Op-Ed: Underfunding Medicaid is a Foolish Decision0

by 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-defeating0

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!0

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

JUST IN: Judge Signs Temporary Restraining Order on Printing of November Ballot0

District Judge Alan Malott signed a Temporary Restraining Order this afternoon preventing the Clerk of Bernalillo County from printing ballots for the November 8, 2016 general election without a summary of the Healthy Workforce Ordinance until further Order from his court. A hearing on this matter will take place on Monday, September 12, 2016 at 4:00 p.m.

The Temporary Restraining Order can be found here.

Complaint Filed to Add Summary of Healthy Workforce Ordinance on 2016 Ballot0

Today, attorneys with the New Mexico Center on Law and Poverty filed a complaint for declaratory and injunctive relief requesting a court order to put the summary of the Healthy Workforce Ordinance on the 2016 general election ballot. The complaint named as defendants the City of Albuquerque and Bernalillo County. Both the City and the County failed to fulfill their legal obligations to send this question to the voters in November.

The summary of the Healthy Workforce Ordinance reads as follows:

Proposing to enact the Albuquerque Healthy Workforce Ordinance such that, beginning 90 days after enactment: First, Albuquerque employers must allow employees to accrue sick leave at the rate of one hour of leave per 30 hours worked. Second, employees may use sick leave for their own or a family member’s illness, injury, or medical care, or for absences related to domestic violence, sexual assault or stalking. Third, employers with 40 or more employees must allow each employee to use up to 56 hours of accrued sick leave each year, and employers with fewer than 40 employees must allow each employee to use up to 40 hours of accrued sick leave each year. Fourth, employers must notify employees of their rights and maintain records. The ordinance also provides for public enforcement, a private right of action, and liquidated damages and penalties for noncompliance or retaliation.

The complaint filed in the Second Judicial District Court is available here.

Job Opportunity: Staff Attorney0

We are looking for a dynamic and creative staff attorney, who would initially be assigned to our Public Benefits Team to enhance our work with low income New Mexicans to address hunger and secure fundamental fairness in the administration of the public safety net.   This is a full-time permanent position.

The work at the Center on Law and Poverty is varied, always challenging and highly rewarding.  The work week is reasonable and the staff superb.  We offer a good non-profit salary and excellent benefits.

Required: Law degree and license; demonstrated intellectual or academic excellence; very strong research and writing skills; demonstrated persistence and capacity to lead; ability to problem-solve creatively; detail-oriented; commitment to economic and racial justice in alignment with the mission of the NM Center on Law and Poverty.  Preferred: experience with advocacy seeking systemic fairness in the administration of government benefit programs or in related institutional contexts; experience working with diverse community groups and other allies; familiarity with poverty law; Spanish fluency.

Apply in confidence by sending a resume and letter specifying which position you are interested in and detailing how you meet the position requirements to hiring@nmpovertylaw.org. We are an equal opportunity employer. People with disabilities, people of color, former recipients of public assistance, or people who have grown up in poverty, are especially encouraged to apply.

Editorial: Shortchanging the Poor0

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 Master0

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