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Medicaid Plan Under Attack

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SANTA FE – New Mexico hospitals are worried about losing millions of dollars in revenue. Tribal officials are worried about losing sovereignty and money. Advocates are worried the poor will lose services.

Dozens of health care providers, Medicaid beneficiaries, insurance company officials and representatives of state and tribal governments and nonprofit agencies on Thursday aired those concerns about the state Human Services Department. Specifically, they were talking about HSD’s 104-page application to the federal government, submitted in late April, to overhaul New Mexico’s $3.9 billion Medicaid program, which serves 560,000 people.

Even though about two thirds of Medicaid funds are provided by the federal government, HSD officials say the program is expected to consume about 16 percent of the state’s general fund this fiscal year, up from 12 percent last year. Such growth could force cuts in other state services, they say.

HSD says its plan, called the Centennial Care waiver, will streamline administration of Medicaid, improve quality of care, allow more people to receive services and reduce costs by $453 million over five years. HSD started outlining its overhaul conceptually last June but the first public input on the resulting application occurred at Thursday’s Medicaid Advisory Committee meeting.

Participants generally praised HSD’s plans to help Medicaid recipients get better care through better patient education and programs to coordinate care among several providers. State officials were not able to provide many of the implementation details audience members were seeking.

New Mexico Hospital Association president Jeff Dye estimated one proposed change could cost Albuquerque’s major hospital systems $48 million a year in lost revenue. The state’s Department of Children, Youth and Families issued a statement opposing the change to what is known as retroactive eligibility because it would interrupt health care over administrative hiccups.

Today, people eligible for Medicaid who haven’t enrolled are allowed to enroll retroactively after they’ve started receiving care. Not allowing them to do so would leave hospitals with unpaid bills. CYFD said recipients are often removed from the rolls because of administrative problems that can be quickly resolved, but recipients, most of them children, lose care in the meantime.

Jemez Pueblo Gov. Joshua Madalena and Roselyn Begay of the Navajo Nation Division of Health both opposed plans to require Indians to receive Medicaid benefits through managed care organizations. Today Medicaid provides fee-for-service payments for Indians’ care.

Earlier HSD proposals would have allowed Indians to opt out of managed care, but officials said Thursday the waiver application requires tribal Medicaid beneficiaries to be enrolled in managed care programs.

Begay said managed care organizations would not provide adequate service on remote reservation lands. Madalena said Jemez’s own health system delivers care using fee-for-service payments to supplement costs.

He blasted state officials for failing to include pueblo representatives on the Medicaid Advisory Committee and said the state did not adequately consult with sovereign tribal nations.

“Outreach to Native American communities does not constitute consultation,” Madalena said.

Jim Jackson of Protection and Advocacy Inc. asked if the state would surrender saved money to the federal government or use it to improve and expand care. “There are still a lot of crucial details not spelled out yet,” he said.

Medicaid director Julie Weinberg told the Journal in an interview, “If we can bend the cost curve and do things we haven’t been able to do, I’m just speculating, but it gives us an opportunity for the department to invest in health care in Medicaid. We don’t want to make a decision on what we want to spend money on now.”

Providers and health plan officials said they don’t have the tools they need to execute some of the state’s quality improvement ideas.

New Mexico Primary Care Association executive director David Roddy said many primary care providers don’t have a way to coordinate care for patients and don’t have the information about patients they need.

Mary Eden of Presbyterian Health Plan said insurers have claims data but only medical providers have patient records necessary to improve care. Joie Glenn of the New Mexico Association for Home and Hospice Care said there are 18,000 people waiting for long-term care services through Medicaid but no one knows what needs those people have or even if some of them are still alive.

Dye said hospitals would have trouble collecting proposed copayments of up to $50 when Medicaid recipients use emergency rooms for non-emergency conditions and that the copayment would do little to reduce inappropriate emergency room use.

Dale Tinker of the New Mexico Pharmacists Association applauded a proposed $3 copayment for brand-name prescriptions when generics are available, but Doris Husted of the Arc of New Mexico warned that many generics do not perform as well as brand name drugs, especially psychiatric medications.

HSD said it will form working groups to hammer out details and differences. The agency said it hopes to have federal approval of its application this summer.
— This article appeared on page A1 of the Albuquerque Journal

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