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Computer ‘glitches’ cut off Medicaid for some NM kids

Copyright © 2018 Albuquerque Journal

When Albuquerque parent Robert Anderson went to pick up a prescription last week, he learned that as of Dec. 31, his four children who were adopted out of foster care were no longer eligible for Medicaid.

“We’re in the middle of a big medical procedure, and I’m saving my receipts to try to get reimbursed later,” Anderson told the Journal. “How long can we do this? How long is it going to take?”

Anderson said that although he and his wife could cover the expenses out of pocket for a short period of time, it would quickly become a financial problem “of staggering size” for his family.

In response to inquiries about Anderson’s case by the Journal, the state determined it had inadvertently ended Medicaid coverage for some children who were part of New Mexico’s state’s foster care system or were adopted out of it.

Presbyterian Healthcare Services, which administers Medicaid coverage for Anderson’s children through the state’s Centennial Care program, directed questions to New Mexico agencies.

In a joint statement by the New Mexico Children, Youth and Families Department and the Human Services Department, the agencies attributed the problem to “several glitches” related to the implementation of a “new system.” CYFD said it will send out 4,000 letters to foster and adoptive families this week alerting them to the issue, which led to some children being erroneously labeled as ineligible for Medicaid coverage and related subsidies.

A Human Services spokeswoman said the state has identified 15 children who had been improperly deemed ineligible for Medicaid, and both agencies are exploring the problem.

A CYFD spokesman said that once the issue is corrected, individuals affected by the glitch can have their Medicaid eligibility restored and applied retroactively. Medicaid subsidies can be $400 a month or more per child, depending on the child’s needs, he said.

In an email, CYFD indicated that at least some of the problems are related to the system known as ASPEN, which stands for Automated System and Program Eligibility Network. In August, the U.S. inspector general identified several security vulnerabilities in New Mexico’s Medicaid data after the Human Services Department migrated to ASPEN, according to a federal report.

The agencies said they are still determining whether Anderson’s problem was caused by the glitches or something else, but his children are now “currently covered by Medicaid with no gap in eligibility.”

But Anderson said he is worried about other families that might find themselves in the same situation.

“We’ll be OK, but what about everybody else?” Anderson said.

According to CYFD, families who believe their children were affected by the issues should first contact their caseworker, with subsequent questions directed to CYFD’s Pamela Munoz at 505-467-9374.