Since last January, New Mexico and other states have faced a stream of threats to assistance programs by lawmakers looking to make deep cuts. Advocates for accessible health care and nutrition don't see an end in sight without a political sea change.
From the attempt by the federal government last summer to repeal the Affordable Care Act's expansion of Medicaid in the state, which has granted health insurance to an additional 200,000-plus New Mexicans since 2014, to a farm bill currently moving through Congress that would make it more difficult for people to obtain healthy foods and limit benefits overall, the possibility of New Mexicans being kicked off federal assistance rolls is real.
State programs have also tightened. Last December, the New Mexico Human Services Department, which administers the state Medicaid program, scaled back some new proposed surcharges on Medicaid enrollees, but kept others, which may go into effect next year.
And the number of people enrolled in both Medicaid and the Supplemental Nutrition Assistance Program, or SNAP, declined by 5.4 percent and 12.9 percent, respectively, over the course of one year.
One reason there are less people receiving assistance from the state, HSD spokeswoman Mary Robertson suggests, is because the federal government's statistics show there are more employed people, though still fewer than before the Great Recession.
"As the economy improves, the need for public assistance, like Medicaid, declines," Robertson writes in an email.
However, the department can't provide causal proof to support the claim. When asked for a jobs report showing how benefits and employment were linked, Robertson emailed SFR employment data from the Bureau of Labor Statistics.
A more likely explanation is that HSD is coming out from under a court order that forbade automatically denying applicants for SNAP and Medicaid benefits.
In an April hearing, a federal judge said that HSD should start automating rejections of Medicaid and SNAP applications once again on May 1. That order reverses one from 2014 where a judge told the department to individually review each application because it had been "closing cases that had not been approved or denied within the appropriate federal timelines."
In another public relations blow, HSD employees in 2016 admitted to faking information on emergency SNAP applications so the department would have more time to process them. HSD has operated under the oversight of a special master since November of that year to ensure it complies with federal law.
A farm bill wending through Congress right now would give HSD more leeway to limit nutrition assistance. The federal legislation would mandate that most people between ages 18 and 60 inclusive work or receive job training for at least 20 hours a week, and 25 hours a week after 2025. It would also reduce the ability of people to purchase food at a grocery store with an EBT card, and instead guarantee them boxes of non-perishable food.
If passed into law, the Center on Budget and Policy Priorities estimates the bill would reduce federal spending on SNAP by $260 billion over 10 years. The Congressional Budget Office estimates 1 million people would leave the program over the same time period because of the stricter rules.
As of February of this year, there were 222,265 New Mexicans receiving SNAP benefits, and the lobbying group New Mexico Voices for Children says 74 percent of SNAP participants live with their families.
In all states, the federal government pays for the benefits that SNAP enrollees receive, while HSD splits administrative costs of the program with the feds.
Gov. Susana Martinez' administration's past efforts to impose work requirements on SNAP recipients without dependents were halted by a judge in 2016. In February, a bill introduced by State Sen. Pat Woods that would have added work requirements was tabled indefinitely.
Cuts to Medicaid, meanwhile, are certainly on their way for some of the 855,000 New Mexicans insured through the aid program, though they won't appear with the severity that advocates once feared—at least, for now.
Congressional Republicans last year initially wanted to replace a provision in the Affordable Care Act where the federal government matches dollars that some states spend on health care and replace it with single, inflexible block grant.
The idea died as Congress' attempts to repeal ACA (also known as Obamacare) failed, though the Trump administration continues to undermine Medicaid expansion by allowing states to impose work requirements on Medicaid recipients (something Gov. Martinez declined to do).
HSD has proposed changes to the state's Medicaid program that would feature additional costs for low-income patients. These include new monthly premiums and copays for certain adults and services, as well as a phasing-out of three-month retroactive coverage for new enrollees by 2020. The changes are supposed to make up for a $32 million shortfall in its fund for the state Medicaid program.
Abuko Estrada, an attorney for the New Mexico Center on Law and Poverty, says HSD submitted these proposed changes as part of a waiver for approval to the federal government. If the waiver is approved, he says, the state will then "negotiate with the federal government the terms and conditions that will apply to the waiver, [and] how the waiver will be implemented."
After that, the second iteration of the state's Medicaid program, known as Centennial Care 2.0, would go into effect Jan. 1 of next year. But the chance of major cuts to the federal Medicaid program will remain as long as Republicans have a majority in Washington.