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Medicaid Reforms Proposed

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SANTA FE – Gov. Susana Martinez’s administration asked the federal government Friday to approve a revised plan to overhaul a program providing health care for a fourth of New Mexico’s population.

The Human Services Department’s latest Medicaid proposal comes nearly six months after the administration initially unveiled a blueprint to improve health care for needy New Mexicans while slowing the growth of a program costing nearly $4 billion a year. About a fourth of the money comes from the state budget, with the federal government paying the remainder.

The administration hopes to implement the Medicaid overhaul in January 2014.

Human Services Secretary Sidonie Squier said the broad outlines of the administration’s original Medicaid overhaul remain unchanged. No enrollment cuts are proposed, and there’s no planned reduction in rates paid to health care providers.

After the department received additional comments from the public and providers, changes were made to ensure Medicaid coverage for more low-income pregnant women and disabled New Mexicans who are working. Previous eligibility proposals would have required some of those people to pay for coverage through a state-run health insurance exchange planned under a federal health care law. The working disabled on Medicare also would have been precluded from getting supplemental health coverage through the exchange.

The department is sticking with a proposal to require Native Americans to obtain Medicaid services through managed care organizations.

Tribal leaders have expressed concerns that a switch to managed care could limit access to health care providers for Native Americans living in remote areas.

But Squier said the department is confident that won’t happen, because the overhaul proposal makes clear that Medicaid-eligible Native Americans can continue to use their current primary care providers through the federal Indian Health Service or other tribal health systems. That will happen regardless of whether a doctor or clinic is part of a managed care network or has a contract with the managed care company. The department also has committed to ensuring prompt reimbursement for Medicaid services by tribal health care providers.

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