The Human Services Department has decided to make the eligibility criteria for a Medicaid-funded family planning program more strict. It says those who will no longer qualify can apply for subsidized insurance through the new federal exchange and get contraceptive coverage that way.
But health advocates say that scenario is fraught with problems – and that a gap in birth control means unintended pregnancies. They’re pressing HSD to reconsider its decision or institute some sort of transition period.
According to HSD, roughly 50,000 New Mexicans take part in the program now, and about 10,000 of them would no longer be eligible as of Jan. 1.
The services include contraception, exams and screenings, lab tests, and sterilization. Being on the program doesn’t qualify participants for full Medicaid coverage, just the family planning services.
Currently, uninsured women and men can be eligible for the program if their incomes are less than 185 percent of the federal poverty level – although by the time certain income is disregarded under the regulations, the effective eligibility level is at 235 percent, or about $2,188 a month.
When the state’s Medicaid overhaul, called Centennial Care, takes effect next year, the eligibility ceiling will drop to about 138 percent, or about $1,285 monthly. Those whose income is above that would have to find other coverage – through the federal exchange, for example.
“The reality is that not everybody is going to be signed up as of Jan. 1, and therefore there will be gaps in coverage,” health policy consultant Ellen Pinnes said. She told legislators this week that would mean more unintended pregnancies, more abortions, and more people newly eligible for Medicaid – making the agency’s decision “pennywise and pound foolish.”
“It doesn’t make any sense,” agreed Julianna Koob of Planned Parenthood of New Mexico, who estimates the number of people impacted could be closer to 20,000. Even if the glitches in the federal exchange get worked out soon and program participants can find affordable insurance, it’s unrealistic to expect they would all be covered by Jan. 1 – and even a week’s gap in contraception can be “a life-changing circumstance,” Koob said.
The HSD did not immediately respond to questions from the Journal on Thursday about the reasoning behind its decision. HSD’s Medical Assistance Division Director Julie Weinberg told the Legislative Health and Human Services Committee on Wednesday there were other sources of contraception, such as clinics, and that the Medicaid program “can’t be all things for all people.”
“We’re encouraging them to go to the exchange and get their care,” Weinberg said.