ALBUQUERQUE, N.M. — Up to 170,000 adults to be eligible for coverage in 2014
SANTA FE – More than eight months after Gov. Susana Martinez announced New Mexico would expand its Medicaid coverage to an estimated 170,000 adults by 2020, her administration says it’s ready for the wave of new enrollees.
Though newly eligible individuals under the expansion will not be able to receive Medicaid benefits until January 2014, they can begin applying for benefits on Tuesday.
The expansion will take effect at the same time that significant other changes – known as Centennial Care – are being made to the state’s Medicaid program in an attempt to drive down the cost of providing health care.
“And through Centennial Care, we are reforming the system to be more patient-centered and offer incentives for healthy living, good follow-up care by hospitals, and less usage of costly emergency rooms for non-emergency purposes.”
While the federal government will foot the bill – at least initially – for the Medicaid expansion, the state is largely responsible for integrating the newly eligible New Mexicans into the joint federal-state health care program.
To that end, the state’s Human Services Department has set up a phone hotline and a website, while an additional 75 workers, approved in this year’s state budget, will be deployed around New Mexico to the 44 field offices the agency runs.
In addition, HSD is holding 200 meetings around the state to inform New Mexicans about the pending Medicaid changes, including expansion.
The agency estimates 133,400 additional New Mexicans will be added to the state’s Medicaid rolls in 2014, with more people being brought on in the coming years.
Roughly 560,000 New Mexicans – or more than one in every four state residents – are currently on Medicaid, meaning the total number of people receiving benefits through the program is projected to top 700,000 by mid-2015.
About half of the people expected to be covered under the Medicaid expansion are already enrolled in a limited state benefit program and will be automatically enrolled into Medicaid, according to HSD.
However, the nonprofit New Mexico Center for Law and Poverty is concerned that some New Mexicans won’t find out that they will soon be able to qualify for Medicaid.
Shireesa Manne, a staff attorney for the Albuquerque-based organization, said many New Mexicans seem to be confused about the changes on the horizon. She said she hopes HSD ramps up its outreach efforts in the coming months.
“I think people are in the dark right now about Medicaid enrollment,” Manne told the Journal . “With the current efforts, we would be very surprised if they met their (enrollment) target.”
Medicaid has historically provided health care coverage primarily for low-income children, pregnant women, disabled adults and the elderly.
Under the expansion, however, low-income adults will likely make up the majority of the individuals added to the state’s Medicaid rolls.
The expansion population could include homeless people, individuals with mental health problems and people only able to find part-time employment.
The long-term cost of providing health care coverage to newly eligible New Mexicans is unclear.
“I don’t think we know, for sure, the health status of those who are going to be coming onboard,” HSD Secretary Sidonie Squier told members of a legislative budget committee last week.
Here is what is clear:
Under expansion, states can – starting in January – provide Medicaid benefits to adults earning up to 138 percent of the federal poverty level, or about $15,288 per year for a single adult. Those thresholds change for single parents or families.
To pay for the additional health care coverage, HSD has submitted a budget request of $5.8 billion to the Legislature for the coming fiscal year. Of that total, slightly more than $1 billion would come from the state General Fund and the rest from the federal government.
Medicaid expansion is a key piece of Obamacare, or the federal Affordable Care Act, which was signed into law in 2010 with the goal of ultimately providing all Americans with health care coverage.
Participating in the expansion is optional since the U.S. Supreme Court ruled in 2012 that states could decide whether or not to grow their Medicaid ranks and accept the additional federal funding.
Martinez, who was elected in New Mexico in 2010, became one of the few Republican governors to approve Medicaid expansion in January of this year.
“I may be a Republican, but I make decisions based on what’s best for New Mexicans,” Martinez said.
She said the Medicaid expansion and increased access to increased health care has the potential to increase the well being of New Mexico families. The additional federal spending will also help the state’s budget, she said.
Among the challenges posed by the Medicaid expansion are the state’s shortfalls of doctors, nurses and other medical professionals.
During a recent speech in Las Cruces, Martinez said New Mexico currently has a shortage of between 400 to 600 primary care physicians. Medicaid expansion will create a need for even more health care providers, she said.
To address that need, Martinez said her administration is coming up with initiatives that – once unveiled – will be specifically geared toward lightly populated parts of the state.
“We need an economy in New Mexico that is built to lead in health care, particularly in response to the increased demand for primary care practitioners,” Martinez said in a statement provided by her office. “We are looking at options for meeting this need in a way that benefits the economies of rural areas in particular.”
State lawmakers have also picked up on the concern.
“We’re getting all this coverage for new people, but we don’t have the providers,” said Rep. James White, R-Albuquerque, during a recent hearing of the Legislative Finance Committee.
“It’s like getting a new car without having the gas.”
However, Manne said the state might become more attractive for health care professionals if its uninsured rate – currently about 21 percent for New Mexicans under age 65 – is driven down by Medicaid expansion.