The Center works in collaboration with a wide range of community groups to improve access to health care for low-income and uninsured patients at New Mexico hospitals. We monitor charity care programs at the hospitals, advocate for improving policies regarding financial assistance programs and collections procedures, and continue to follow up on successful advocacy to increase language interpretation services. While significant progress has been made, the Center continues to work with the hospitals to address ongoing policies and practices that prevent uninsured and low-income or indigent patients from accessing health care and financial assistance for their bills, and that often result in low-income or indigent patients accumulating medical debt and being wrongfully sent to collections.
UNM Hospital is the largest public hospital in New Mexico, and the only Level 1 Trauma Center in the state. People in need of emergency trauma care are brought to UNMH from across New Mexico.
As a public hospital, UNMH is entrusted with the responsibility of providing health care services to hundreds of thousands of New Mexicans, including many who are uninsured, poor and/or immigrants. When the Center learned about problems routinely experienced by these groups of people while trying to access services at UNMH, we began to advocate with the administration to make improvements to the Hospital’s policies. After years of inaction by the Hospital, the Center filed two lawsuits against UNMH, one seeking greater accountability for public funds that the Hospital receives for providing indigent care and another complaint regarding its failure to provide adequate interpretation and translation services to non-English speaking patients.
In response, UNMH made major changes for uninsured and low-income patients, adopting new financial assistance policies that reduced costs for them by 30%, that no longer required 50% payment in advance of services, and that provided them with affordable payment plans. UNMH improved its entire language interpretation delivery system, more than doubling the number of interpreters on staff, posting extensive signage in Spanish and Vietnamese and producing videos in Navajo (Diné). UNMH has mandated institution-wide training about the importance of using formal translation and interpretation services, and now uses innovative equipment and tools for providing language services.
However, the Hospital has yet to improve key policies and practices that continue to prevent uninsured and low-income patients from accessing financial assistance and that result in thousands of uninsured people being sent to collections each year. Although UNMH established an Office of Community Affairs, the hospital has made little progress in working with the community to improve its policies and practices in the following areas:
- Collections & Reducing Medical Debt: Records show that UNM Hospital sent over 275,000 billing accounts for uninsured patients to collections in FY 2008. The Center continues to encounter low-income patients who have been sent to collections because of systemic billing errors, restrictive eligibility requirements for charity care, or because the patients never received information about financial assistance. While the Hospital has expressed its intention to never send indigent patients to collections, and has been given information by the Center and community advocates on ways to improve billing and collections practices to conform with guidelines of the American Hospital Association, the Hospital has yet to take action to improve its policies.
- Access for Native Americans: See our web page on Urban Indian Health Care for more information about the obligations of UNMH to provide priority access to care for Native Americans and seek payment from the federal government for these services.
- Financial Reporting on Use of County Funds for Charity Care: UNM Hospital is supported with over $80 million in taxpayer funds through the Bernalillo County mil levy, with the expectation that these funds be used for providing health care and charitable assistance for the uninsured. Despite repeated requests for information on how much funding the hospital receives from the mil levy and other public and private sources, and how much is charged to and spent on financial assistance programs, the Hospital discontinued providing summaries that adequately track public funds.
- Screening Patients and Distributing Information about Financial Assistance Programs: Low-income patients continue to obtain medical services at UNMH without ever receiving information about the hospital’s charity care programs and payment plan options. Community advocates have encouraged UNMH to provide more information to patients and community organizations about its programs and to create patient-centered materials about financial services. In response, UNMH revised several brochures on its financial assistance programs, has posted these on its website, and is working with community members to ensure that information is widely distributed. However, the hospital has yet to commit to a plan for screening all uninsured patients for financial assistance programs, or for ensuring that front line staff is educated about the programs and routinely informs patients about them.
- Immigration Requirements for Charity Care Programs: The hospital continues to discriminate against New Mexico residents in its financial assistance programs due to their immigration status, despite strong public policy reasons against doing so as a charitable health care institution. Read a brief summary of the Center’s research memo to UNMH.
Currently, the Center serves on two hospital committees: the UNMH /Community Interpretation Committee, and the Patient Access Committee. Through these committees, the Center continues to push the hospital to complete its work on services for patients who do not speak English, and to improve access for the indigent. The Center also maintains regular communication with hospital administrators and attorneys to inform them about the law as well as systemic problems that indigent patients face in accessing care at UNMH.