Healthcare Reform

UPDATES:
  • New! Toolkit on healthcare reform – Check out our new Healthcare Toolkit & Trainings web page for short brochures, handouts and more! (August 2013)
  • Become a health care “guide” for New Mexico – Learn more on our Healthcare Toolkit & Trainings web page about how to become a healthcare “guide” to help people enroll in coverage. (August 2013).
  • The Exchange must develop stronger enrollment and outreach programs – The Center and our partners are urging the Exchange to take action to get people enrolled in Medicaid and to get more federal funds for a robust in-person assister program. See our factsheet that summarizes these issues. The Center provided a presentation and handout to the Legislative Health and Human Services Committee in July about key concerns and next steps. We’ve also provided the Exchange this factsheet about effective strategies for outreach and enrollment, and this letter about its legal obligations for “no wrong door” enrollment into effort. Join us in these efforts by emailing dorianne@nmpovertylaw.org.  (August 2013).
  • Native American convening on healthcare reform – The Center hosted a gathering for over 150 tribal leaders, healthcare providers, and advocates to discuss key concerns and advocacy steps regarding healthcare reform implementation in New Mexico. See the Medicaid handout, Exchange handout, and Outreach & Enrollment handout, and learn more about advocacy efforts at our web page on Native American Healthcare. (June 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. Learn more about Medicaid and other healthcare opportunities on our Healthcare Toolkit & Trainings web page. Check out the most recent video from the Kidswell Briefing! (Jan 2013)
  • Looking for more information about healthcare reform implementation efforts across the country? Visit the KidsWell Campaign website to find valuable information on state efforts to implement national healthcare reform.
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HEALTHCARE REFORM IN NEW MEXICO

Healthcare in New Mexico will dramatically change in 2014. Over 350,000 New Mexicans will be able to access free and low cost healthcare coverage through Medicaid and a new marketplace called the Health Insurance Exchange.

Learn more about these new options through our Healthcare Toolkit & Trainings web page!

Medicaid Is Expanding

Medicaid is a public program that provides free and comprehensive healthcare services. Starting on January 1, 2014, Medicaid will be expanding to provide coverage to over 160,000 more New Mexicans. You can apply starting October 1, 2013 for coverage that begins January 1, 2014.  Find more information about Medicaid expansion here.

Health Insurance Exchange

The Exchange is a new marketplace where nearly 200,000 New Mexicans will be able to access low cost or even free health insurance starting on January 1, 2014. The Exchange will take applications starting October 1, 2013 for coverage that begins as soon as January 1, 2014. There is a limited window for enrollment – you must get enrolled before March 31, 2014 or else you cannot apply again until the next year. There is an exception for Native Americans who can apply anytime of the year. Find more information about the Exchange here.

Employer Coverage

Some large employers will be required to provide healthcare coverage to full-time employees or else pay tax penalties, starting in 2015. Small employers do not have to provide healthcare benefits, but they may qualify for tax credits to help buy coverage for employees.  If you are an employee that gets healthcare benefits through your employer, you can still get Medicaid if you qualify for it. However, you cannot get financial help to buy insurance through the Exchange unless your employer’s plan is unaffordable or inadequate. The Exchange will decide if your employer’s plan is sufficient.  Find more information about employer coverage here.

Consumer Protections with Health Insurance

Many new rules are going into effect for insurance companies. Children can stay on their parents’ plans until age 26. New rules on “Medical Loss Ratios” require health plans to spend a larger percentage of money from patient premiums on healthcare rather than administration or profits. Insurers also will not be allowed to deny anyone coverage due to pre-existing conditions and women can no longer be charged higher prices just because they are women.

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PRESENTATIONS AND TRAININGS

Please see our new Healthcare Toolkit and Trainings webpage to learn more about our trainings.

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OUR ADVOCACY ON HEALTHCARE REFORM

New Mexico has yet to make the promise of healthcare coverage into a reality. If the state continues to lag with its enrollment efforts, New Mexicans could face major barriers to getting free and low-cost healthcare. Please email us at contact@nmpovertylaw.org to join our list serve for regular action alerts and updates for how to get involved.

Outreach and Enrollment for Medicaid and the Exchange

Over 350,000 New Mexicans will qualify for new healthcare coverage through Medicaid and the Exchange on January 1, 2014. The state is responsible for enrolling everyone in these programs and making sure people know about their healthcare options. If the state does a good job, the enrollment process will be easy and will reach communities throughout the state. But if the state does not make strong progress, then the system will be challenging, confusing, and could ask for unnecessary paperwork. A lack of strong outreach and enrollment efforts will also perpetuate the serious disparities in healthcare coverage for low-income communities, between rural and urban areas, and for racial/ethnic minorities in the state.

The Center is working to: 1) Encourage the state to provide aggressive outreach and accurate information about Medicaid expansion; 2) Simplify the enrollment process and preventing unnecessary paperwork; 3) Advocate for “no wrong door” enrollment so that the Exchange educates and helps people get enrolled in Medicaid; and 4) Ensure the state engages in outreach and enrollment strategies that are effective for Native American, immigrant, rural and other underserved communities.

Affordability Problem for Low-Income New Mexicans

We are deeply concerned that tens of thousands of low-income New Mexicans will remain uninsured after 2014 because their incomes are too high for Medicaid and yet too low to afford coverage through the Exchange, even with financial help. See our factsheet and presentation about affordability concerns. If you are caught in this gap between Medicaid and the Exchange and would like to support efforts for a solution, please contact us by emailing dorianne@nmpovertylaw.org.

The Center continues to urge state policymakers to consider solutions that would make coverage more affordable for low-income families. One option is called the “Basic Health Program”. See our factsheet explaining how the program works. There are also other options such as establishing a state-funded premium assistance program. These solutions could save low-income families thousands of dollars each year.

In 2012, the Center successfully advocated for the New Mexico legislature to adopt a memorial, sponsored by Senator Michael Sanchez and Representative Gail Chasey, to study a Basic Health Program in New Mexico and the affordability of coverage. In response to that memorial, the Legislative Finance Committee released our report in December 2012 that analyzes the affordability problem and recommends next steps to policymakers. In 2013, we successfully advocated for the Legislature to put funding towards an in-depth study about the costs for a Basic Health Program. However, that funding was vetoed by Governor Martinez.

Native Americans and Healthcare Reform

Although the federal government has the obligation under numerous treaties and by statute to provide healthcare coverage to all Native Americans, it has never fully delivered on this promise. As a result, Indian Health Services (IHS) is not adequately funded and services vary widely in different areas. For example, emergency care or specialty services may be unavailable. Thousands of Native Americans in New Mexico are in medical debt because they have had to seek care from non-Indian health providers and did not have healthcare coverage to pay the bills.

Over 45,000 Native Americans will be able to get healthcare coverage through Medicaid or the Exchange. This will help strengthen the Indian health system and ensure that Native Americans have access to comprehensive healthcare services. Native Americans cannot be charged fees for Medicaid, and most Native Americans who seek health insurance on the Exchange will qualify for free coverage. Find more informational materials on our Healthcare Toolkit & Trainings page.

The Center has been working closely with tribal leaders, health providers, and advocates to ensure that health care reform implementation efforts in New Mexico protect the rights of Native Americans. Learn more on our Native American Healthcare web page.

Immigrants and Healthcare Reform

For lawfully present immigrants, healthcare reform expands access to health insurance and requires people to maintain coverage. However, undocumented immigrants are excluded from both the benefits and the mandate to get coverage. For more information about healthcare reform impacts immigrants, take a look at our Healthcare Toolkit & Trainings web page. For a more in-depth explanation of how healthcare reform will expand access to healthcare for lawfully present immigrants, see our webpage on Immigrants and Healthcare page.

The Center is advocating for the state to address the concerns of immigrants and their families as it develops enrollment systems under healthcare reform. These systems must provide language interpretation and translation services for people with limited English proficiency. The system must also have consumer assistance workers (called “healthcare guides” or “navigators”) who are familiar with the complex rules that determine which immigrants qualify for Medicaid or financial help for the Exchange. In addition, paperwork requirements are often more confusing and burdensome for immigrants. Under healthcare reform, the state has an obligation to reduce paperwork and work with families to help them prove immigration status and income.

Past Advocacy

The Center has been closely involved in efforts to implement healthcare reform in New Mexico since the Affordable Care Act was passed in 2010. In 2012, we took a lead role in a successful statewide advocacy campaign to persuade the Governor to expand Medicaid to over 150,000 more adults. Learn more about those efforts on our Medicaid page. In 2011, we wrote an in-depth report about how New Mexico could best develop an Exchange to meet the needs of our state. The Center also worked extensively that year on legislation to set up a consumer-friendly Exchange in New Mexico where insurance companies would be prohibited from serving on the governing board (see our factsheet and Q&A). That bill was vetoed by the Governor. We also advocated for the New Mexico Legislature to pass a memorial sponsored by Representative Mimi Stewart that requested the state to plan and develop a streamlined enrollment system for Medicaid and the Exchange. See our factsheet about the memorial, which was passed by the House.

In April 2012, we helped secure a presentation by experts at the Georgetown Center for Children and Families about developing a navigator program in New Mexico that was attended by over 40 state legislators, legislative and Division of Insurance staff, advocates, healthcare providers, and experts. We also successfully advocated for the New Mexico Legislature to pass a memorial, sponsored by Senator Tim Jennings and Representative Miguel Garcia, calling on the Human Services Department to provide periodic reports to the Legislature about the state’s activities under a $34 million Level One Exchange Establishment Grant from the federal government.

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KIDSWELL PROJECT

Our partner, KidsWell has created an informative and easy to use website that provides state-by-state summaries of health care reform implementation and campaigns impacting children’s health. We refer to the information on kidswellcampaign.org regularly and hope you will, too.

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RESOURCES

Presentations/Materials:

Please see our Healthcare Toolkit & Trainings page for presentations and materials on healthcare reform.

Factsheets/Reports:

Factsheet: Exchange Must Act on Outreach and Enrollment Assistance (August 2013)
Presentation: Outreach and Enrollment Concerns for Medicaid and the Exchange (for NM Legislative Health and Human Services Committee) (July 2013)
Handout: Action Steps to Increase Coverage in Medicaid and the Exchange (for NM Legislative Health and Human Services Committee) (July 2013)
Factsheet: Importance of No Wrong Door Coverage for Medicaid and the Exchange (July 2013)
Factsheet: Effective Outreach and Enrollment Strategies for New Mexico (May 2013)
Factsheet: Will Healthcare Be Affordable for New Mexicans After Reform? (June 2012)
Presentation: Basic Health Program and Affordability Concerns in New Mexico (April 2012)
Handout: Basic Health Program in New Mexico (March 2012)
Factsheet: Support A Streamlined Enrollment System for Healthcare Memorial (February 2012)

Comments/Letters:

Comments to BHP- Proposed Regulations (November 2013)
Comments to CMS- Hardship Exemption Application
(November 2013)
Letter to Exchange: Legal Requirements for Medicaid outreach and enrollment assistance
(July 2013)
Comments to NM Office of Health Care Reform on Blueprint Application for State-Based Exchange (Dec 2012)
Comments to HHS: New Mexico Blueprint Application for State-Based Exchange (Dec 2012)
Comments to HHS: Proposed Interim Exchange Regulations (May 2012)
Advocates letter to Federal Government: Concerns about New Mexico’s Healthcare Exchange Establishment Grant (Nov 2011)

Media:

Article: Grant Application Reveals Tension over Health Insurance Exchange, quoting Staff Attorney Kelsey Heilman (June 2013)
Article: Health Insurance Exchange Ok’s Unexpected $7.5 Million Expense, quoting Staff Attorney Sireesha Manne (June 2013)
Op-Ed: Insurance Exchange Needs More Consumer Protections, by Executive Director Kim Posich (Jan 2013)

Links:

Healthcare.Gov KidsWell Campaign
Georgetown Center for Children and Families
Kaiser Family Foundation Health Reform Source
Community Catalyst ACA Implementation

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