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.”
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.
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.
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.
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.
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.
That’s our reaction to testimony from Human Services Department caseworkers who claim that their bosses inflated the resources of needy people applying for emergency food assistance through the Supplemental Nutrition Assistance Program. Why the bureaucratic fudging of paperwork? More assets (as little as $400) would mean the applicant no longer qualified for expedited help. New Mexico already faces sanctions for not processing aid claims fast enough; too many delays, and the department would be shown — again — that it is not complying with court directives. Thus, the incentive to lie.
We have long known that navigating federal programs, whether for food or medical help, in New Mexico is overly complex and burdensome. What last week’s hearing in federal Magistrate Court revealed is that in some cases, there appears to have been willful obstruction. The troublesome testimony came during a motion hearing asking for the Human Services Department to be held in contempt of court for not complying with a 25-year-old consent decree. The 1991 order came out of a 1988 lawsuit — obviously, the troubles in the department predate even the last two governors.
The New Mexico Center for Law and Poverty claims that New Mexico is illegally denying and closing off food assistance through the Supplemental Nutrition Assistance Program, or SNAP, what used to be known as food stamps. Five workers in the Income Support Division from different parts of the state all agreed they had been told that if they couldn’t meet a seven-day deadline for emergency food assistance, they were to pass the file to a supervisor. At that point, the boss could modify the file so the applicant wasn’t eligible for emergency help. Using delays, the state could process the claim and not miss a deadline — that would help the department’s numbers on federal audits.
These workers — who fear retaliation over testimony and should be protected — deserve praise for speaking out. One 10-year employee from Taos even kept notes on an original application; a supervisor reportedly later added $400 in “phantom” assets, but the original file contains a different story, according to testimony. The problems aren’t alleged to occur just with SNAP, but also in processing Medicaid applications.
New Human Services Department Secretary Brent Earnest tried to argue in the daylong hearing that the complexity of federal regulations and an overwhelmed department are at the root of problems with processing applications; he’s likely right, and we believe he is trying to correct the situation. He inherited the mess. But the fact remains that New Mexico cannot run its federal assistance programs in compliance with the law. That’s been apparent for years.
What happens next is up to federal Magistrate Carmen Garza, who was assigned the case by U.S. District Judge Kenneth Gonzales a year ago. We agree with lawyers who want more oversight over the state’s benefits process. Medicaid and SNAP recipients do not deserve the runaround. They deserve to be treated with respect and to receive — in a timely fashion — the help they are due. That the state is an obstacle to assistance, rather than making aid possible, needs to change.
Appointment of an independent monitor is the right step now, especially over the troubled Income Support Decision. We understand Earnest’s concerns that such a monitor diverts money from directly helping the poor; that’s an important point. However, the dysfunctions in the department have to be untangled. That means direction from outside to streamline the process; the fallback, so far as federal law allows, must be to approve applications rather than seek to deny. That a department already failing to process basic applications wants to add more paperwork — through new, unnecessary work requirements — demonstrates the department does not have the best interests of the needy at heart. Independent oversight is needed.
The contempt hearing and any decision on oversight should not be the end of this matter, either. Both the attorney general or the U.S. attorney, after hearing this testimony, should investigate charges that workers are being encouraged to delay applications, even to the point of supervisors falsifying assets. That’s fraud, pure and simple, if allegations can be proved. State Auditor Tim Keller announced his own investigation Friday. Something is rotten in the Human Services Department — and that core disregard for the law and the human dignity of aid recipients won’t be repaired without vigorous, independent oversight.
An advocacy group says data in a legislative report confirms suspicions that a majority of pending Medicaid applications in the last two years were eligible for benefits.
For Sovereign Hager, a staff attorney with the Center on Law and Poverty, the fact that the vast majority of those applications were still eligible for benefits is vindication of her organization’s legal battles with the state on the issue.
According to figures from the state Human Services Department, which administers the federal Medicaid and Supplemental Nutrition Assistance Program, the department saw 223,000 overdue renewal applications for Medicaid benefits between May 2014 and December 2015. The state agency estimates 97 percent of those applications met Medicaid requirements, despite being overdue.
“These overdue cases are the ones HSD would like to close for procedural reasons,” Hager said.
She’s referring to a May 2014 court order that barred HSD from automatically denying unprocessed Medicaid and SNAP cases. The state agency had been automatically denying all cases that it hadn’t processed within 30 days ever since it changed its IT servers in the fall of 2013.
That court order came after the Center for Law and Poverty filed a legal motion to force HSD to follow requirements from a 1991 consent decree born out of a lawsuit against the state.
The lawsuit, filed in 1988 by Debra Hatten-Gonzales, accused HSD of jeopardizing Medicaid and food stamp eligibilities. The Center on Law and Poverty contends that in 25 years, HSD has never properly followed the consent decree.
Next week a federal judge will hear the Center’s motion asking for HSD to be found in contempt of court. The Center wants the judge to appoint independent expert to oversee key functions of the state agency until the state complies with the consent decree. Some lawmakers are joining in on the call for independent oversight.
“It really is a concern,” state Sen. Howie Morales told NM Political Report. “HSD is not addressing these issues unless a court orders them to.”
Though Hager contends the eligible overdue Medicaid applications since 2014 came thanks to the lawsuit, HSD attributes only 3 percent of them to the ongoing litigation. The state agency attributes the rest of overdue applications that otherwise meeting benefit eligibilities to Medicaid expansion from the federal Affordable Care Act.
A spokesman for HSD didn’t return a voicemail left Thursday by NM Political Report seeking comment.
The memo also estimates the lawsuit has cost the state $5.4 million since 2014. Most of that money—$3.4 million—is from administrative costs. The rest come from additional Medicaid costs.
The Legislative Finance Committee report also warns that an appointed independent monitor could “pose a significant financial risk.”
Morales acknowledges that costs are “a concern” but “not an underlying issue.”
“The underlying issue is HSD not following the law,” Morales said.
It’s a contention that HSD, which has accused the Center on Law and Poverty for not being “cooperative” or “constructive” with the process, doesn’t agree with.
In an April 11 letter to the Legislative Finance Committee, HSD Secretary Brent Earnest writes that his department “is in substantial compliance with the Debra Hatten-Gonzales court orders” and has made recent efforts to “streamline the application process via online and over-the-phone applications.”
“The department has put together a multi-disciplinary team of individuals that are focused on meeting the requirements of the DHG lawsuit,” Earnest wrote. “It is the department’s plan to continue to comply with the requirements of the consent decree and disengage from the lawsuit as soon as possible.”
The Legislative Finance Committee compares the potential independent oversight of parts of HSD to what recently happened to the California Department of Corrections. There, an independent monitor has overseen the state’s prison health care since 2006. That year, the oversight cost the state $882 million. By 2009, the costs skyrocketed to nearly $2 billion.
But Hager says this comparison is unfair. Instead, she refers to “churn”—known as the process when people eligible for benefits have an application rejected and then reapply—as in itself costly to a state.
This type of churn in Philadelphia cost Pennsylvania $9 million in “unnecessary administrative costs,” according to a 2015 Center on Law and Poverty analysis,
“Were it not for the lawsuit, those people would have reapplied and it would have cost the state money,” Hager said.
As you know, New Mexico’s Medicaid program is facing a huge budget shortfall amounting to over $400 million dollars in combined state and federal funds. A broad group of stakeholders and a meaningful, ongoing level of public input are necessary to deal with this shortfall. However, the current process is insufficient in these areas. Below, please read our press release regarding the lack of transparency and need for a greater level of input in the process. Additionally, you will find more information on the budget shortfall and the Medicaid program’s impact on the state.
By Kim Posich, Executive Director of the New Mexico Center on Law and Poverty
New Mexico is in a budget crisis. Our state’s economy is in shambles. We have the worst employment rates in the country and revenue projections have dropped over $200 million dollars from just before the session and they could get even worse.
The result of this economic free fall will be continued under-funding of our schools, jobs, economic development and public safety efforts – all the things most important to New Mexicans. Time is running out at the state legislature. If lawmakers do not take clear aim at the challenges we face, New Mexico will strike out for our families and children.
Strike one will be the budget. Deep cuts are coming that will threaten jobs and public safety. Healthcare, driven by Medicaid, is one of the only growing job sectors in New Mexico yet Medicaid is short by over $60 million in the budget being considered by the legislature. If we cut Medicaid by $60 million, we lose over $140 million in federal matching dollars. The Human Services Department has been clear that there is no room to make cuts other than to reduce services and payments to healthcare providers.
Our schools are still grossly under-funded, shortchanging our children and hurting our prospects for attracting and keeping businesses in New Mexico. With the current budget, we cannot invest in our teachers, Pre-K programs and educational initiatives that have been proven to work in preparing children for academic success and graduation.
The budget also underfunds agencies important for public safety. The judicial branch is struggling with its caseload and the corrections department lacks needed staffing. Deep cuts are also in store for the state’s behavioral health system including crisis intervention services. These are all essential to the integrity of our justice and rehabilitation system and ensuring our communities are safe.
Strike two will be failing to raise revenues. There are sensible opportunities to increase revenues without raising taxes and harming our families. One such proposal is delaying recently passed corporate tax breaks for two years. New Mexico cannot afford them right now. Another opportunity is to increase distributions from our $15 billion permanent fund, to provide needed funds to our education system, including early childhood education.
There are also ways to rebalance our tax structure to make it less heavily reliant on working families. According to the Institute on Taxation and Economic Policy, the lowest income New Mexicans are paying a higher percentage of their income on overall taxes than the highest income households. We could modify capital gains deductions that do not benefit most New Mexicans. We could modify income brackets and actually lower taxes for working and middle class New Mexican families who are the vast majority of our residents.
New Mexico is also still sitting on over $1 billion in unused capital funds, as the state auditor’s office has discovered. These funds could be recouped to fill one-time shortfalls and our reserves, and yet little action has been taken by the Governor’s office to mobilize this funding.
Strike three will be public safety. The best antidote to crime is to have good paying jobs, a strong education system and healthy communities. Unfortunately, many of the so-called “tough on crime” bills being proposed in the legislature will be ineffective at reducing crime. If we are serious about our safety, then we must invest in our communities, behavioral health, law enforcement training and the justice system. Right now, our budget lacks in all these areas.
We need to make New Mexico safe. We need good paying jobs. And most importantly, we need a school system that will do right by our children. There is still time to make a turnaround. The Governor and Legislature should step up to the plate to raise revenues. We need our leaders to fund a state budget that addresses our economic crisis and the needs of everyday New Mexicans.
A new report finds that the Medicaid Expansion has significantly increased jobs and revenues in New Mexico, generating a surplus that covers the cost of expansion itself. The report by Dr. Lee Reynis, economist at University of New Mexico’s Bureau of Business and Economic Research, updates prior research from 2012 and details the economic and fiscal impact of Medicaid expansion.
Over 200,000 adults in New Mexico gained healthcare coverage through Medicaid when the program was expanded under the Affordable Care Act. The federal government is paying for the entire cost of Medicaid expansion until this year when the contribution gradually steps down to 90 percent by the year 2020, with the state responsible for paying the 10 percent remainder of costs. The federal share totals over $11 billion between 2014 to 2021.
The report finds that the additional economic activity associated with the influx of federal dollars from Medicaid Expansion generates significant revenues from insurance premium taxes, gross receipts taxes, and income taxes as well as savings from programs no longer needed, including the State Coverage Insurance program. Additionally, the number of adults who are uninsured has dropped dramatically reducing uncompensated care costs for providers. From this activity, the State is expected to see a surplus of over $300 million dollars from Medicaid expansion between fiscal years 2014-2021.
Overall, the healthcare sector is leading job growth in New Mexico, adding over 1,500 new jobs in 2014 alone. Income and earnings have also risen for the healthcare workforce, with Medicaid accounting for 25% to 46% of the total increases in personal income in New Mexico. For a state historically underserved with healthcare providers, the Medicaid Expansion is providing funding to help grow our health care workforce and is encouraging investment in hospitals and treatment facilities with an emphasis on quality improvement.
News about the impact of Medicaid expansion comes at a time when New Mexico’s legislature is determining next year’s budget for Medicaid. Revenue forecasts have worsened due to dropping oil prices. Abuko D. Estrada, staff attorney for the New Mexico Center on Law and Poverty, says, “Medicaid is one of the best investments our state leaders can make. The program is paying for itself and is a boon for our economy, while providing quality health care coverage for New Mexicans in these tough times.”
By Abuko Estrada, Healthcare Staff Attorney at the New Mexico Center on Law and Poverty.
Since 2008, it has been gloomy in New Mexico. Our state is still recovering from the Great Recession. Our job growth has been among the worst in the nation, leaving us well short of pre-recession job levels. We are the only state in the nation where more people are moving out than moving in.
Our economic forecast still looks dismal.
There has, however, been one ray of sunshine–our healthcare sector is growing and over two hundred thousand New Mexicans have financial relief due to Medicaid expansion.
Now that we finally see a bright spot, let’s not ruin a good thing.
When New Mexico expanded Medicaid in 2014, our state had many reasons to celebrate. Polls showed overwhelming public support for Medicaid, with most voters in favor of Medicaid expansion and opposed to making cuts to the program.
The skyrocketing uninsured rate was taking its toll, leaving people without treatment or forcing families into medical debt and even bankruptcy. Medicaid expansion has meant that over 220,000 more New Mexican adults have health care coverage. This expansion of adult coverage also helped capture more uninsured children, reducing that rate by almost 16 percent during the first year alone.
New Mexicans knew that Medicaid expansion would boost job growth. In fact, the health care industry is driving job growth for our state. According to the Legislative Council Service, health care jobs have accounted for 56 percent of the new jobs over the last year.
We knew that Medicaid expansion would reduce costs for hospitals and healthcare providers, allowing them to invest in new facilities and their workforce. New Mexico’s 28 hospitals have already seen a 30 percent drop in the uncompensated care of uninsured patients from 2014. Our federally-qualified health centers, which have generally operated under budget deficits due to uncompensated care, had net income of $1.8 million dollars in fiscal year 2014. According to the New Mexico Primary Care Association, the better financial picture will allow the health centers to raise provider pay and increase capacity around the state.
We knew that Medicaid expansion would lead to economic relief for our families. In the past, people were routinely sent to collections for medical bills they could not pay. Healthcare coverage through Medicaid gives families more disposable income and the ability to build assets rather than struggle with debt. Every taxpayer also paid for state and county funds for hospitals to treat uninsured patients.
Finally, we knew that Medicaid expansion would be good for state revenue by injecting over $1 billion non-state dollars into the economy each year, primarily into the private sector, and increasing insurance taxes. In fiscal year 2014, The Department of Finance and Administration says New Mexico collected $115 million in insurance taxes. Economists with the Legislative Finance Committee estimate that number will grow to $247 million dollars by 2020.
For the first three years of expansion, we got all of these benefits at no cost to the state. In 2017, we will only pay 5 cents on the dollar, while the federal government takes on 95 percent of costs. After 2020, we will pay no more than one dime for every dollar to maintain these benefits. The insurance tax on Medicaid managed care companies retrieves 4 of these cents – canceling out nearly all of the State’s costs in upcoming years.
Still, some policymakers question the value of expansion and would like to cut support for the program.
It would be wrong to reverse course now and dump one of New Mexico’s best investments. Our state could lose hundreds of millions, if not billions, of dollars in economic activity.
Every dollar lost would damage our health care industry and workforce, stunting the driving sector for our job growth. Halting this growth could prove disastrous for our rural areas, which already face provider shortages. It would become more difficult to attract providers and build capacity.
New Mexico can only move forward if we capitalize on what we have. When the weather is finally breaking, let’s not take it for granted. By making the right choice to fully fund and support Medicaid, we can invest in a brighter future.