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Is access quicker for Medicaid recipients, big donors?

Copyright © 2019 Albuquerque Journal

Money, or the lack of it, can conceivably make a difference in how long it takes to see a medical provider in New Mexico.

Those with low incomes on New Mexico’s Medicaid program are entitled to federally mandated health care access, including minimum medical appointment wait times.

And, if online testimonials are any indication, a donation or estate gift of at least $50,000 to Presbyterian Healthcare Foundation’s “Luminary Circle” Program, could be the ticket to faster access to medical providers – a contention disputed by Presbyterian even though the testimonials by prominent New Mexico donors appear on its website.

The state Human Services Department requires the three Centennial Care managed care organizations that serve Medicaid members in New Mexico to provide adequate geographic access to primary care and other types of providers.

And, enrollees are supposed to be able to obtain a health care appointment within a reasonable amount of time.

For instance, according to the state Legislative Finance Committee, Medicaid members are supposed to be seen for routine, asymptomatic outpatient appointments within 30 days; routine appointments but with symptoms have a 14-day time frame. Specialty providers are to see Medicaid members “consistent with clinical urgency, no more than 21 days,” the LFC reported in a 2016 evaluation.

New Mexicans interviewed by the Journal for this series – many with private health insurance – said they experienced far longer wait times for both primary care and specialists.

The LFC’s evaluation said timely access for Medicaid patients was important.

“Expanding Medicaid coverage … is of limited value unless we can confirm that there is meaningful access to care” for the estimated 850,000 people, or 40 percent of New Mexicans, enrolled in the state’s Centennial Care, the LFC stated.

But contractors have not been penalized for failure to meet access standards because the state HSD has considered health provider shortages to be circumstances beyond the control of MCOs, stated a May 2016 legislative report.

Donor edge?

According to the Presbyterian Healthcare Services’ website, the Presbyterian Healthcare Foundation offers a complimentary membership in the “Luminary Circle” to donors who reach a lifetime giving of $50,000 in gifts and pledges, or at least $50,000 in estate gifts.

The program provides liaisons to assist members, in part, with establishing with a new physician or specialist, with billing issues, and with physician appointments, the website states.

“Luminary Circle members are treated to the following benefits,” the website states, including “a members-only hotline to access inpatient, outpatient, or emergency medical services in the Albuquerque/Rio Rancho area.”

Of the two pages of donor testimonials that appear on the website, some people who had been hospitalized said they were thankful for “perks,” such as valet passes, gift baskets and meal cards for patients and their families.

Two donors mentioned the help accessing “appointments with specialists.”

“Recently, I needed a specialized doctor and could not get in anywhere in a timely manner,” wrote Steve and Debbie Maestas. “They made it happen in 24 hours. I could not have been in better hands than Luminary Circle.”

Art dealer Mary Ann Weems said the Luminary Circle “is ABSOLUTELY the best INVESTMENT a family can make. One no longer has to wait weeks or months for appointments with specialists nor sit in the ER alone and not knowing when you’ll be seen.”

Asked about preferential access for donors, Presbyterian Healthcare Services released the following statement last week:

“As a not-for-profit, community-based health provider, Presbyterian believes that everyone in the community should have equal access to quality care. Membership in the Luminary Circle, or any other program, does not provide quicker access to care than any other patient that we serve at Presbyterian.

“The Luminary Circle helps members navigate a hospital stay or a new diagnosis. One benefit is helping members make an appointment through the same scheduling system used for every other Presbyterian patient. At a stressful time such as experiencing a debilitating illness, something as simple as assistance with making an appointment can be a tremendous relief that helps a person feel like they are getting an appointment faster than they could if left to make the call themselves while they are ill.”

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