ACA Repeal Plan Jeopardizes New Mexicans’ Healthcare, Economic Recovery

Statement by Sireesha Manne, Healthcare Supervising Attorney at the New Mexico Center on Law and Poverty

 

 

We call upon our elected leaders to strongly oppose the U.S. House’s reckless legislation to repeal the Affordable Care Act. It would threaten the healthcare system providing coverage to nearly half of all New Mexicans and, which experts agree, has been one of the few bright spots in the state economy.

New Mexico’s low income and rural communities would be especially hard hit. Our state would be forced to cut Medicaid coverage or ration services for hundreds of thousands of children, people with disabilities, the elderly, and low income adults. Two thirds of our children in New Mexico are enrolled in Medicaid, and the program is the primary payer for nursing homes and community-based long-term services and supports for people with disabilities

Alarmingly, the bill is currently rushing through the House for a vote without public hearings. The lack of transparent, public debate is unacceptable for a bill that would endanger so many lives, exacerbate poverty, and inflict long-lasting damage on our healthcare system. Our families deserve to know the critical facts and their full impact.

The House proposal would make deep cuts to Medicaid by reducing and permanently capping federal funding for the program and for each person enrolled in Medicaid. This includes phasing out enhanced federal funding for the Medicaid Expansion that gained coverage for over 260,000 New Mexicans – reneging on the federal government’s promises to support state expansion of coverage for low-income adults. The legislation unfairly shifts billions of dollars of costs to the states.

The results would damage the entire healthcare system, especially in rural areas that have struggled with practitioner shortages. Already Medicaid payments to healthcare clinics, nursing homes, and safety net hospitals have been cut in the recent years due to state budget shortfalls and are too low to support even the basic costs of services. More practitioners are refusing to see Medicaid patients and thousands of jobs have been lost in the healthcare field. The damage from Medicaid cuts would be very difficult – if not impossible – to reverse if federal support is limited by funding caps.

Healthcare coverage will become unaffordable for low-income families, pricing thousands of New Mexicans out of the health insurance market. The bill will shrink tax credits given to families to help buy health insurance by $1,600 per year on average and much more for many older consumers and lower income families, according to the Center for Budget and Policy Priorities. People that cannot keep up with the premiums will also be punished with a 30 percent surcharge to their insurance rates if they miss payments.

New Mexico’s economy will be threatened by this legislation. Medicaid supports over 50,000 jobs from federal funding that tops $4.5 billion each year. The expansion of Medicaid under the Affordable Care Act added over 5,000 jobs. Healthcare became a leading sector of job growth in an otherwise stagnant economy.

New Mexico has struggled with one of the highest unemployment rates in the country. We would see thousands more jobs lost and a downsizing of the healthcare system with cuts to federal support for Medicaid and health insurance subsidies.

The legislation gives tax cuts to the wealthy, big insurance, and pharmaceutical companies by making deep cuts to Medicaid, reducing funding for Medicare, and getting rid of financial subsidies that are targeted for hard working, low income families. In other words, tax cuts for the rich are being paid for by taking away healthcare coverage from the poor.

We ask our leaders to carefully weigh the consequences of this proposal and listen to the views of the public. A recent poll has found that most voters in the state do not want to repeal the Medicaid Expansion. Nearly three-quarters of New Mexican voters oppose reducing federal funding for Medicaid. Overall, four out of five voters believe Medicaid is important or “very important” to our residents.

The Affordable Care Act led to historic achievements in New Mexico by cutting our uninsured rate in half. Over 95 percent of our children now have healthcare coverage. We cannot afford to go backwards and lose the substantial progress we have made.

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Download the a copy of the press release here.

ACTION ALERT: Ask New Mexico’s Leaders to Stand Up for our Healthcare

We’ve all been working hard to build a great healthcare system for New Mexicans. Along the way, we have seen significant gains for our state for which we are thankful.

  • 95% of our children in New Mexico have healthcare coverage now, mostly because of Medicaid.
  • Over 250,000 adults gained coverage from the Medicaid Expansion in 2014.
  • Medicaid supports over 50,000 jobs in our healthcare sector and keeps clinics, hospitals and caregiving agencies open in our state.
  • • Medicaid saves costs for everyone by covering uninsured people and offering preventive and life-saving care.

As we move forward, we cannot afford to lose our gains. We lost over $330 million for healthcare and over 3,000 jobs this year for failing to adequately fund Medicaid. Now with uncertainty about healthcare at the national level, we must work harder than ever to protect and strengthen our healthcare.

Please call our leaders and ask them to fully fund Medicaid. It will only take a few minutes. Let them know why you are thankful for Medicaid.

Governor Susana Martinez – (505) 476-2200
Senator John Arthur Smith, Chair of Legislative Finance Committee – (575) 546-4979
Representative Patty Lundstrom, Member of Legislative Finance Committee – (505) 722-2980

Please call this week – before December 9th. The Legislative Finance Committee and the Executive branch are putting together state budget proposals for next year. It’s important these individuals hear from you this week.

Judge Holds NM Human Services Chief in Contempt

human-services-departmentOriginally published in the Albuquerque Journal September 28, 2016
https://www.abqjournal.com/854783/judge-finds-contempt-in-hsd-legal-case.html

SANTA FE – A federal judge held New Mexico’s top human services official in contempt Tuesday for failing to comply with court orders aimed at improving the administration of food aid and Medicaid health care benefits.

The contempt order against Human Services Secretary Brent Earnest by U.S. District Court Judge Kenneth Gonzales upheld findings that the cabinet secretary did not diligently attempt to comply with court orders concerning the handling of Medicaid benefit renewals, eligibility for immigrants, training for agency employees and other administrative requirements.

The judge, in his Tuesday order, also said objections filed by the agency were without merit and that the overall direction of the case was troubling.

“It remains clear that HSD and its officials have failed to exercise the leadership, control and managerial oversight to effectively come into compliance with the court orders,” Gonzales wrote.

However, a spokesman for the Human Services Department, which runs the federally funded Supplemental Nutrition Assistance Program, or SNAP, took issue with at least part of the judge’s order.

“We strongly disagree with the judge’s characterization of the department, which doesn’t take into account all of our efforts to resolve long-standing issues – some of which are three decades old and occurred under several administrations,” HSD spokesman Kyler Nerison said. “However, we are pleased that the court has agreed with us to bring in an outside monitor to help resolve those issues.”

“Regardless, we are going to continue providing services to New Mexicans who need it the most,” he added.

The contempt finding accompanies the judge’s earlier approval of plans for a court-appointed special master to help ensure federally funded benefits are administered properly amid internal investigations by state and federal agencies into allegations that food aid applications were falsified.

The civil contempt order carries no additional sanctions or penalties.

Sovereign Hager, an attorney at the New Mexico Center on Law and Poverty and advocate for aid beneficiaries in the litigation, said the order sends a strong message nonetheless.

“I think this is a message that if things don’t work out with a special master and the state doesn’t come into compliance, the court will look to harsher remedies,” she said.

New Mexico has one of the nation’s highest poverty rates, and there were more than 536,000 New Mexicans receiving food assistance benefits under SNAP, which was formerly known as food stamps, as of July, according to HSD. That figure was up by more than 7 percent – or nearly 36,000 people – from a year earlier.

The judge’s contempt order is the latest twist in a 1988 lawsuit. Earlier this year, a series of hearings were conducted by U.S. Magistrate Judge Carmen Garza, who had been tasked with monitoring compliance with a consent decree in the lawsuit and previous court orders.

Those hearings showed potential problems with the SNAP program, including testimony that state intake workers had been ordered to falsify income for some applicants, effectively denying them emergency benefits.

The testimony prompted criticism of Gov. Susana Martinez’s administration by top legislative Democrats and party officials, including a call from Sen. Gerald Ortiz y Pino, D-Albuquerque, the chairman of the interim Health and Human Services Committee, for Earnest to resign.

Earnest took over as HSD secretary – after Martinez picked him for the job – in December 2014 after the agency’s former secretary stepped down.

Read the Order from Judge Gonzales here.

Op-Ed: Underfunding Medicaid is a Foolish Decision

shutterstock baby with doctor for website -2015-12-17by Abuko Estrada & Sireesha Manne

Originally published in the Albuquerque Journal, September 26, 2016. https://www.abqjournal.com/852766/underfunding-medicaid-is-a-foolish-decision.html

As taxpayers, we expect that when government spends our money it will be leveraged toward the best investments that provide the most benefits to our state.

Currently, New Mexico receives four dollars in federal funds for every state dollar invested in Medicaid. This money goes directly into patient care and supports over 50,000 mostly private-sector jobs in the state.

Rather than maximizing this $4 to $1 return on investment, New Mexico underfunded the Medicaid budget in the 2016 legislative session.

For fiscal year 2017, New Mexico is losing over $265 million in federal matching funds for Medicaid by failing to come up with $67 million to meet Medicaid’s minimum budget needs. Our health care system is taking a massive financial loss of over $330 million this year — or nearly $1 million a day!

This is a budgeting disaster for New Mexico that is expected to result in thousands of jobs being lost and, worse yet, a reduction in care to patients. Health care had been one of the only growing job sectors in the state because of the expansion of Medicaid that has added over 4,800 jobs in 2014 alone. However, due to budget shortfalls, the state has decided to reduce Medicaid payment levels for hospitals, doctors and other medical practitioners.

In response, health care providers have issued serious warnings that the low Medicaid rates will force them to downsize staff and potentially even close entire facilities.

The decision to cut Medicaid is self-defeating because New Mexico desperately needs jobs and a stronger health care system.

Nearly every county in the state – 32 out of 33 counties – has shortages for primary care, dental care and mental health care. The problems are most severe for patients in rural areas, where over 30 percent of residents live.

A prime example of health care workforce shortages is the closing of the obstetrics department at Alta Vista Regional Hospital in Las Vegas, N.M. Since 2010, three other hospitals have ceased their obstetric services, forcing expectant mothers to travel unreasonable distances for prenatal care.

Medicaid patients face the most serious consequences of these shortages. The Legislative Finance Committee recently found that up to half of providers in some areas in New Mexico are refusing to take new Medicaid patients.

Another report has found that a quarter of Dona Aña County residents needing hospitalization are going to Texas to get services. However, as illustrated in a recent news article, many doctors in Texas now refuse to see these patients because our state’s Medicaid reimbursement rates are too low.

This is just the beginning.

Medicaid provides health care coverage to two out of three children in New Mexico, as well as seniors, people with disabilities and low-income families. However, due to Medicaid budget shortfalls, the state next plans to cut health care benefits and charge higher patient fees.

Studies have shown that these changes are likely to result in massive losses of coverage for low-income families and will prevent patients from accessing needed services, only deepening New Mexico’s health care crisis.

New Mexico needs to responsibly maximize Medicaid matching funds. The first step is to fix the state’s revenue system. New Mexico is losing needed dollars to tax cuts and loopholes created in the last 15 years for large corporations and the highest-income earners, which have not proven to produce jobs or benefit the state.

There are several ways to raise revenues without hurting working families, such as freezing corporate tax rates at their current levels, which are now on par with other states and further reductions are not needed, taxing capital gains and investment income at the same rate as earned income and targeting products that are undertaxed and that are not necessities, such as new vehicles, alcohol and tobacco.

By not acting, New Mexico is losing precious resources that our state needs to spur job growth and support our health care infrastructure. Let’s put our money into our wisest investments – Medicaid is certainly one of the best.

Op-Ed: State’s decision to cut Medicaid is self-defeating

by Abuko Estrada and Sireesha Manne

Originally published September 19, 2016, NMPolitics.net http://nmpolitics.net/index/2016/09/states-decision-to-cut-medicaid-is-self-defeating/

COMMENTARY: As taxpayers, we expect that when government spends our money it will be leveraged toward the best investments that provide the most benefits to our state. Currently, New Mexico receives four dollars in federal funds for every state dollar invested in Medicaid. This money goes directly into patient care and supports over 50,000 jobs in the state, mostly in the private sector.

Rather than maximizing this $4-to-$1 return on investment, New Mexico underfunded the Medicaid budget in the 2016 legislative session.

For fiscal year 2017, New Mexico is losing over $265 million in federal matching funds for Medicaid by failing to come up with $67 million to meet Medicaid’s minimum budget needs. Our health-care system is taking a massive financial loss of over $330 million this year – or nearly $1 million a day!

This is a budgeting disaster for New Mexico that is expected to result in thousands of jobs being lost and, worse yet, a reduction in care to patients. Health care had been one of the only growing job sectors in the state because of the expansion of Medicaid, which added over 4,800 jobs in 2014 alone.

However, due to budget shortfalls, the state has decided to reduce Medicaid payment levels for hospitals, doctors and other medical practitioners. In response, health-care providers have issued serious warnings that the low Medicaid rates will force them to downsize staff and potentially even close entire facilities.

The decision to cut Medicaid is self-defeating because New Mexico desperately needs jobs and a stronger health-care system. Nearly every county in the state – 32 out of 33 counties – have shortages for primary care, dental care, and mental health care. The problems are most severe for patients in rural areas, where over 30 percent of residents live.

A prime example of health-care workforce shortages is the closing of the obstetrics department at Alta Vista Regional Hospital in Las Vegas. Since 2010, three other hospitals have ceased their obstetric services, forcing expectant mothers to travel unreasonable distances for prenatal care.

Medicaid patients face the most serious consequences of these shortages. The Legislative Finance Committee recently found that up to half of providers in some areas in New Mexico are refusing to take new Medicaid patients.

Another report has found that a quarter of Dona Aña County residents needing hospitalization are going to Texas to get services. However, as illustrated in a recent news article, many doctors in Texas are now refusing to see these patients because our state’s Medicaid reimbursement rates are too low.

This is just the beginning. Medicaid provides health-care coverage to two out of three children in New Mexico, as well as seniors, people with disabilities and low-income families. However, due to Medicaid budget shortfalls, the state next plans to cut health-care benefits and charge higher patient fees.

Studies have shown that these changes are likely to result in massive losses of coverage for low-income families and will prevent patients from accessing needed services, only deepening New Mexico’s health-care crisis.

New Mexico needs to responsibly maximize Medicaid matching funds. The first step is to fix the state’s revenue system. New Mexico is losing needed dollars to tax cuts and loopholes created in the last 15 years for large corporations and the highest income earners, which have not proven to produce jobs or benefit the state.

There are several ways to raise revenues without hurting working families, such as freezing corporate tax rates at their current levels, which are now on par with other states and further reductions are not needed; taxing capital gains and investment income at the same rate as earned income; and targeting products that are being under-taxed and that are not necessities, such as new vehicles, alcohol and tobacco.

By not acting, New Mexico is losing precious resources that our state needs to spur job growth and support our health-care infrastructure. Let’s put our money into our wisest investments – Medicaid is certainly one of the best.

Abuko Estrada and Sireesha Manne are attorneys with the New Mexico Center on Law and Poverty.

Action Alert: Stop Damaging Cuts to Medicaid!

New Mexico’s healthcare system is facing a crisis due to budget cuts for Medicaid. Over 875,000 people in our state get healthcare coverage through Medicaid and the program supports over 50,000 jobs in New Mexico.

Medicaid lost significant federal match funds this year – $4 for every $1 in state funding cuts – losing over $265 million in federal funds that would have gone into our economy to support patient care and thousands of jobs. Soon, the Governor and Legislature will be going into a special session to cut even more of the state budget due to revenue shortfalls.

The budget shortfalls have already cut Medicaid to the bone – resulting in lower payments to healthcare providers that are expected to cause job loss, intensify workforce shortages and make it even harder for Medicaid patients to find doctors and services. The next step will be to begin cutting Medicaid healthcare benefits and charge higher fees for low-income patients – changes that will cause people to lose coverage and reduce access to care.

The Governor and these legislators below are making critical decisions about the budget and MUST hear from you by next Thursday, September 22. Please call them todayThis will only take 5 minutes. For each call, leave a short message with the Governor’s staff, the legislators or a voicemail that includes your name, phone number, and an ask to not cut Medicaid.

Thank you!


Name Phone Number
Governor Martinez (505) 476-2200
Rep. Larry Larrañaga ‪(505) 821-4948
Rep. Jason Harper ‪(505) 554-7970
Rep. Patricia Lundstrom ‪(505) 722-2980
Sen. John Arthur Smith (575) 546-8546
Sen. Stuart Ingle (575) 356-3088

Editorial: Shortchanging the Poor

Republished from the Las Vegas Optic. See the original column here.

Tuesday, July 19, 2016 at 6:30 pm (Updated: July 19, 6:42 pm)

U.S. Magistrate Judge Carmen Garza has concluded that the New Mexico Human Services Department should have someone looking over its shoulder to help ensure that it complies with court orders and federal law in the administration of federally funded benefits.

According to The Associated Press, Garza is also recommending a contempt finding against the agency, which oversees the distribution of federal food aid and Medicaid health care benefits to the poor.

To be sure, those are merely proposals at this point; the department has 14 days to file its objections, and the department is already saying that it doesn’t agree with everything in the judge’s decision.

Still, it’s unfortunate — though not surprising — that such extreme measures are necessary to get the department to follow the law and to finally comply with court orders that have gone unfulfilled.

The harsh measures being recommended are not surprising because of the striking testimony presented during the court proceedings in the case.

“Caseworkers’ sworn testimony that they were instructed by managers to fraudulently alter applicant information has essentially not been refuted,” Garza said. According to The Associated Press, Garza also noted that managers overseeing supplemental nutrition benefits invoked their Fifth Amendment right against self-incrimination during the proceedings.

The Human Services Department’s office of inspector general and the U.S. Department of Agriculture are investigating that part of the case.

We don’t doubt that the state Human Services Department has a difficult job with tight deadlines and large caseloads.

But it’s also important to remember that the agency exists to serve as a safety net for our state’s most vulnerable residents.

The aid this agency provides helps our state’s poor put food on the table for their families and get medical care for them. Playing games with that aid is unconscionable and wrong.

If it takes a special master looking over the agency’s shoulder to force it to do the right thing, then so be it.

According to The Associated Press, the special master would have expertise in determining eligibility for Medicaid and food aid. That individual would also be knowledgeable with the organizational and computer systems used to manage the state’s caseload.

The New Mexico Center on Law and Poverty, which brought forth the federal lawsuit on behalf of aid beneficiaries, was pleased with Garza’s decision, which was issued Monday.

“The things we have been asking for are very simple,” attorney Sovereign Hager told AP. “Train your workers on what the law requires, make sure the IT system does what it’s supposed to, make sure notices are intelligible and make sense.”

That seems reasonable to us.

NM Human Services Department Found in Contempt, Federal Magistrate Recommends Special Master

SNAP Logo

Las Cruces, NM – On Friday, July 15, 2016, Federal Magistrate Carmen Garza entered proposed findings that the NM Human Services Department (HSD) be held in contempt for failure to comply with multiple Court Orders and federal law concerning administration of food and medical assistance to eligible families. Judge Garza found that “it is apparent that HSD and its officials have not exhibited the leadership, oversight, or coordination necessary to implement the Court Orders.” Judge recommended the appointment of a Special Master with expertise in food and medical assistance be appointed to facilitate HSD’s compliance with federal law and Court Orders.

The Order comes after three days of evidentiary hearings about HSD’s failure to provide food and medical assistance to families as required by federal law. Judge Garza noted numerous violations of federal law and Court Orders by HSD, finding that worker trainings and notices to families applying for food and medical assistance are “replete with repeated mistakes” and that HSD had not brought state regulations and policies into compliance with federal law. Nor could HSD tell the Court when compliance would be achieved. The Court further noted that testimony by HSD employees that HSD staff have been altering application in order to deny eligible applicants emergency food benefits and improve HSD’s timeliness statistics “was essentially not refuted.”
In entering a finding that the Secretary Brent Earnest should be held in Contempt, Judge Garza noted the Department’s recent willingness to seek expert assistance, stating “While the Court appreciates this acknowledgement, the Court is troubled it took over thirty hours of status conferences, over five hundred pages of joint status reports submitted to the Court, three days of evidentiary hearings on its Order to Show Cause, and testimony by HSD employees alleging fraud on the part of HSD, to which high level officials responded by pleading the fifth, for Defendant to discuss making these types of changes. For the question before the Court, Defendant’s realization has come entirely too late.”

As a remedy for contempt, Judge Garza recommends that the Court appoint and supervise a Special Master to act as a full time advisor and consultant to HSD. The Special Master will have expertise in food and medical assistance programs and will report to the Court on the extent of the Department’s compliance.

Judge Garza stated “Defendant’s inability to fully bring his application processing practices into compliance with the Court Orders has profound effects on the citizens of New Mexico. Indeed, when an eligible SNAP or Medicaid applicant is denied or delayed in receiving benefits, that individual loses benefits he or she may rely on to eat, feed his or her children, or to receive essential medical coverage . . . It is essential for this Court to acknowledge the need for these services to be effectively, efficiently and properly rendered to those who are eligible in this state.”

Attorneys at the Center and Law and Poverty, along with co-counsel Daniel Yohalem and Jane Yohalem, represent the class of plaintiff applicants for food and medical assistance in the case. Gail Evans, Legal Director at the NM Center on Law and Poverty stated, “We are pleased that the Court will appoint and supervise an expert to oversee HSD’s compliance with federal law in providing food and medical assistance. The Department needs expert assistance with important changes that will help the state provide benefits accurately and efficiently. This includes IT changes, the creation of a manual and effective training for state workers and comprehensible notices to families participating in the programs. We look forward to working with the special master to bring the Department into compliance with the law.”

For more information contact Gail Evans at (505) 255-2840/(505) 463-5299 or Sovereign Hager (505) 417-2084.

Read the full press release here.

Read Justice Garza’s recommendation here: Part 1 Part 2

Panel recommends state reject Medicaid copays, premiums

Republished from the Santa Fe New Mexican. Click here to read the original article.

By Justin Horwath

A panel appointed by the New Mexico Human Services Department voted Thursday against imposing copays or premiums on low-income patients who receive Medicaid.

Meeting at the state Capitol, the committee voted down the proposal to recommend the department impose premium payments for Medicaid enrollees with an income between 125 percent and 138 percent of the federal poverty level. New Mexicans within 138 percent of the federal poverty level — an annual income of $16,404 for a household of one — or below are eligible for Medicaid.

Abuko Estrada, staff attorney for the New Mexico Center on Law and Poverty, urged a Human Services Department-appointed panel to vote against premiums and co-pays for Medicaid enrollees because of a lack of data about the potential impact. He said the department should look for other ways to find Medicaid savings beyond cutting the benefits package. Luis Sánchez Saturno/The New Mexican
Abuko Estrada, staff attorney for the New Mexico Center on Law and Poverty, urged a Human Services Department-appointed panel to vote against premiums and co-pays for Medicaid enrollees because of a lack of data about the potential impact. He said the department should look for other ways to find Medicaid savings beyond cutting the benefits package. Luis Sánchez Saturno/The New Mexican

The department does not necessarily have to abide by recommendations of the Benefit Package, Eligibility Verification and Recipient Cost-Sharing Cost-Containment Subcommittee. The department appointed the subcommittee after the Legislature passed and Gov. Susana Martinez signed into law a budget bill that directed the department to plug an $87 million shortfall in state funding for Medicaid — which translates into a potential $417 million cut in services due to federal matching money.

Medicaid, also known as Centennial Care, is a state-federal program that provides health insurance to children, the disabled and poor adults. It currently provides primary and emergency care as well as behavioral health services to 766,000 people in the state.

But the number of those who qualify for the program has risen under the Affordable Care Act, which now allows states to bring low-income adults into Medicaid. And those costs are rising faster than the state budget.
In trying to limit the cost increases, the state is moving forward with another set of proposals that would trim reimbursements for many services to doctors, specialists, dentists, therapists and hospitals. Those changes are awaiting approval from the federal government and expected to go into effect July 1.

The subcommittee looking at copays and premiums included those from the health care industry as well as advocates for the poor. Larry Martinez, the regional director for Presbyterian Medical Services, drafted the motion to impose premiums on enrollees.

Ruth Hoffman, director of the Lutheran Advocacy Ministry of New Mexico, voted against the proposal. She said the department should make a report to the Legislature about how it’s responding to the budget language directing it to make cuts to Medicaid.

“We all know this is not going to generate much money at all,” Hoffman said.

Sandy Potter, a vice president for Blue Cross Blue Shield, one of the four insurance companies that oversees Medicaid, agreed. “I just think it’s not going to make a hill of beans,” she said.

Joe Martinez, consumer outreach coordinator for Health Action New Mexico, told panel members they should vote down the motion because New Mexicans newly enrolled in Medicaid are just beginning to understand its benefits.
“Then to impose premiums and cost-sharing, it’s nothing more than making it more difficult and getting another pattern of denial” from the department, he said.

Members also voted down 5-4 a proposal to impose copays on Medicaid enrollees who use hospital emergency rooms for nonemergency care.

Erik Lujan, a subcommittee member with the All Pueblo Council of Governors, said that tribal members often go to the emergency room because it’s difficult to see a specialist on the spot.

Subcommittee members voted in favor of making a recommendation to the department that it impose copays on members purchasing more expensive brand-name drugs as opposed to the cheaper generics.

Nancy Smith-Leslie, Medicaid director for the Human Services Department, told the panel that Medicaid members currently use about 80 percent generic and 20 percent brand-name drugs.

Potter, of Blue Cross Blue Shield, made the proposal. She said other state Medicaid programs have higher rates of generic drug use.

“There’s an enormous opportunity to reduce costs,” Potter said.

Abuko Estrada, staff attorney for the New Mexico Center on Law and Poverty, urged the panel to vote against the recommendation because of a lack of data about its impact. He said the department should look for other ways to find Medicaid savings beyond cutting the benefits package.

The recommendation passed on a 5-3 vote.

Justin Horwath can be reached at 505-986-3017 or jhorwath@sfnewmexican.com.

NM Political Report: Accusations of widespread fraud at HSD grow while officials plead the fifth

Republished with permission from the NM Political Report. Read the original article here.

By Joey Peters | May 13, 2016

LAS CRUCES — In a scene of high drama reminiscent of the TV drama “Law and Order,” three prominent state Human Services Department officials invoked their fifth amendment rights nearly 100 times in federal court Friday afternoon.

Legal Director Gail Evans and co-counsel Dan Yohalem outside the federal courthouse in Las Cruces.
Legal Director Gail Evans and co-counsel Dan Yohalem outside the federal courthouse in Las Cruces.

Their refusal to answer questions came directly after sworn testimony from six HSD employees who alleged a widespread practice of fraudulently altering federal food benefits applications.

The practice, according to eight former and current HSD employees who testified in federal court last month and today, amounts to adding false assets to the applications of people who would otherwise qualify for emergency aid from their Supplemental Nutrition Assistance Program, otherwise known as food stamps.

“I still don’t understand why I had to falsify assets,” Shar Lynne Louis, a case processor at HSD’s Income Support Division (ISD) office in Gallup who retired last July, said in court.

Louis testified that the state had been practicing the pattern of fraud since at least 2003, when she first came to the department.

Federal law requires states to give food benefits for applicants who qualify for emergency, or expedited, benefits within seven days of applying. But HSD, according to many testimonies, has been long burdened with emergency applications that aren’t processed within the required seven days.

Instead of processing emergency applications late, department officials instructed employees to add fake assets so the application no longer meets expedited SNAP requirements.

“They make up the resources, whatever the case is, whatever the situation is,” Veronica Arciero, a case processor in the Silver City, said of the department’s handling of late emergency applications.

This practice of adding of what one attorney called “phantom assets” helps HSD to clear its backlog of overdue emergency applications, according to testimonies.

Arciero said the consequence of the practice amounted to putting applicants’ cases “on hold so they don’t they don’t receive the benefits they should have.”

“It’s lying,” she said. “It’s not something the customer is reporting.”

Mary Alice Duran, another employee who processed cases for 25 years in Santa Fe, Taos and Las Vegas and retired in 2013, also said the practice meant people qualified for emergency food aid didn’t receive their benefits later.

“It creates a hardship for the family,” Duran said.

One current employee who works in Silver City, Alexandra Hancock, even testified that she was reprimanded for processing a late application the correct way instead of adding fake assets to delay the benefits.

Specifically, Hancock testified that she fixed a late case where the applicant had reported $700 in income for the month and another employee wrongly wrote that income as $1,500. Because the applicant’s rent and utility expenses exceeded his monthly income, he qualified for expedited SNAP aid, according to Hancock.

But after she fixed and processed the case, Hancock told the court that Income Support Division Director Marilyn Martinez and former Deputy Director Laura Galindo instead told her she would be referred to HSD’s human resources department if it happened again.

“You had to answer for proving the benefits?” Sovereign Hager, an attorney for the Center on Law and Poverty, asked Hancock in court.

“It was said we had to do everything in our power to stop late expedites,” Hancock responded. “There was nothing I could have done other than entering fraudulent resources.”

She added: “We’re leaving kids and parents and the elderly without the food they need on their table.”

The Center on Law and Poverty is asking the federal court to appoint an independent monitor to oversee the state’s SNAP and Medicaid processing.

Martinez, Galindo and Taos County ISD Director Emily Floyd all invoked their Fifth Amendment rights when brought to the stand, refusing to answer a total of 97 questions Hager and attorney Daniel Yohalem* asked between the three of them.

The U.S. Constitution allows people to invoke Fifth Amendment rights to avoid implicating themselves in illegal activity. Invoking the Fifth Amendment itself cannot be used to implicate the person in illegal activity.

Questions that Martinez, Galindo and Floyd refused to answer ranged from whether they played ordered the fraud, retaliated against workers and lied to federal court in previous court hearings and motions.

The officials did not respond to any questions, including those to provide background on the working of HSD.

Last month, ISD Deputy Director Shanita Harrison in her own testimony accused three employees who testified with fraud allegations of instead making mistakes on their case processing themselves.

Jeanette Roybal, who works for ISD in Las Cruces, told the court that she had experienced workplace retaliation since first testifying about SNAP fraud in federal court last month.

“They’ve been monitoring me more often,” Roybal said of her supervisors. “They’re constantly stopping by and they’ll stand and stare at me.”

Roybal also said her workplace emails concerning a case with false assets had been deleted since she gave her first testimony last month. She also testified that her managers have access to her workplace emails.

Paul Kennedy, an attorney who represented HSD in court Friday, asked Roybal whether her managers would have had to personally go through her workplace computer to access her and delete her emails.

“As far as what I’ve been told, no,” Roybal responded.

An HSD spokesman who attended the court hearing would not answer questions from NM Political Report about the allegations or why their officials invoked their Fifth Amendment rights immediately following the proceedings. Instead, Kyler Nerison instructed NM Political Report to send him questions via email, to which he did not respond.

Kennedy told NM Political Report he wasn’t “authorized” to comment on the proceedings.

During the hearing, attorney Christopher Collins, who also represents HSD, referred to department’s internal investigation of the allegations, launched last month shortly after the allegations became public. HSD Secretary Brent Earnest also sent employees a directive telling employees to process expedited SNAP cases per federal law.

“People [today] testified that they received that received that directive and are following that directive,” Collins said.

He also said HSD issued a request for proposal to bring an outside consultant to oversee the department’s training of ISD employees and compliance with federal law. Such a process, Collins said, “could be implemented within 12 months.” The request for proposal process alone, Collins said, would take six to nine months.

Collins argued for judge to give the department 90 days before allowing both parties to make their closing arguments. Federal Magistrate Judge Carmen Garza instead scheduled the next court hearing for early July.

“Whatever is going on here—and we don’t know and are certainly concerned by what we hear—we don’t have all the facts,” Collins said in court.

The SNAP processing fraud allegations are part of ongoing legal motions by the Center on Law and Poverty to enforce a 25-year-old consent decree that the organization says HSD is not following. The consent decree came in 1991 as the settlement of a class action lawsuit that accused HSD of not properly processing SNAP and Medicaid benefits.

After the hearing, Hager told NM Political Report that she found the Fifth Amendment pleadings “very troubling” that the HSD officials would “invoke a right to not incriminate themselves” by not answering questions about the department’s “basic operations.”

Yohalem told told NM Political Report that he has “never seen this happen” in his 42 years of practicing civil rights law.

“If the department didn’t know what was going on,” Yohalem said of the fraud allegation testimonies, “why would they take the fifth?”

State Auditor Tim Keller’s office has also launched a separate investigation into the fraud allegations.

*Daniel Yohalem is representing the Santa Fe Reporter newspaper in a public records lawsuit against Gov. Susana Martinez. That lawsuit originated in 2013, while Joey Peters worked as a reporter for the newspaper.