Center on Law and Poverty Comments on Resubmitted Centennial Care 1115 Waiver

A Few Quick Comments on the Resubmitted Centennial Care 1115 Waiver
by Quela Robinson From The Center on Law and Poverty


The final 228-page proposal submitted today contains changes which represent important victories for the 550,000 New Mexicans currently enrolled in the program. The state is no longer planning to reduce eligibility for the Working Disabled and Pregnancy Medicaid programs to the bare minimum required by federal law. Instead, the final proposal preserves current eligibility levels so that working disabled individuals under 250% of the federal poverty level (FPL) and pregnant women under 185% FPL can continue to get coverage.  However, eligibility for the Medicaid category that provides Family Planning services will be reduced for people with incomes under 185% FPL to 138% FPL and eligibility for the Breast and Cervical Cancer program will be reduced from 250% FPL to 138% FPL.

HSD will also delay implementation of a proposal to stop paying for the medical bills of individuals who have received healthcare services in the three months prior to becoming officially enrolled in Medicaid. The current policy, known as “retroactive coverage” ensures that healthcare providers are paid for services and it alleviates financial hardship and expensive debt for low-income families. The Department has chosen to eliminate this coverage in July 2014, rather than in January of that year, explaining that Medicaid enrollees will be given an extra six months to seek coverage after healthcare reform takes full effect on January 1, 2014. However, the proposal will still burden many low-income New Mexicans. The Department has no plans to do outreach or address existing barriers in the application process to ensure that every person who qualifies for Medicaid is enrolled in the program. As a result, many individuals will not know they are eligible and will not apply until they need healthcare services and have unpaid medical bills.

Significantly, the state has also included a new proposal to extend twelve month “continuous eligibility” to adults enrolled in Medicaid. This ensures that individuals won’t lose Medicaid if their employment or income changes over the course of one year. This is a major new benefit that will create stable and continuous coverage for hourly, temporary or seasonal workers whose income often fluctuates, or for those who are temporarily unemployed.

Despite these important changes, one of the most controversial proposals from the original waiver application remains. The state intends to move forward with imposing co-pays on Medicaid patients when they visit emergency rooms but turn out not to have had actual emergencies, despite almost uniform opposition from Medicaid recipients, providers and hospitals. These fees will heavily impact patients who cannot get care due to New Mexico’s severe provider shortage. As a result, the proposal will likely fall short of the federal law's requirement that states ensure that there are actually accessible and available alternatives for care before these fees can be charged.

In sum, the final Centennial Care application contains promising new changes that protect Medicaid beneficiaries. However, there continue to be cuts to retroactive coverage and new fees for emergency room use that will impact low-income New Mexicans. It also appears that the state is moving forward with mandating enrollment of Native Americans into managed care, despite firm rejection of this proposal at every tribal consultation. Lastly, the final waiver application makes no mention of whether the state will be taking up the opportunity under healthcare reform to extend Medicaid to every low-income adult under 138% FPL.

The final Medicaid application is available on HSD’s website:http://www.hsd.state.nm.us/Medicaid%20Modernization/index.html