In Through the Out Door

Feds say NM must integrate health insurance enrollment

Last year, Gloria Goodman found out that she and her husband were making too much money to continue getting health insurance for their family through Medicaid.

After two years on Medicaid, Goodman now needed to enroll her family in a health care program through the state's Health Insurance Exchange. The exchange, recently rebranded as BeWellNM, is tasked with creating the online marketplace for health care plans under the federal Affordable Care Act.

When Goodman, who is a skin therapist in Albuquerque, went to shop for a new plan with the exchange, she says workers told her that she had to apply for coverage through Medicaid before she could apply for coverage through the exchange.

She already had a letter from Medicaid telling her she no longer qualified for coverage under the federal program, but that wasn't enough.

"It was a back and forth having to fill out Medicaid stuff, even though I didn't qualify for it," she says.

After three months and some solicited help from the New Mexico Center on Law and Poverty, Goodman eventually got new coverage for herself, her husband, who works as a contractor in the building industry, and her two kids—but not before the family experienced a two-month gap without insurance.

Goodman's situation illustrates one of the recent complications of the rollout of the ACA, known to many as Obamacare. The health care law came with two major pieces—an expansion in Medicaid, the decades-old federal health care program for the poor, and the rollout of other coverage through the state insurance exchange systems.

One provision of the ACA, called "no wrong door" and "single door," is supposed to ensure that people like Goodman don't get caught between either system. And New Mexico hasn't been doing a good job of getting it done.

"There has to be what amounts to a single application process—one-stop shopping," says Jim Jackson, executive director of Disability Rights New Mexico. "New Mexico has not fully complied with it."

In November, the federal Centers for Medicare & Medicaid Services (CMS) told the exhange that its enrollment must share a portal with Medicaid. Amy Dowd, the CEO for the New Mexico exchange, says that's underway.

"We're still sizing that and assessing," Dowd tells SFR. "My experience in working with CMS is that it's a very fluid environment. Regulations have been new and evolving since the Affordable Care Act passed."

Dowd became head of the exchange last August and has been presiding over the current open enrollment period. Uninsured New Mexicans eligible for either Medicaid or insurance through the exchange have until Feb. 15 to enroll this year.

Dowd adds that New Mexico isn’t the only state to face design changes “late in the game.”

Abuko Estrada, a staff attorney at the Center on Law and Poverty, says his organization started hearing about the problem last October. Though "no wrong door" has been a part of Obamacare since the law passed in 2010, Estrada says that the guideline by the feds to make New Mexico put both Medicaid and the exchange on one portal is something new.

"I do think they were acting in good faith and moving toward what they thought was good for the consumer," he says of the exchange.

‘This state…is going to drive me crazy’

Emails show true colors

Just because a state agency implements a policy doesn’t mean its leaders believe in the idea.

Emails newly obtained by SFR shed light on how former Human Services Department officials felt about Medicaid expansion.

In an April 2012 email, Matt Kennicott, spokesman for the department, wrote to HSD Secretary Sidonie Squier that Gov. Susana Martinez was “too afraid” to speak out against the federal expansion of Medicaid through President Barack Obama’s Affordable Care Act.

Medicaid subsidizes medical insurance with federal taxpayer money for individuals living up to 138 percent of the federal poverty level. That’s almost $16,000 in annual salary for a single person.

“Why Matt?” replied Squier. “Why is the Gov’s office so weak on this issue?”

“It all boils down to polling and not saying something that will upset the approval numbers,” Kennicott wrote back.

Martinez eventually decided to expand Medicaid rolls to cover additional tens of thousands of New Mexicans through the new health care law—despite pressure from Republicans to reject the expansion of the federal program.

Squier told SFR last week in a phone interview that she resigned from her cabinet position because the state’s politics are “too blue for this red girl.”

Formerly, Squier had worked in the federal human services department under George W Bush as well as similar positions in Texas and Florida.

Martinez spokesman Enrique Knell dismisses the messages as “two-year-old e-mails that show agency staffers speculating about a decision made by the Governor, not them.”

The governor’s decision to expand Medicaid, he writes, “has proven to be correct, as an analysis by The New York Times shows New Mexico as one of the states that has benefited most from Medicaid expansion,” adding that 183,000 New Mexicans have signed up for Medicaid as the rate of uninsured New Mexicans fell by 5 percent from 2013 to mid-2014.

But the messages—which Kennicott calls “my personal opinion, where I was blowing off steam”—show the cabinet secretary and spokesman of the state agency opposed to expanding some of the very public-assistance programs the agency administers.

“That so sucks,” Squier replied to Kennicott’s email about polling. “This state and the people who think it’s OK to live off of other people is going to drive me crazy.”

“Me too,” Kennicott replied, continuing the April 2012 chain. “It’s terrible. Maybe we can begin softening them a bit over the next few months. We’re going to have to be prepared with reaction when SCOTUS [The US Supreme Court] comes out with their opinion—hopefully the right way—and it’s going to have to be strongly worded.”

The governor’s office didn’t respond to Kennicott’s contention in his 2012 email that Martinez didn’t speak out against Obamacare because of polling numbers. SCOTUS upheld the law’s legitimacy.

Martinez revisted the topic in her 2013 State of the State address saying, “I didn’t support Obamacare,” then adding, “but it’s the law of the land. The election is over and the Supreme Court has ruled. My job is not to play party politics, but to implement this law in a way that best serves New Mexico.”

--Justin Horwath

Letters to the Editor

Mail letters to PO Box 4910 Santa Fe, NM 87502 or email them to editor[at]sfreporter.com. Letters (no more than 200 words) should refer to specific articles in the Reporter. Letters will be edited for space and clarity.

We also welcome you to follow SFR on social media (on Facebook, Instagram and Twitter) and comment there. You can also email specific staff members from our contact page.