Little Changes

The state announced Wednesday that it had reneged on some planned changes to New Mexico's Medicaid program, but its plans for next year may still result in some higher costs for low-income patients who are enrolled in Medicaid. The updates aim to incorporate public criticism and suggestions to a draft of the program, known as Centennial Care 2.0, that was released in September.

The changes to the program include a $10 monthly premium for adults whose salaries are 100 percent above the federal poverty line and who enrolled in Medicaid as a result of the federal Affordable Care Act's expansion; imposing a $25 copay on "non-emergency" visits to the Emergency Room and a $10 copay for choosing brand name drugs over generic; and a phasing out of "retroactive coverage," wherein Medicaid covers medical bills for the three months prior to somebody signing up for coverage, by 2020.

In addition, the program will now cover services for substance abuse disorder, including screenings for treatment, brief interventions and referral to treatment, and adult residential treatment. The changes will affect about 855,000 New Mexicans currently enrolled in Medicaid.

Although the changes will still mean that some covered by Medicaid in New Mexico have to shell out more money for care, they reduce the financial burden that the department initially intended to place upon patients. The department originally planned to impose premiums and copays on a much broader swath of people and eliminate retroactive coverage at an earlier date.

"We're pleased to see HSD has removed and delayed some of the harmful provisions from earlier application, but we are deeply concerned about the cuts that remain," says Abuko Estrada, a staff attorney at the New Mexico Center on Law and Poverty. The changes, he says, are going to leave "families in financial debt and shift more of compensated care costs on health care providers, which hurts their ability to provide quality care for all New Mexicans."

The department's secretary, Brent Earnest, told legislators at a meeting of the Legislative Finance Committee that the changes would save the state's general fund $35 million in a year, and $90 million over the next five years. The waivers were conceived to close a shortfall of about $32 million in the state's Medicaid program funding.

On Sept. 8, the New Mexico Center on Law and Poverty submitted a request for records to the Human Services Department, asking for any and all impact analyses related to the Centennial Care 2.0 program. The center received 64 responsive records that gave a glimpse into how the older proposed changes to the state's Medicaid program would affect low-income people.

The records showed that under the old proposed changes, 65,900 Medicaid patients would have been charged premiums, and all enrollees would have paid copays totaling $4 million. Medicaid currently covers all of these expenses for enrollees.

HSD has not released any analyses describing how the changes it announced today would affect enrollees.

Around 50,000 people have unenrolled from Medicaid over the last year. Earnest told legislators this was due to some individuals not having submitted materials to re-enroll on time and a lag in the re-ceritification process within the department.

The department expects the number of people enrolled in Medicaid to top 877,847 next June, and 887,000 a year later, presuming there are no major changes to the program at the federal level.