Affordable Care Act

New SCOTUS conservative bloc could overturn ACA, with big impacts on NM

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If the U.S. Supreme Court overturns the Affordable Care Act during the 2020-2021 judicial term, the result for New Mexicans could be catastrophic, according to various officials and experts. The Supreme Court is scheduled to hear California v. Texas on November 10. If Judge Amy Coney Barrett is confirmed by the U.S. Senate on Monday, as is expected, this will be among the first cases she will hear as a Supreme Court justice. If she is confirmed, she will create a new 6-3 conservative bloc on the court bench which could lead to a ruling that the entire ACA is unconstitutional. If this happens, 20 million Americans could lose health insurance coverage, according to a report by the Urban Institute, a Washington, D.C.-based think tank.

Aging and Long-term Services Division

Guv optimistic, but still cautious, as COVID-19 number improve

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Gov. Michelle Lujan Grisham and state officials had good news for New Mexicans when it came to COVID-19 during her Thursday press conference. 

The number of cases, after reaching a peak in mid-July, have dropped down in the past couple of weeks through much of the state. The positivity rate on tests has also dropped, even as the number of tests remains high in the state. But Lujan Grisham noted that there is a long road ahead, and it’s not an invitation for New Mexicans to abandon COVID-safe practices. She warned the state is not “out of the woods” yet, even as things trend in the right direction. Because of this, and other efforts, Lujan Grisham and Aging and Long-term Services Secretary Katrina Hotrum-Lopez announced that limited nursing home visitation would be allowed.

coronavirus

Health officials: Data shows masks, social distancing works

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State Human Services Department Secretary Dr. David Scrase offered some data supporting the use of masks and social distancing to help slow the spread of COVID-19. 

The use of face masks in public has become a polarizing topic among some communities as the state has loosened its restrictions on businesses, including closures, over the last week. 

While cloth masks aren’t suitable for use in healthcare settings, Scrase said they are still useful at preventing the spread of the illness among the general public. A review published in May that analyzed 21 studies found that mask use provided a “significant protective effect,” and reduced the risk of infection significantly, ranging from 80 percent among healthcare workers to 47 percent among the general public.  

Research has found cloth masks are not as effective at preventing infection as other types of masks. A separate review that focused specifically on cloth masks recommended policymakers standardize cloth mask materials to ensure the fabric offers high filtration of particles. Another study found that adding a nylon stocking outer layer to cloth face masks increased particle filtration, and brought some mask filtration efficiency above that of the 3M surgical masks. 

The World Health Organization recommends that masks be worn tight against the face to minimize gaps, stretching across the nose and below the chin. One study found that face masks are more effective at reducing transmission of viruses that transmit easily among asymptomatic individuals.

Childcare Assistance Program

Childcare workers with COVID-19 can get state-funded insurance

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The state announced that uninsured childcare workers who test positive for COVID-19 will be able to enroll in a state insurance plan during the public health emergency. Uninsured early childcare workers and their families will be able to enroll in New Mexico Medical Insurance Pool (NMMIP), the state’s high-risk pool, during the public health emergency if they or their family members test positive to COVID-19, a type of coronavirus. The state will pay the premiums, according to the statement. Under emergency rules issued by the Superintendent of Insurance, deductibles and copayments are also waived for treatment of COVID-19, influenza and pneumonia through NMMIP. This new rule will apply to all childcare workers and their immediate family members who test positive regardless of income or immigration status, Gov. Michelle Lujan Grisham said in the statement.

Quick Reads

Legislative roundup, Feb. 12, 2019

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Days remaining in session: 33

Prison profits: Gov. Michelle Lujan Grisham’s inaugural committee says it will give a donation from the private prison company Geo Group to charity. The Florida-based firm runs several prisons in New Mexico and has contributed to politicians on both sides of the aisle. According to financial disclosures Lujan Grisham’s inaugural committee published last week, Geo Group donated $2,500 to the Democratic governor’s inaugural festivities. Democratic politicians have faced awkward questions about financial contributions from the private prison industry amid outrage over the federal government’s zero-tolerance policy toward undocumented migrants. Companies like Geo Group have stood to gain from the federal policy.

2018 Legislative Session

Some Martinez vetoes get pushback

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Some vetoes by Gov. Susana Martinez are raising eyebrows among legislators and others—and at least one partial veto may be challenged in court. Wednesday was the final day for Martinez to decide whether or not to sign bills from this year’s legislative session. She signed 80 bills into law, but vetoed 31 others. Some she rejected using her veto pen, while with others she just allowed time to run out in what is called a “pocket veto.”

One portion of a bill that may see a new life was part of the crime omnibus bill the Legislature passed in response to the spike in crime, particularly in Albuquerque. The bill combined a number of ideas aimed at reducing crimes.

Behavioral Health

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

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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.

Behavioral Health

The slow-motion unraveling of New Mexico’s Medicaid crackdown

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There’s no getting around it. Four years after Gov. Susana Martinez’s administration charged 15 behavioral health organizations with potentially defrauding the state’s Medicaid program, its case has experienced a slow-motion unraveling. No Medicaid fraud was ever found. And those eye-popping estimates that added up to $36 million the organizations had overbilled Medicaid? In the summer of 2017, the Human Services Department (HSD) is seeking drastically lower reimbursements for overbilling the public health insurance program for low-income residents, a review of public records and state court documents has found.

Brent Earnest

Special master: HSD staff shakeup needed to address SNAP problems

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LAS CRUCES—A year-old scandal involving alleged systemic fraud with the state’s management of federal food aid benefits was the elephant in the federal courtroom Thursday. Both Kenneth Gonzales, a federal district judge, and Lawrence Parker, a court-appointed “special master” who is tasked with guiding the New Mexico Human Service Department (HSD) in its federal compliance with Medicaid and Supplemental Nutrition Assistance Program benefits, alluded to the scandal at the hearing. “What nobody wants to see, and you especially, is a culture that allows this to happen,” Gonzales told HSD Secretary Brent Earnest. Parker emphasized that “many of those same people” who were alleged in 2016 to have instructed HSD employees to falsify SNAP applications to meet federal quotas “are still in place” at the department.[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]No ads. No clickbait.

Easter Seals El Mirador

NM settles $2.8M Medicaid overpayment claim for $485

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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.