State program addresses uninsured.
Gov. Bill Richardsonï¿½s plan to extend basic health care to 400,000 uninsured New Mexicans died a highly publicized death last month when state lawmakers got sick over the planï¿½s fine print. But in its wake, a little-known program may provide a backdoor approach to covering the vast majority of the stateï¿½s uninsured.
ï¿½It could be very big,ï¿½ Robin Hunn, executive director of Santa Fe Project Access, tells SFR. Hunn is referring to the State Coverage Insurance (SCI) program, which could offer free or nearly free health insurance to 211,000 uninsured New Mexicans.
If approximately 100,000 of the stateï¿½s uninsured population are children already eligible but not enrolled in existing programs, as health policy experts estimate, SCI alone could extend coverage to approximately 70 percent of the the stateï¿½s remaining uninsured adults.
ï¿½Itï¿½s not going to be all of the uninsured in New Mexico, but itï¿½s a good chunk,ï¿½ Carolyn Ingram, Medical Assistance Division director of the state Human Services Department, says. In fact, she notes that currently 101,000 uninsured are eligible for coverage under SCI. The full 211,000, she adds, is the estimate of eligible New Mexicans by 2013 if the Legislature continues to fund the program.
Those who qualify under SCI will receive a comprehensive package of benefits that include primary care, specialty care, inpatient and outpatient hospitalization, lab work, x-rays and a range of other therapies. Eligibility is determined on the basis of income, with the formula set in such a way that many middle-class New Mexicans are eligible.
For example, Hunn cites cases in which a single individual who earns $1,625 per month, a couple that earns $3,000 per month or even a family of five with a sole breadwinner earning $4,255 per month, all qualify for ***image2***SCI at 100 percent of the federal poverty line. At that level there are no premiums and only $3 co-payments for prescription drugs. Above that, participants pay premiums between $95 to $110 per month in addition to other small co-pays.
Although SCI was started in 2002 under former Gov. Gary Johnson, a libertarian-leaning Republican, and given a waiver by the Bush administration that same year, the program ï¿½sat on the shelf,ï¿½ as Hunn puts it, until Gov. Richardson tapped it as a means to cover the uninsured in 2005. In 2008, the state will spend $20.3 million on SCI, along with a generous federal match of $80.3 million plus $2.2 million generated by premiums and co-pays, Ingram notes.
ï¿½We have to live within the funding that the Legislature has given us,ï¿½ she adds as a caveat. ï¿½We hope thereï¿½s money to keep expanding the program and growing enrollment.ï¿½
As of Feb. 1, approximately 15,000 New Mexicans were enrolled, including 425 from Santa Fe County.
While thatï¿½s a drop in the proverbial bucketï¿½as many as 43 percent of the countyï¿½s entire population may be uninsured, according to a finding by the Santa Fe County Health Improvement Plan in 2006ï¿½itï¿½s a start.
At the Santa Fe County Health and Human Services Departmentï¿½s Galisteo Street offices, Hunn and Lynda Longacre, Santa Fe Project Accessï¿½ enrollment coordinator, are busy signing up as many uninsured New Mexicans as they can. They say theyï¿½ve signed up 214 people since November.
On March 3, they helped 20 applicants with all the appropriate paperwork. The first appointment of the morning was Esperanza Garza.
ï¿½And youï¿½re currently not pregnant?ï¿½ Longacre asked the grandmotherly Garza.
ï¿½Oh, no,ï¿½ Garza said, laughing.
ï¿½We have to ask,ï¿½ Longacre explained, before telling Garza she wonï¿½t need to pay any premiums.
On her way out, Garza breathed a sigh of relief. ï¿½With this, it will allow me to go to the doctor and make sure Iï¿½m OK,ï¿½ the Taos native and diagnosed diabetic said. ï¿½I really havenï¿½t gone to a doctor or anything and I need to.ï¿½
Le Anne Siow, a Molina Healthcare community outreach coordinator, shows up every Monday with Hunn and Longacre to sign up new clients like Garza. Asked if she sees SCI as a backdoor approach to extending access to many uninsured New Mexicans, she vigorously nods her head.
ï¿½Yeah, I do,ï¿½ Siow says. The biggest problem she sees is spreading the word about SCI and a handful of other low- to no-cost state programs.
ï¿½Thereï¿½s a program for everybody,ï¿½ she says.