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Plan to boost Medicaid patient costs is scaled back

SANTA FE – New Mexico is scaling back its proposal to impose premiums on some Medicaid patients and require more copays – partly in response to blunt criticism in a series of public hearings this year.

But opponents say the proposal still needs substantial work.

The state’s application to revise its Medicaid system – submitted Wednesday for federal approval – still would impose a $10 monthly premium on adults who make about $12,100 to $16,600 a year in 2019, with the possibility of $20 a month in future years. An earlier version of the proposal sought to apply the premiums to more income categories.

The state Human Services Department also withdrew some of its proposed copays. Under the application submitted Wednesday, the state is asking for approval to impose new copays on Medicaid patients who go to the emergency room when they don’t actually have an emergency and on people who buy brand-name drugs when a generic is available – but not for office visits and hospitalizations, as first proposed.

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Brent Earnest, secretary of human services, said the goal is to “really drive better use of the health care system,” encouraging people to seek preventive and other less costly care.

The proposal still would eliminate a rule that allows people to seek retroactive coverage if they’ve received care before enrolling in Medicaid, though the elimination would be phased in over time. (Now, people can request coverage for health bills in the three months before they enrolled.)

Abuko Estrada, staff attorney for the New Mexico Center on Law and Poverty, said the state’s proposal still needs work.

“While HSD has removed or delayed some of the harmful proposals,” Estrada said, “we are deeply concerned about the significant cuts that remain that will jeopardize coverage and access to care for our children and families. Premiums for adults with low wages who live near the poverty line will cause thousands of people to lose coverage, as experience has shown in other states.”

Phasing out retroactive coverage, he said, “will leave our families in financial debt and shift more uncompensated care costs onto health care providers, hurting their ability to provide quality care to all New Mexicans.”

Earnest told legislators Wednesday that his department expects the proposal, if accepted by the federal government, to save about $90 million in New Mexico’s general operating budget over a five-year period.

He delivered some good news on the department’s budget request for next year. The improving economy and enrollment trends suggest the state will need an extra $68 million for Medicaid next year – not $82 million, as projected earlier.


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