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Friday, March 27, 2009
Shine Some Light on How State Administers Medicaid
By Kim Posich
Executive Director, New Mexico Center on Law and Poverty
The New Mexico Medicaid program is funded by $800 million of New Mexico taxpayers' money. The program is worth it. It is perhaps one of the most powerful economic stimulus tools at our disposal, bringing billions of federal dollars into the state and forming an important part of the foundation of our state's health-care system. Yet, remarkably, the New Mexico Medicaid program operates in the shadows, seemingly impervious to public and legislative attempts to hold it in the light of standard accountability.
For several years now, the Human Services Department has repeatedly rebuffed attempts by both the public and the Legislature to gain access to important performance data for the Medicaid program.
As enrollment in Medicaid began plummeting in 2004, toward the biggest disruption to health care among low-income New Mexicans in history, community groups and the Legislature began seeking performance data to evaluate the administration of the program. The department responded by significantly limiting information. The information it did provide was often unclear, inadequate and of little use for the purposes of oversight. The department claimed it was the best it could do. Officials variously blamed their computer system, the former administration, being short-handed, or lawsuits by nonprofit organizations.
In August 2007, Gov. Richardson ordered the Human Services Department to address Medicaid enrollment, and within months enrollment began to climb. But still, the department refused to provide basic performance data. This past summer, the Legislative Finance Committee took the unusual step of appealing to the attorney general for help. Yet, incredibly, even though the attorney general wrote that the Finance Committee was entitled to the information to audit the state budget, the department still refused to provide it, claiming it was “confidential.”
Recently, Medicaid enrollment began falling again — by a shocking 4,448 people. This is the first time since May 2007 that a significant decrease in enrollment occurred.
As matters stand now, it is unlikely the public will ever know why. And matters may get worse. Last month, it appears that the Human Services Department tried to quietly pass a bill that, according to the Journal, “would have gutted the law intended to shine a spotlight into how the state conducts business” (Albuquerque Journal, Feb. 28). The article reported that the measure was drafted and promoted by the general counsel of the Human Services Department. A few days later, the Journal reported the department was accused of withholding key documents from ValueOptions, as the company challenged the state's bidding process to provide New Mexico's behavioral health services contract. Astonished, the CEO of one company involved in the bidding remarked, “The Human Services Department is not operating in the sunshine” (Albuquerque Journal, March 4).
A few days ago, the Legislature passed two bills — HB 130 and HB 544 — that would make it law for the department to report basic performance data about the Medicaid program. The Human Services Department vigorously opposed them both. But the measures drew strong support from a wide range of advocacy and health-care provider organizations and were wildly popular with legislators. One passed both the House and the Senate unanimously, the other nearly unanimously.
Now the measures await Gov. Richardson's scrutiny. The governor has been promoting transparency, accountability and good government. Signing these bills into law fits well into these priorities. New Mexico needs more sunlight in the Human Services Department.
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