Caleb Vaughan

Lawsuit: State, managed care organizations not providing care to ‘most vulnerable’ children

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Disability Rights New Mexico and three families filed a suit against the state and three managed care organizations for allegedly not providing necessary care to medically fragile children. The managed care organizations are New Mexico Blue Cross and Blue Shield, Presbyterian Health Plan and Western Sky Community Care. 

Medicaid is required to provide at-home care to severely disabled children whose ability to live at home is dependent upon trained nursing, the complaint states. Jesse Clifton, a lawyer with Disability Rights New Mexico, said the state has about 400 medically-fragile children, some of whom are not receiving any at-home nursing despite qualifying for it. He said he anticipates more families will join the lawsuit. The state is providing federal funds for that coverage, Clifton and Holly Mell, also a lawyer for Disability Rights New Mexico, told NM Political Report.

COVID-19

As coronavirus spreads, advocates say it shows why paid sick leave is needed

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With the coronavirus continuing to spread, some say the crisis emphasizes the need for paid time off for health emergencies in New Mexico. So far, there are no known positive cases of the coronavirus, also called COVID-19, in New Mexico, according to state Department of Health spokesman David Morgan. Jodi McGinnis Porter, director of communications for the New Mexico Human Services Department, said that as of the end of Sunday, 57 people in New Mexico tested for the virus and all tests were negative. But the state health department said last week that the agency anticipates positive tests at some point. Every state surrounding New Mexico has had at least one test positive case and there are hundreds of confirmed cases nationwide. 

The financial toll of the growing spread of the coronavirus is still not clear, but the Dow Jones dropped 2,000 points Monday and the price of oil dropped to $30.24 a barrel according to MarketWatch.com.

Presbyterian Health Plan

AG sues Presbyterian over millions in alleged unpaid taxes

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New Mexico’s Attorney General says one of the state’s largest healthcare providers committed fraud by deliberately underpaying taxes for over a decade by falsifying Medicaid deductions and credits. Attorney General Hector Balderas filed the claim in state court in Santa Fe Tuesday, alleging that Presbyterian Health Plan, Inc. and Presbyterian Healthcare Services filed claims for tax deductions and credits related to Medicaid for above what the company qualified for between 2001 and 2015.[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The state’s best political coverage. [/perfectpullquote]The suit refers to Presbyterian’s actions as “systemic and deliberate.”

“When insurance providers break the rules, they must face consequences,” Balderas said in a statement released by his office. “My office is working with the State Auditor to make sure that Presbyterian—and any other companies that engaged in similar fraudulent conduct—are held responsible for the serious injuries imposed on New Mexican taxpayers.”

Meanwhile, a separate audit of premium tax collections continues, State Auditor Tim Keller said in a statement. In a statement to NM Political Report, a spokeswoman said Presbyterian is “confident that we have acted in good faith and with the intent to comply with our legal obligations and responsibilities” and said the company “vehemently reject[s] the allegations made today and we look forward to a positive resolution to this matter.”

“We are genuinely alarmed and surprised by the timing and nature of these allegations,” the emailed statement from Communications Manager Melanie Mozes said.

Lobbyist Reports

Lobbyists spent more than $85,000 in first weeks of session

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Members of New Mexico’s citizen Legislature only receive $164 per day for expenses, plus mileage, during the session. But there are other perks to the job. For instance, the industry group called Ski New Mexico last week handed out VIP membership cards to 110 of the 112 state lawmakers, entitling them to two free days of skiing at any of eight ski areas in the state. The total value of the cards was $27,500, according to a lobbyist expense report filed this week by George Brooks, executive director of Ski New Mexico. That expense represented a large portion of the $85,000-plus that lobbyists and the organizations that hire them have reported spending on meals, parties, receptions and gifts for legislators and others so far in the session, which began just over two weeks ago.