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Medicaid needs better health, fiscal outcomes

When the state Human Services Department announced in February 2012 that it planned to revamp the Medicaid program it administers, a hue and cry surrounded the proposal to institute minimal co-pays.

The focus should have been on how the re-christened Centennial Care would improve health outcomes while helping to rein in spiraling costs.

Next year there will be no changes to who qualifies for Medicaid, although New Mexico has one of the most generous programs. No changes in reimbursement rates to health care providers. No changes to what care clients will get.

But there will be changes to how that care is tracked, delivered and paid for.

Medicaid clients will finally have someone coordinating their care, have incentives to get preventative care and screenings, have to make a small co-pay for name brand drugs and have to decide if allowing a non-emergency health concern get to the emergency-room tipping point is something they want to help pay for.

The higher-than-generics or office-visit co-pays may be the deciding factors that change client behavior, but improved health outcomes should be the deciding factor not only for taxpayers but advocates for the state’s low-income and disabled population.

Human Services Secretary Sidonie Squire says Centennial Care will “change the way we do business, and it’s just going to increase health outcomes.”

The changes also will make the health care experience for those on Medicaid more like that of those who have private health insurance.

And those changes in turn should help control costs – a vital component to keeping Medicaid financially viable in a state that spends $1 billion on it annually, where 1 in 4 residents is on the program and an estimated 175,000 more are expected to join under the Affordable Care Act. It is vital HSD tracks its revamped Medicaid to see if it delivers healthier medical and fiscal bottom lines.

Because the alternative to these reasonable increases in oversight and cost would be reductions in eligibility, reimbursements and/or coverage – something HSD has worked to avoid, and something that will not deliver healthier outcomes to New Mexico’s most vulnerable medical population.

This editorial first appeared in the Albuquerque Journal. It was written by members of the editorial board and is unsigned as it represents the opinion of the newspaper rather than the writers.



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