Obamacare exchanges in limbo

California’s Obamacare exchange scrubbed its annual rate announcement this week, the latest sign of how the ongoing political drama over the Affordable Care Act is roiling insurance markets nationwide. The exchange, Covered California, might not wrap up negotiations with insurers and announce 2018 premiums for its 1.4 million customers until mid-August — about a month later than usual. Similar scenarios are playing out across the country as state officials and insurers demand clarity on health care rules and funding, with deadlines fast approaching for the start of open enrollment this fall. “It’s insane,” said John Baackes, CEO of L.A. Care Health Plan, which has about 26,000 customers on the California exchange. “Here we are in the middle of July and we don’t even know what rules we will be operating under for open enrollment.

A Moral Choice: As pressure mounts, faith sustains veteran ABQ doctor who performs third-trimester abortions

If Curtis Boyd lives by one professional mantra, it’s this: Unless a woman has full autonomy over her body, she lacks full citizenship and lives instead as a second-class citizen. The controversial and celebrated abortion provider explains this thoughtfully on a hot, dry Fourth of July day in his Albuquerque office. A wiry man of 80 years, Boyd wears a gray surgical gown and says he’s working the holiday because the type of procedure that his clinic, Southwestern Women’s Options, is known for requires multiple days. The clinic sits near I-25 on Lomas Boulevard, a crowded east-west thoroughfare on the edge of downtown Albuquerque. Across the street looms a pink billboard paid for by the group Prolife Across America.

Boyd: Risks grew worse after Roe v. Wade

Though Dr. Curtis Boyd spent five years before Roe v. Wade risking time in jail and his medical license by performing abortions, he says things got worse after the landmark ruling legalizing abortion across the country. At first, he says the anti-abortion movement wasn’t given much credence. But he points to the election of Ronald Reagan and the Republican Party’s embrace of a stance against abortion access as a turning point. During the 1980s, Boyd says protesters often swarmed his car to block his exit from the clinic parking lot. His staff, eyewitnesses to the protests, would call the cops to intervene.

With agreement in hand, behavioral health CEO believed vindication was inevitable

Even in his final days of battling leukemia in early 2016, Jose Frietze was fighting for the youth services agency he founded in 1977. The state Human Services Department had accused the organization — Las Cruces-based Families and Youth Inc. — of potential Medicaid fraud and overbilling by $856,745 in 2013. A stop payment of $1.5 million in Medicaid funding for services already provided crimped FYI’s cash flow, leading to layoffs. And because of the accusations, FYI was forced to hand off part of its business to an Arizona company brought in by Gov. Susana Martinez’s administration. Frietze’s daughters Victoria and Marisa remember how tough the allegations were on Frietze and their family.

Ortiz y Pino

Gov. Martinez chose unnecessary cuts to Medicaid

Most of the attention on the results of the 2017 special session has focused on the dangerously thin margin between revenue and expenditures the governor’s red pencil actions left our State facing for the coming year. Projections at the time were that New Mexico would have less than one half of one percent (each percent of a $6 billion budget is $60 million) as cash reserves available if tax collections dipped or unanticipated critical spending was required. Sen. Jerry Ortiz y Pino is a Democrat who represents the 12th state senate district. But as bad as that situation is, there is another consequence of Governor Susana Martinez’s actions which has left most legislators baffled: her deliberate rejection of at least $120 million in federal Medicaid money that would have flowed into that program if she hadn’t vetoed a sensible, thoroughly-vetted “provider fee” that the Hospital Association had voluntarily put on the table. The hospitals of the state are not nuts.

Feds to look into behavioral health services in NM

The federal government will take a look into New Mexico’s behavioral health services, according to the four Democratic members of the state’s congressional delegation. In a letter last month to Sens. Tom Udall and Martin Heinrich and Reps. Michelle Lujan Grisham and Ben Ray Luján, the federal Department of Health and Human Services Inspector General Daniel Levinson confirmed the upcoming review. “OIG will review the extent to which behavioral health providers are included in the States’ managed care plans and the types of care offered by these providers,” Levinson wrote in the June 28 letter.

State makes ‘shockingly little progress’ in mending SNAP scandal

More than one year after three top state officials refused to answer questions in federal court about fraud allegations and nine months after a federal judge held their cabinet secretary in contempt of court, the state Human Services Department (HSD) appears to still be seriously mishandling how it processes federal benefits to New Mexico’s poor. This includes an apparent department directive instructing caseworkers to limit interviews with those enrolled in and seeking federal benefits and lie to their superiors about it. Now, the advocacy organization representing plaintiffs in a decades-long lawsuit against HSD is asking a judge to impose monetary sanctions on HSD and its secretary, Brent Earnest. The call for sanctions comes over the department’s alleged failures to meet federal guidelines on processing Medicaid and Supplemental Nutrition Assistance Program (SNAP) benefits. Update: Special master: HSD staff shakeup needed to address SNAP problems

Medicaid is the federal health care program for the poor while SNAP, formerly known as food stamps, provides federal food aid to the poor.

NM settles $2.8M Medicaid overpayment claim for $485

As Gilda Radner’s Emily Litella might have said, “Nevermind!”

More than four years after accusing Southwest Counseling Center of overbilling the state by $2.8 million in Medicaid reimbursements, the Human Services Department has settled with the former Las Cruces behavioral health provider for $484.87. SWCC was one of 15 health organizations accused of overbilling and potential fraud by Gov. Susana Martinez’s administration in 2013. The state suspended Medicaid payments to the organizations pending an investigation, and outsourced behavioral health contracts to five Arizona companies, which effectively crippled the network of New Mexico behavioral health providers. All the while, the state kept an audit they used to justify the move secret, making it impossible for each organization to know what they were being accused of specifically. See a timeline and read of coverage of the Medicaid freeze here.

Latest GOP health care draft threatens NM Medicaid

SANTA FE, N.M. — The latest version of the GOP plan to repeal and replace Obamacare is being made available for review just one week before it is to be voted on in the Senate – and it contains drastic implications for Medicaid in New Mexico. Senate Majority Leader Mitch McConnell has enacted rules to bypass committee hearings on the bill, which supporters hope to get signed before the Fourth of July recess. If that happens, people on medical assistance in New Mexico face severe challenges, according to Edwin Park, vice president for health policy with the Center on Budget and Policy Priorities. “The emerging Senate bill, which is largely mirroring the House bill, would scale back the Medicaid program, and then the coverage levels that were even in place pre-Affordable Care Act would be rolled back as well,” Park said. The largest group of New Mexicans to be affected would be children.

Walgreens faces sex discrimination complaint after refusal to fill prescription

Two advocacy organizations filed discrimination complaints against an Albuquerque Walgreens pharmacy for allegedly refusing to fill a birth control prescription. The complaint, sent to the New Mexico Human Rights Bureau, was written by the American Civil Liberties Union of New Mexico and the Southwest Women’s Law Center. The organizations allege a pharmacy employee at a store on Coors Boulevard refused to fill a misoprostol prescription to a teenage woman who was at the store with her mother last August, citing personal reasons. This refusal, according to two complaints, violates the New Mexico Human Rights Act, which bars discrimination based on sex. “Refusing to fill prescriptions that are directly tied to the attributes that make women different from men—i.e. the ability to become pregnant—constitutes sex discrimination,” the complaints read.