The federal government recognizes that changes to a program so vital to the economic and physical health of our state cannot be made behind closed doors. Why hasn’t our state?
Did you know the next time you go to the emergency room worried that a bad cold might be a super flu, you could be charged $50? Even if the nearest doctor’s office is 50 miles away?
Did you know that Native Americans may soon be prevented from getting health care services from a preferred doctor and instead be required to enroll in a managed care network?
These are the types of major changes that the state plans for its Medicaid program that serves more than half a million low-income New Mexicans.
If you haven’t heard about the changes, you’re not alone – the state hasn’t mentioned anything to the public about them for almost a year now. It’s a surprising move from Gov. Susana Martinez’s administration, which prides itself on transparency and open government.
In fact, the administration just managed to avoid federal rules that would have required more transparency. The state plans to overhaul Medicaid in ways that are not currently allowed under federal law, so the state must get approval by the federal government to waive current laws.
Avoiding new transparency rules
New federal rules just went into effect on April 27 that require all states to have public hearings and provide real opportunities for input before submitting these “waiver” applications. New Mexico avoided these rules by sending its application on April 25, two days before the new rules went into effect and in spite of promises made by the state’s Human Services Department to comply with the spirit of the new regulations.
Nobody saw this final application before it was submitted – not legislators, not health care providers and certainly not the public. Even the Medicaid Advisory Committee, a federally created stakeholder group that is supposed to be consulted on these very issues, didn’t see the final proposal.
The last time the Human Services Department sought input on its proposals was last summer. They held six public meetings around the state where they presented some rough ideas about their plans and led a scripted question-and-answer period. Unfortunately, the meetings were held in the middle of the day, making it difficult for most people with day jobs to attend.
HSD then held four workgroups with experts and then presented a rough draft of the waiver application to the same audience of experts and legislators at two invitation-only meetings. Since no public meetings were held, most of the half-million Medicaid recipients and most of the rest of the public didn’t know what the state was planning.
Entitled to know
They are entitled to know. Some of the plans will seriously affect both patients and health care providers. For example, the state is planning to charge fees to people who go to the emergency room that are later found not to have had a true emergency. The state also wants to end the practice of paying three months of past medical bills for new Medicaid recipients, even though they were eligible when they incurred the bills and even though it will lead to more medical debt, burdening doctors and hospitals with the unpaid bills.
The state also wants to require all Native Americans to use managed care despite vocal opposition from many tribal leaders and a troubled history with managed care in the past.
Because the state didn’t ask, they don’t know what the public thinks about these significant and now final decisions. Major policy changes to the Medicaid program are precisely the kind of information that should be shared with the public.
Medicaid provides health insurance to one out of every four New Mexicans, bringing in between $6.3 billion and $8.7 billion in new federal money to the state economy. Medicaid sustains 60,000 jobs in New Mexico and makes up 16 percent of the state budget. This is precisely the sort of issue Martinez should publicize.
The federal government recognizes that changes to a program so vital to the economic and physical health of our state cannot be made behind closed doors. Why hasn’t our state?
Robinson is a staff attorney for the N.M. Center on Law and Poverty.