoed by the Governor. See a factsheet about the bill.

FACTSHEETS:

MEDIA:

top