House passes food stamp supplement unanimously

By Matthew Reichbach

The House of Representatives passed a bill unanimously that would take advantage of federal funds to shore up food stamp benefits as well as putting the rest of the federal stimulus funds towards Medicaid before the money reverts back to the federal government. The bill would provide $450,000 in funding for food stamp additions for elderly and disabled New Mexicans.

Rep. Dennis Roch (R-Tucumcari) said that his legislation, HB 18, needed to pass soon because the money would revert back to the federal government at the end of September.

“This cannot wait until January,” Roch told the House Appropriations and Finance Committee earlier Friday. “It absolutely cannot.”

The non-controversial bill cleared two committees before the House passed the legislation on Friday.

In addition to making sure that over $6 million in Medicaid funding does not revert to the federal government, the supplement makes sure that elderly and disabled New Mexicans receive at least $25 in Supplemental Nutrition Assistance Program (SNAP) funding, even if the amount of federal funding dips down to $16.

This will fund the program through the next three quarters.

Some of the money in the fund could be general funds that were in there to match with the federal funds before it reverted back to the federal government, Roch said on the House floor.

House Majority Leader Ken Martinez (D-Grants) expressed concern over using one-time money, in this case federal stimulus funds, to cover a recurring expense.

Gov. Susana Martinez used federal stimulus funds to keep the program going in June. Otherwise, the program was set to end by July 1.

The bill now heads to the Senate, where it must pass before Martinez can sign the legislation.

Odds and Ends

The House and Senate also both passed Public Education Committee redistricting legislation. The committee has the power over approving charter schools.

Health insurance reform may benefit New Mexico economically

By Matthew Reichbach

The Medicaid expansion through the health care reform law will more than pay for itself in New Mexico according to analysts from New Mexico Voices for Children. Bill Jordan, Policy Director for New Mexico Voices for Children, and Kelly O’Donnell, an economist, gave a presentation to the Revenue Stabilization and Tax Policy interim committee Friday in Albuquerque explaining how New Mexico’s tax structure lends itself to taking advantage of the Patient Protection and Affordable Care Act (PPACA).

The two were questioned by the committee on how the tax structure would help and whether or not the health care act would actually help lower income residents receive health insurance.

There are two main revenue streams from the federal government that New Mexico will benefit from according to Jordan. One is the money coming in directly from Medicaid. The other money is the money that would come in the form of tax breaks for health insurance for low-income individuals.

“Those are the two main streams of funds and ways that people will get insurance,” Jordan told Clearly New Mexico following the hearing. “Both of those, Medicaid and the private insurance that is bought on the health care exchange, are taxed already and will be taxed with a 4 percent health insurance premium tax. And that plus our gross receipts tax and other minor taxes, like personal income tax, will generate enough tax revenue that we’ll have more than enough money to pay for our share of the Medicaid expansion that’s coming.”

HSD, advocacy groups at odds over Medicaid’s future

The hearing comes after the state’s Human Services Department has said a redesign of Medicaid is necessary because it is unsustainable as it is currently run. Many more people will be eligible for Medicaid in 2014 because of the PPACA. The federal government will cover the vast majority of the costs for the first few years, though this phases out and New Mexico will be on the hook for ten percent of the costs of the new Medicaid enrollees when it is completely phased out.

This summer, HSD Cabinet Secretary Sedonie Squire rejected a call for a public Medicaid Redesign Task Force. The call came from advocacy organizations, including New Mexico Voices for Children, which were not happy about the secrecy of the Medicaid redesign.

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It’s Official: Gov. Martinez Wants Full Repeal of Federal Health Care Reform

By Charlotte Chinana

“The first step for a successful Medicaid transformation is the full repeal of the Patient Protection and Affordable Care Act.”

– An excerpt from a letter signed by 29 Republican Governors – including New Mexico’s
Susana Martinez – outlining seven principles for Medicaid Reform.

A day before the Health and Human Services Interim Committee met and heard from the NM’s Human Services Department (HSD), about their plans to redesign the state’s Medicaid program, Gov. Martinez joined several of her colleagues in signing on to a letter calling for the “full repeal” of the Federal Health Reform Act (otherwise known as the “Patient Protection and Affordable Care Act” – or PPACA).

The repeal-support letter, written as a response to a report released in March, by Senate Finance Committee Ranking Member Orrin Hatch (R-UT), and House Energy and Commerce Committee Chairman Fred Upton (R-MI), reiterates the claims made regarding costs that the states would assume, by expanding Medicaid under PPACA.

According to the Hatch-Upton report, it “conservatively estimates” that the PPACA Medicaid expansion would “cost state taxpayers at least $118.04 billion through 2023” – and provided state-by-state projections.

The report and its findings, however, were subsequently challenged by the Center on Budget and Policy Priorities, on the grounds that the report is “wholly unsound”:

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Legislators Raise Questions about Medicaid Redesign Plan

By Charlotte Chinana

“Is the ultimate goal to remove people from the rolls to save money?” asked Sen. Nancy Rodriguez. “Is there concern that there are ‘too many’ people enrolled [in the Medicaid program]?”

“No.” replied Sidoine Squier, Secretary of the Human Services Department (HSD).”We’re not ‘going after’ the Medicaid program.” added Squier, hoping to alleviate concerns regarding the intent behind the State’s Medicaid overhaul plans. “We’re looking at ‘making it work’ for recipients.”

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Aside from stressing that the department’s overall objective is to “ensure that people in the state get quality care,” representatives from the HSD were on hand Tuesday afternoon, for the Health and Human Services (HHS) Interim Committee meeting, to answer questions about the “Medicaid Modernization Plan,” and/or reiterate the ‘four principles’ of the department’s redesign, which include:

  • Incorporating all Medicaid services into a “second generation” of care better tailored to meet the needs of New Mexico’s vulnerable population, while offering a full spectrum of benefits from newborns to nursing care;
  • Increasing personal responsibility by implementing sliding scale co-pays for some high-cost services, and pursing financial incentives to reward healthy behavior;
  • Instituting pay for performance targets that move us toward paying for health care outcomes, rather than quantity of services provided; and
  • Increasing administrative efficiencies by combining all our waivers into a single waiver so we can manage the program – rather than the waivers.

As to be expected, for every question answered, several more emerged:

– While members of the HHS committee generally agreed that we should pay for outcomes, various legislators raised some pretty good questions about the proposed “financial incentives” – specifically, what would be incentivized, how it would be reported, and to whom.

– A handful of legislators also inquired as to why the department was essentially proposing concepts for “accountable care outcomes” that were outlined in a bill that was pocket vetoed by the Governor earlier this year (HB34).

“All that bill talks about, is exactly what you’re talking about,” said Sen. Jerry Ortiz y Pino. “If the Governor’s problem with that bill was that ‘it’s not sustainable’ – what is the administration’s definition of sustainable?”

– Members of the committee also asked what the “single waiver” proposed by the HSD would look like – specifically, what parts of the state’s Medicaid program would the department want the federal government to waive?

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Medicaid redesign underway without public input; Nearly 1 in 4 New Mexicans affected

By Charlotte Chinana

“A complete redesign of Medicaid has far-reaching implications and the legislature will have many questions, especially the members of the Health and Human Services Interim Committee which is charged with oversight of the NM Medicaid program.”

~ Sen. Dede Feldman, Chair of the Health and Human Services Interim Committee,
in a letter to Sidonie Squier, Secretary of the NM Human Services Department.

While Congress is currently considering various budget proposals that would affect Medicaid spending across the country, New Mexico’s Human Services Department (HSD) is attempting to address the combination of “increased enrollment and decreased funding,” by redesigning the state’s Medicaid program.

In this latest round of “selective transparency in governing,” the people, once again, find themselves in the un-coveted position of “distant afterthought”; and as one might deduce from Sen. Feldman’s quote, the Medicaid overhaul process has – thus far – also failed to include involvement from the state’s legislative branch.

To quickly recap the HSD’s redesign time-line so far:

According to the HSD, the department also hopes to finalize its redesign plans by early fall, so that it can begin the actual overhaul process, during the subsequent 18-to-24 months. Continue reading

Medic(aid) no longer?: A look at what Medicaid cuts will mean for NM’s American Indian population

A Clearly Guest post by Anthony Fleg of Native Health Initiative

As American Indian Day is celebrated at the New Mexico Legislature on Friday, there is much to worry about amongst Tribal health leaders who fear drastic cuts in Medicaid will cripple an already under-funded health infrastructure. Navajo Nation President Joe Shirley recently wrote to the State’s Medical Assistance Division (MAD) expressing his Tribe’s opposition to cuts in Tribal health, with Pueblo and Apache leaders voicing concerns as well.

By the statistics, requests from Shirley and other leaders make sense. American Indians continue to live sicker and die younger than other New Mexicans, a trend replicated throughout the United States. 2008 data from the NM Department of Health shows that this population fares the worst amongst NM racial/ethnic groups in 9 of the 20 health indicators measured, including homicide, motor vehicle deaths, and youth obesity. American Indians in our state are three times more likely to die from diabetes and alcohol than the best performing groups in these areas.

Dr. Kristine Suozzi, Coordinator of the New Mexico Health Equity Working Group points out, “We simply cannot take healthcare away from the most vulnerable. It is in all of our best interest to provide healthcare services to the level of the need for those services in our state. Suozzi points to a recent letter by UNM economists to Governor Richardson, a warning that cutting income and services to those who need them will have a spiraling downward effect on our overall economy.

The funding of health care for American Indians continues to lag far behind the national average, roughly 1/3 of that spent per-capita by those with private insurance, and ½ of that spent on prisoners. While the Indian Health Service (IHS) provides much of the funds for on-reservation care, 17% of the IHS budget comes from third-party payers such as Medicaid. The majority of the Native population does not live on reservations, and for this group, Medicaid becomes an even larger source of healthcare coverage. In all, almost half of our state’s American Indians (43%) are on Medicaid, and 66% of this group are children.

Last September, when the MAD announced impending cuts to Medicaid, Tribal leaders and advocates, along with Medicaid supporters such as the New Mexico Center on Law and Poverty (NMCLP) began to strategize how to minimize these cuts, and more importantly, minimize the impact that such cuts would have on the vulnerable populations they serve.

Sireesha Manne, a lawyer with the NMCLP remarks, “With the $4 to $1 match in federal funding, it would be fiscally irresponsible to forego funds that are critical to our economic recovery and thousands of jobs in the healthcare sector.”

Manne is equally unimpressed with proposals to restructure Medicaid benefits.”We’re looking at devastating cuts to healthcare coverage for people living in poverty. This will make the difference of whether a family member with a disability can continue to receive services at home, or whether a child can see the eye doctor or dentist.”

One proposal, introduced in House and Senate Joint Memorials by Ray Begaye and John Pinto, respectively this Tuesday, requests the development of a program to establish Native Americans in a separate category of Medicaid eligibility with its own benefits package.

The bill invokes legal arguments, pointing out that under New Mexico’s State-Tribal Collaboration Act signed into law last year by Gov. Bill Richardson, Tribes must be given information regarding redesigns of programs such as Medicaid so that Tribal leaders an opportunity to give “important systemic input into the redesign.”

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It’s Happening

We wrote last month about the specter of cuts to some of the state’s sickest and most needy.

Well, it’s happening, right now.

The Albuquerque Journal reported today that the state Department of Health will cut $9 million in Medicaid spending for people with developmental disabilities – a program that serves 4,000 and has a waiting list of 4,700.

The paper reports that clients who actually do receive services from the state will be asked to “reprioritize” their annual allocation for therapy and other medical services. People who are on the waiting lists will simply stay on them…maybe forever.

From the Journal story:

Maureen Sanders, an attorney for the advocacy group for the developmentally disabled, The Arc of New Mexico, said cuts would be problematic for people in the program.
“While I have not had an opportunity to look at the specifics, the approach at first blush seems to try to address the budget crisis at the expense of some of our most vulnerable individuals in the community,” Sanders said.

It’s the nightmare scenario that advocates have feared  – and it’s only going to get worse when the state Legislature meets later this month to discuss the state financial picture for 2011. There will be hundreds of millions to make up…and many legislators are talking about doing it by further cutting services to the poor and sick.

It’s already starting to sound like a broken record, but when the legislature convenes, please join us in asking legislators to consider pulling back tax cuts and raising revenues instead of slashing services.