Center on Law and Poverty comments on Centennial Care

Medicaid “Centennial Care” Waiver:

 Oppose Proposals that Harm Low-Income Families

Please join us in asking the Human Services Department to make the following changes to New Mexico’s waiver application before they resubmit it to the federal government:

1.      Do Not Eliminate “Retroactive Coverage”

·         The state is seeking waiver authority to stop paying healthcare providers for certain medical bills. Currently Medicaid has a feature called “retroactive eligibility” where children and adults who are enrolled in Medicaid can get their medical bills reimbursed for the three months before they were officially enrolled in the program. This ensures that low-income families are not sent to collections for unpaid medical bills.

·         Eliminating retroactive coverage will send families into debt. Families should not have to choose between seeking urgent medical care for their children or face financial ruin.

·         Hospitals and Indian health providers will face the loss of hundreds of millions of dollars of revenue statewide and bear the costs of unpaid patient debt.

·         The state’s assumption that retroactive eligibility will not be needed as of January 2014 because everyone will have health coverage is incorrect. Native Americans and very low income people are exempt from healthcare reform’s mandate to get coverage and may not enroll right away. Many of them will have medical debt when they seek coverage.

·         This proposal fails to satisfy the legal requirements for Section 1115 waivers. It is contrary to the objective of the Medicaid Act to serve the best interests of recipients and to assist people whose income and resources are insufficient to meet the costs of healthcare. The proposal also fails to meet the research or demonstration requirements of a Section 1115 waiver. HSD has not evaluated the impact of the proposal on Medicaid recipients, and therefore cannot show that it is an innovative way to improve care. At least one federal appellate court has also ruled that merely saving costs does not meet the purpose of these waivers. See Newton Nations v. Betlach, 9^th Cir. (2011).

2.      Do Not Add Co-pays and Fees for Emergency Rooms

·         The state plans to charge co-pays to Medicaid patients for using an emergency room when they are found to not actually have emergencies.

·         Individuals who go to the ER often believe they have emergencies, and should not be deterred from accessing care for fear of having to pay fees that they cannot afford.

·         While the state is proposing not to charge Native Americans co-pays when using Indian Health providers, the waiver application does not clearly address whether co-pays will be charged to Native Americans who must seek care at hospitals outside of this system.

·         This proposal fails to promote the objectives of the Medicaid Act and does not meet the research or demonstration requirements of a Section 1115 waiver.  Over 35 years of research has already demonstrated that cost sharing and co-pays cause people to delay or forsake access to necessary care.

·         NM’s proposal will likely violate federal law which requires that before an individual can be charged co-pays, a provider must inform the individual of the name and location of an “actually available and accessible alternative sources of non-emergency, outpatient services” that charge only a nominal copayment. See 42 U.S.C. 1396o-1(e). These alternatives are not available in our state’s rural and frontier areas.

3.      Consult with Tribal Leadership and Indian Health Providers about Managed Care for Native Americans.

• State and federal law require the state to consult and collaborate with tribes and Indian health providers on Medicaid policies that directly affect Native Americans. These laws include New Mexico’s State Tribal Collaboration Act, the American Recovery and Reinvestment Act (ARRA), Executive Order 13175, and federal guidance from CMS.
• Throughout the waiver process, Native American representatives and tribal leadership have expressed almost uniform opposition to mandatory managed care and have objected to the elimination of the fee-for-service option, citing negative experiences with managed care dating before the implementation of CoLTS in 2008. Waitlists for services remain in the thousands, and outreach and education about the program in rural areas has been insufficient and ineffective. There are also concerns that people will not have access to providers in their area and will have to travel far to get services.

4.      Use This Opportunity to Make Positive Changes for Children and Families.

·         New Mexico still has not simplified the enrollment process by adopting proposals such as “express lane” enrollment where the Medicaid agency could find children who use programs such as SNAP (food stamps) or IHS and easily enroll them into Medicaid. This would help reduce major disparities in enrollment – 90% of the children in New Mexico who are eligible for Medicaid but still not enrolled are Native American or Latina/o.

·         The state should ask for a waiver to adopt “continuous eligibility” for adults. This would allow adults to stay on Medicaid for one year without having to reprove their eligibility each time their family’s income changes over the year. This is especially important for temporary, contract, and seasonal workers so they can have continuous coverage. The state already has continuous eligibility for children. And while the administration says it is considering the option for adults, it was not included in the last waiver application.

                                                                                          

The New Mexico Human Services Department (HSD) will be holding public meetings to seek feedback about the Medicaid waiver application. Information and updates will be available on the HSD website at: http://www.hsd.state.nm.us/Medicaid%20Modernization/index.html