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Gov. wants to scrap Medicaid copays

New Mexico Gov. Michelle Lujan Grisham on Wednesday talks about her decision to remove most of the New Mexico National Guard troops from the Mexican border. (Greg Sorber/Albuquerque Journal)

New Mexico Gov. Michelle Lujan Grisham. (Greg Sorber/Journal file)

Copyright © 2019 Albuquerque Journal

SANTA FE – Gov. Michelle Lujan Grisham’s administration is seeking to halt certain Medicaid policies pushed by former Republican Gov. Susana Martinez, including mandatory copays and premiums for some Medicaid recipients.

In a letter sent this week to a federal administrator, State Medicaid Director Nicole Comeaux said the new administration “does not intend to pursue” the policies included in the state’s federal Medicaid waiver and instead plans to reverse course.

Lujan Grisham, a Democrat who took office last month, said Wednesday that the policies would limit emergency access and disrupt health care services for thousands of state residents.

“I have no intention of implementing policies that put a financial strain on low-income New Mexicans as well as administrative hardship on our health care provider network,” Lujan Grisham said in a statement.

In rolling out the proposals in 2017, the Martinez administration said they would limit cost increases, provide incentives that promote quality over quantity in New Mexico’s health care system, and encourage personal responsibility.

Ex-Human Services Secretary Brent Earnest said in December 2017 that the goal was to “really drive better use of the health care system.”

But the plan came under fire from Democratic lawmakers, who argued that imposing new copays and premiums, however small, could discourage people from seeking care when they need it.

One of the targeted policies is a $10 monthly premium for adults who became eligible for Medicaid under a 2014 expansion approved by Martinez. The premiums would affect an estimated 50,000 New Mexicans who make between about $12,000 and $16,000 yearly.

Another policy that could be reversed is a copay of $8 for nonemergency use of hospital emergency rooms and for buying brand-name drugs when a generic version is available. That would apply to an even broader swath of state Medicaid recipients.

Both policies are scheduled to take effect in the coming months, with the copays set to start on March 1. With that date fast approaching, Comeaux said in her letter to a federal Centers for Medicare & Medicaid Services official that the state wants to find the “best and fastest” way to reverse the decision.

The premiums and copays were previously projected to generate millions of dollars annually for the Human Services Department. But top agency officials indicated Wednesday that scrapping the policies could actually lead to long-term cost savings by encouraging Medicaid recipients to seek prompt treatment.

More than 832,000 New Mexicans – or about 40 percent of the state’s population – were enrolled in Medicaid as of December, according to the Human Services Department.

Of that amount, about 475,000 were adults and 357,000 were children.

The joint state-federal health care program also paid for 72 percent of the births in the state in 2015, the highest rate in the nation.

However, after years of rapid enrollment growth, the state’s Medicaid population has largely leveled off over the past two years, likely due in part to an improving state economy.

New Mexico Human Services Secretary David Scrase said the Lujan Grisham administration will work with hospitals statewide to come up with ways to reduce unnecessary emergency room use.

“However, we do not believe that copayments are an effective strategy in driving changes in provider or member behavior,” said Scrase, who was a physician at the University of New Mexico School of Medicine before being appointed by Lujan Grisham.

Although Medicaid is a federal program, states are given certain leeway in running it. Total New Mexico Medicaid spending is expected to approach $6 billion for the budget year that starts in July, with the federal government picking up the bulk of that tab.