February 13, 2019

State aims to halt Medicaid copays and premiums

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The New Mexico Human Services Department is taking steps to reverse a number of Medicaid policies enacted by former Gov. Susana Martinez that state officials say would create unnecessary financial strain on hundreds of thousands of low-income patients and limit access to medical services and prescription drugs.

Gov. Michelle Lujan Grisham announced Wednesday she has directed the agency to seek approval from the federal Centers for Medicare and Medicaid Services to eliminate $8 copayments for patients receiving nonemergency services at hospital emergency departments or purchasing brand-name drugs, and $10 monthly premiums for about 50,000 adults covered by Medicaid under expanded eligibility rules.

Both cost-share policies for patients in the state’s Medicaid program, called Centennial Care, were set to go into effect March 1. The copays would have effected about 650,000 people, according to a news release issued by Human Services spokeswoman Jodi McGinnis Porter.

The agency sent a letter Tuesday to the Centers for Medicare and Medicaid Services, asking to halt those policies as well as a policy limiting eligibility for retroactive Medicaid benefits, which took effect Jan. 1.

A spokesman for the federal agency said it has received the letter and intends to respond to New Mexico officials.

“Removing barriers to care will really save money in the long run,” state Medicaid Director Nicole Comeaux said in an interview Wednesday. “The goal is really to improve the health of the Medicaid population in New Mexico.”

Human Services Secretary David Scrase said in a statement that “New Mexico sees value in reducing unnecessary use of the health care system and we will work with our hospital partners to examine alternative options for reducing unnecessary emergency department use.

“However,” he said, “we do not believe that co-payments are an effective strategy in driving changes in provider or member behavior.”

The Medicaid cost-share policies of the Martinez administration had failed to consider a shortage of medical providers in New Mexico, Comeaux said, particularly those who serve low-income residents, and didn’t take into account data showing how Medicaid patients actually use medical services in the state.

“I have not seen data that convinced us the [former administration’s] decisions were founded in numbers that we felt like justified the cost that would be inflicted on Medicaid members,” Comeaux said.

The copay policy was unnecessary, she said, because 85 percent of patients are already purchasing generic medications rather than brand-name drugs.

And, she added, a worried parent should not be penalized for taking a sick child to a hospital emergency room at midnight, only to find the illness wasn’t dire.

The $10 monthly insurance premium would have applied to patients with income just above the federal poverty level.

“For an individual who is making just over $1,000 month,” Lujan Grisham said in the news release, “adding a $10 premium for health coverage will likely result in no coverage, eventually creating pent-up demand for services over the long term.”

One policy change announced Wednesday could take several months to have an effect.

In the past, New Mexico’s Medicaid patients had been eligible for three months of retroactive benefits after qualifying for coverage through Centennial Care. In January, however, the eligibility period was shortened to just one month. Retroactive coverage would have been eliminated entirely in 2020.

Comeaux said changing the retroactive coverage period back to three months requires a technical change to the state’s Medicaid system. She could not say when the shortened period would be reversed; however, she said, the 2020 elimination of all retroactive benefits will not take effect if the federal agency approves the change.

In the statement Wednesday, Lujan Grisham said, “I have no intention of implementing policies that put a financial strain on low-income New Mexicans as well as administrative hardship on our health care provider network.”

Comeaux said she had heard from providers who support the policy changes. Her office sees a number of other opportunities to improve Medicaid in the coming months, she added.