ABQ Journal Article "State Revenue To Surpass Estimates"

Albuquerque Journal

State Revenue To Surpass Estimates

By Dan Boyd / Journal Staff Writer

SANTA FE - Robust oil prices and production, primarily in southeastern
New Mexico, will propel state revenue levels to come in roughly $250
million higher than expected for the just-completed fiscal year, based
on preliminary figures.
With possible federal budget cuts and other economic concerns looming,
top-ranking state officials and lawmakers say the extra money likely
will be needed.
"This is proof that New Mexico has a very, very volatile revenue base,"
Finance and Administration Secretary Tom Clifford said Tuesday. "This
doesn't remove our need for caution."
The stronger-than-expected revenues mean the state likely will end up
taking in nearly $5.8 billion for the fiscal year that ended June 30, an
increase of roughly 7 percent - or about $380 million - over the
previous year.
However, figures to be released today by the Department of Finance and
Administration show that about $200 million of the $250 million in
higher-than-expected revenue stems from oil and natural gas taxes and
royalties, which tend to fluctuate from year to year.
Oil and natural gas taxes and royalties currently make up about 16
percent of the state's revenue, even more under some calculations.
Rep. Luciano "Lucky" Varela, D-Santa Fe, vice chairman of the
Legislative Finance Committee, said some of the unexpected money could
be used during the 2013 legislative session to fill shortfalls in state
agency budgets.
"It's a good thing that we do have some extra dollars so we can consider
some of those deficiencies and supplementals," Varela said.
He also warned that the state could face federal budget cuts and may
have to spend more money in order to expand its Medicaid program.
In addition, rank-and-file state employees have not received a pay
increase in three years, and Varela said he is concerned not enough
public employees have been hired under Gov. Susana Martinez's
administration.
Bolster reserves
For now, the additional revenue will be used to bolster the state's
reserves, which are on track to end the fiscal year at about $750
million, or more than 13 percent of recurring state spending, according
to DFA.
That money, which was previously expected to total about $500 million,
can be used as a buffer in case of unanticipated expenses or future
revenue fluctuations.
However, even with more dollars than expected flowing into the state's
coffers during the just-completed fiscal year, New Mexico's incoming
revenue still has not returned to pre-recession levels.
The state took in about $6 billion during the 2008 fiscal year before a
severe economic downturn caused revenue levels to drop by more than $1
billion over a two-year period.
Martinez, who pledged to make state government more effective during her
2010 gubernatorial campaign, said the growth of the state's cash
reserves - which sat at about 5 percent of recurring spending two years
ago - is proof of prudent fiscal oversight.
"We remember where this money comes from and New Mexicans should feel
confident that we're using their tax dollars in the most efficient way
possible," Martinez said in a statement.
Legislative and executive branch economists are expected to release new
state revenue estimates next month. Those estimates will include the
just-completed fiscal year, the current year and future years.
While economic recovery has been slow in most of the state, as reflected
in unemployment figures and a weak housing market, the boom in oil
production in southeastern New Mexico has led to a population increase
in that part of the state.
- This article appeared on page A1 of the Albuquerque Journal
http://www.abqjournal.com/main/2012/07/11/news/state-revenue-to-surpass-
estimates.html

KRQE Report "Martinez unsure on Medicaid expansion"

Martinez unsure on Medicaid expansion
Other GOP governors say no to expanding coverage
Updated: Thursday, 12 Jul 2012, 7:56 AM MDT
Published : Thursday, 12 Jul 2012, 7:56 AM MDT

Katie Kim


SANTA FE (KRQE) - Gov. Susana Martinez said she is undecided on whether she will decide to expand Medicaid health insurance coverage to poor people as called for in President Barack Obama's health care overhaul or if she will join other Republican governors in refusing to.

"It is going to be the administration at the end of the day that makes the final decision as to whether or not we are going to expand it and to what level," said Martinez.

The U.S. Supreme Court health care ruling last month said Washington cannot force states to expand Medicaid coverage to adults at 133 percent above the poverty line, or people who make less than $15,000 a year. In New Mexico, officials at the Human Services Department estimate that would make 170,000 more people eligible.

"That is an enormous number of folks," said Martinez. "We don't want to reduce the level of care to someone who is handicapped or disabled and can't work just to bring on a healthy adult and say we're now insuring this individual."

Martinez said many of those people who would be newly eligible may be healthy and covering them under Medicaid could mean cutting benefits for others.

The federal government would cover almost all of the expansion cost in the first few years. But HSD spokesman Matt Kennicott said the state could be on the hook for $350 million to $500 million through the year 2020.

Republican governors in Texas, Wisconsin, Florida, Louisiana and South Carolina have already said they will not expand their Medicaid coverage, according to media reports.

Martinez said she is not ready to go that far yet.

"We're going to find a way to pick and choose what is best for New Mexico based on its population and the needs of this population," said Martinez.

But many Democrats in the legislature claim a full expansion of Medicaid would bring a massive infusion of federal dollars and end up helping everyone.

"The more people that are insured on Medicaid, the less cost that all the other taxpayers in the state of New Mexico will incur because their insurance won't have to pay for all the uninsured," said Sen. Cisco McSorley, D-Albuquerque. "Right now, if you have insurance in the state of New Mexico, you're paying for the uninsured."

Martinez said she has no definite timetable for a decision. The national health insurance program is set to start in 2014.

The U.S. House voted Wednesday for the second time to repeal the health care law. Five Democrats joined Republicans in voting for the repeal.

Pueblo of Jemez reponse to Tribal Consultation on Centennial Care

Tribal Consultation

New Mexico Human Services Department (HSD)

March 20, 2012

Indian Pueblo Cultural Center

The Pueblo of Jemez opposes the NM Medicaid modernization plans as detailed in the Centennial Care concept paper, issued February 21, 2012.

The Centennial Care concept paper is presented under the guise of “ensuring care of New Mexicans for the next 100 years, but its resultant product is to reduce costs by limiting medical services and care coordination to all New Mexicans. Specific to Native Americans, those same limitations are imposed, along with a direct threat by the state to tribal sovereignty and authority. This assessment is based on the following:

1. Threat to Tribal Sovereignty and Authority

PART I: P.L. 93-638 law authorizes tribal nations to contract their shares of health care funds that would have been spent by the IHS on their individual tribal membership. This law authorizes individual tribal nations to then determine and design the best health care system for that tribal population. Most tribes use a series of surveys, health data and expenditure analysis, prevalence data and a number of other health measures to determine the shape and scope of their tribal health system, for which the tribe then conducts financial planning. A part of that financial planning includes 3rd party revenue collection.

NM HSD’s Centennial Care concept paper poses a direct threat to the intent of PL 93-638 and tribal sovereignty in the following ways:

• The State describes a fully MCO run Medicaid system for the state. Although there is a recommendation in the Native Americans section that the MCOs selected by the state be required “to contract with the IHS and or 638 clinics as part of their network…” (27), there is no indication as to the timeframe or the scope of the relationship. Thus, there is no confidence that the tribal health clinics will immediately be made an integral part of the health care of our Medicaid eligible tribal members.
• The Centennial Care paper indicates that when a Medicaid eligible individual applies for Medicaid, he/she must select a health plan (MCO). This means that the individual automatically goes into the MCO “system” because fee for service, which is the practice utilized by tribal health clinics, will no longer be an option.
• The MCO’s will stratify our Medicaid eligible population and conduct care coordination through the MCO’s designated system. Following the state’s plan, our patients, in the interim while the MCO is attempting to develop effective tribal contracts and coordination, will be taken out of our tribal system.
• The Centennial Care paper describes the state’s intent to eliminate the “opt-out” provision for tribes, similar to what has occurred with other MCO’s in the state (CoLTS). Under this scenario, the tribe cannot proceed with its own determined care coordination on behalf of the patient, but must stick with the MCO directed care.

PART II: In 2000, the Indian Health Care Improvement Act was amended to include Public Law 106–417, also called the ‘‘Alaska Native and American Indian Direct Reimbursement Act of 2000’’. This act allows for direct billing of medicare, medicaid, and other third party payors, and to expand the eligibility under such program to tribes and tribal organizations. The ACA of 2010 contained the reauthorization of the Indian Health Care Improvement Act (IHCIA), not only confirming, but also expanding tribal authority to plan and design tribal health systems and to direct bill CMS for reimbursement.

• Under the state plan, the selected MCO’s will stratify our Medicaid eligible population and conduct care coordination from there through the MCO’s designated system.
• Based on the description, it is a very real concern that Indian health programs could find themselves without an ability to collect from any source for services rendered at tribal health clinics for Medicaid eligible patients.
• This would leave the Indian health programs with not only a loss of potential new revenues, but also an actual reduction in revenues from prior levels (where such claims had previously been paid by Medicaid).

• Medicaid makes up approximately 70% of our annual 3rd party revenue.
• The Pueblo of Jemez uses Medicaid as a 3rd party resource to supplement the cost of care for our patients through our tribally designed health system.
• The loss or reduction of this significant resource would negatively affect our tribal health care delivery system either by preventing us from maintaining current service level, which is partially supported by Medicaid reimbursements, or by preventing us from expanding our billable service delivery.
• Such an outcome would be directly counter to the Congressional intent in enacting IHCIA and Public Law 106–417: Alaska Native and American Indian Direct Reimbursement Act of 2000 (Exhibit A).
• Even if a tribe were immediately brought into the MCO via contract, it has been the experience of tribes working with MCO’s in the state that new MCO’s do not pay in a timely manner in the general in the first year of business.
• The state’s plans for a “proliferation of patient centered medical and health homes” (pg. 14) would bring tribes into the care coordination system, but are considered long range plans. The Centennial Paper describes the MCO’s as being initially responsible for basic care coordination and health homes being developed over the next several years.
• The state’s plan is culturally inappropriate to the Native American population of this state.
• Tribal health clinics already offer a “health home” to our tribal members.
• Under the state model, care coordination would begin through an initial phone interview with an MCO employee. This is concerning primarily because technology assessment of the state indicate that the population with the least amount of telephone access are rural New Mexicans, specifically Native Americans.
• Clients will go through a “stratification of risk”, which the Centennial Care paper indicates will be based on “evidence based, best practices”. Tribal data concerning standards of care and improved health outcomes are not included as part of the MCO consideration, though they are part of the tribe’s consideration for care coordination.
• Further, the state’s plan indicates that after the initial phone interview, the client will then be assigned a “risk group care coordinator” who will complete a comprehensive assessment. Based on the description of the need to interview family members and care givers, this interview will require a face to face visit.
• Many of our tribal communities use English as a second language. Communicating health concerns, discussing medical terminology, diagnosis, treatments plans and family dynamics is most effectively done by our tribal clinic based benefits coordinators, not the MCO.
• This is an area that current MCOs have struggled with and which will simply not be attainable under the proposed MCO run Medicaid model.
• In fact, our tribal benefits coordinators are providing the intensive care coordination for the existing MCOs in the state for our tribal members.
• Finally, at the point the MCOs shift the care coordination responsibility to the health home site, the Centennial Care paper does not indicate if and how the MCOs will be required to properly reimburse the tribes for that care coordination service. It appears that moving forward, as it occurs with current MCO relationships, the percentage of the capitation rate that the MCO’s receive for care coordination will not be passed on the entity actually conducting that coordination.
• The Pueblo of Jemez offers both State and Tribal remedies:
• State Remedies
1. Mini-Grants: The Centennial Care paper describes that the state will establish two pilot site projects. One is to develop health homes in pilot sites in Albuquerque, and the other is related to developing bundled rates for hospital stays. This urban location of the first pilot project is out of touch with NM, which is primarily rural.

By the January 2014, the Pueblo of Jemez, like many other tribal health centers will have its own provider network, operating very much along the same lines as a managed care entity.

Therefore, the Pueblo of Jemez proposes that the state issue mini-grants to tribal health entities to establish tribal health homes as pilot sites in the first year of this modernization effort. The tribal health homes would fully participate as partners in the state’s plans for Medicaid modernization, including:

1. Tribal sites will receive IT infrastructure on par with the other pilot sites for access to such things as the Medicaid Management Information System, which the state pays for existing MCOs;
2. Tribal sites will have access to the consolidated credential and re-credentialing processes;
3. Tribal sites will have access to (if desired) the state’s contract Third Party Administrator;
4. Tribal sites will direct bill for Medicaid.
1. The state must retain the “opt out” provision for tribes for all state- MCO relationships.

These first two remedies to alleviate many concerns related to tribal sovereignty, protect direct reimbursements to tribes and ensure culturally appropriate health care delivery.

3. Tribal Participation must be required in the development of the RFP’s for the MCO’s and on the selection committee of the MCO’s.
4. Tribal Subject Matter Experts (SME) must participate in selection or evaluation of proposed evidence based, best practices identified as applicable to Native American populations.
5. There must be equitable tribal representation on the governing board that will provide direction and oversight to the state’s Modernized Medicaid system.
3. Tribal Remedy
1. CMS Tribal Consultation (Exhibit B): Unlike any other population in the State of New Mexico, tribes have the option to work directly with CMS. Specifically, under the CMS Tribal Consultation Policy, signed into effect in November 2011: “…consultation must occur on an ongoing basis so that Indian Tribes have an opportunity to provide meaningful and timely input on issues that may have a substantial direct effect on Indian Tribes.” (page 3) If the State of New Mexico continues, as planned to seek CMS authorization and waivers to implement its Medicaid Modernization as described in the Centennial Care document, the tribes are within their authority to dispute the matter directly to CMS; tribes may request that CMS facilitate mediation between the tribes and the state, and deny any waiver request from the state that diminishes tribal sovereignty or attempts to limit federal law.

Center on Law and Poverty Talking points on Centennial Care

The NM Human Service Department (HSD) is taking public comment at four public hearings.  Will you attend one or more to make your voice be heard?

The state needs to hear these messages:

1.                   While you listened to the public and eliminated most co-pays in your plan (thank you), it still contains some co-pays for when people go to an emergency room but are found not to have emergencies. These fees will discourage people from getting emergency care and penalize people who don’t have access to primary care doctors such as on the evenings or weekends, or in rural areas of the state.   Get rid of these co-pays too.

2.                   Your plan calls for stopping the retroactive coverage that covers medical bills from the 3 months before a person enrolls in Medicaid.  This coverage is very important to low-income people who shouldn’t have to choose between getting urgent medical care or going into debt and collections.  Keep it.

3.                   You are considering adopting 12 month “continuous eligibility” for adults who are enrolled in Medicaid so that they won’t have to worry about losing Medicaid if their employment changes during the year. You should adopt this – it provides important stability for families, especially temporary and contract workers, so they don’t have to keep reapplying for coverage

Letter from Medicaid Coalition asking Governor Martinez to Expand Medicaid

July 11, 2012

The Honorable Governor Martinez
Office of Governor Susana Martinez
490 Old Santa Fe Trail, Rm. 400
Santa Fe, NM 87501

Dear Governor Martinez:

We, the undersigned organizations—representing thousands of New Mexicans—urge you to implement the Medicaid Expansion for low-income adults under the federal Affordable Care Act. We believe it is the right thing to do for New Mexicans and is a win-win situation for New Mexico. Here are just some of the benefits:

• Expanding Access to Health Care. Medicaid Expansion will provide health coverage for well over 100,000 New Mexicans, most of whom are “working poor” adults—they have jobs but no health insurance. When they get any health care, it’s likely to be in the emergency room at great expense. Medicaid coverage will mean these individuals can get check-ups and preventive services, follow-up care for accidents or illnesses, and management of chronic diseases. This is a golden opportunity to reduce New Mexico’s high rate of uninsured and bring us up from the bottom of the national rankings on health coverage. Far beyond statistics, this is literally a matter of life and death for people who otherwise can’t afford insurance or routine health care.

• A Real Bargain for the State. The federal government will pay the entire cost of the expansion for the first three years. The federal share then will gradually phase down to 90% for 2020 and thereafter. The most the state will ever pay is just ten cents on the dollar. Even that minimal portion of the cost will be more than covered by revenues to the state from existing health care taxes generated by the Medicaid Expansion. Additionally, the expansion will save the state $40 to $60 million annually because we’ll no longer have to fund the State Coverage Insurance program.

• New Mexicans Will Get the Benefits of Our Own Tax Dollars. Many other states will choose to expand Medicaid and the costs will be paid mostly by federal dollars. If New Mexico does not expand Medicaid, we will still be paying federal taxes to support other states’ programs without getting the benefits of health care coverage for New Mexicans.
• Fairness. The federal law was written assuming that low-income people could get coverage through Medicaid. They are not eligible for subsidies to buy private insurance. If New Mexico refuses to expand Medicaid, poor families—including parents and people working for low wages—won’t have the means to afford it.

• Economic Stimulus and Jobs. Federal Medicaid funds for the expansion will inject billions into New Mexico’s economy starting in 2014. The economic activity generated by these new federal dollars will create tens of thousands of new jobs in our state, especially in rural areas, and increase revenues to state coffers.

• Reduce Uncompensated Care. New Mexico hospitals and other health care providers furnish an estimated $335 million in uncompensated care every year. When people have health coverage like Medicaid, doctors, hospitals, and other health care providers can count on getting paid for their services. That’s not only good for the providers, but it also reduces the burden on local governments to help cover these costs through their County Indigent Funds, which are paid for by taxpayers.

• Lower Health Insurance Premiums. Uncompensated care also raises insurance premiums for everyone as hospitals and other providers try to recover those costs. A typical New Mexico family with private insurance pays an estimated $2,300 extra each year to cover uncompensated care. Because we have the second highest percentage of uninsured residents in the country, this cost-shifting to insurance premiums is particularly high in New Mexico—and it will continue if we leave people uninsured rather than covering them through the expansion of Medicaid. Businesses that pay for health insurance for their employees will be big losers if the state does not expand Medicaid coverage.

• Health care for Veterans. Half of all uninsured veterans will be eligible for health care coverage under the Affordable Care Act. A refusal to expand Medicaid to low-income adults will leave many of these veterans without access to health care coverage.

For all these reasons we urge you to protect all New Mexicans by implementing the Medicaid Expansion and bringing the federal funds to cover our poorest citizens. We welcome the opportunity to meet with you and/or members of your staff should you have any questions or would like to discuss this further.

Sincerely,

New Mexico Voices for Children

New Mexico Center on Law and Poverty

Health Action New Mexico

Southwest Women’s Law Center

Equality New Mexico Foundation

New Mexico Religious Coalition for Reproductive Choice

Interfaith Workers’ Justice New Mexico

New Mexico Alliance for Retired New Mexicans

CC: Secretary Catherine Torrez

Secretary Sidonie Squier

Members, New Mexico Legislature

David Abby, Director, Legislative Finance Committee

Inter-Tribal Meeting tomorrow

HSD next round of input meetings on Centennial care

Susana Martinez, Governor
Sidonie Squier, Secretary

Media Contact: Matt Kennicott (505) 827-6236 or (505) 819-1402
matt.kennicott@state.nm.us

June 15, 2012
For Immediate Release

New Mexico Human Services Department Announces Public Hearings
Additional Input to be Received at 4 Additional Meetings

Santa Fe – The State of New Mexico Human Services Department (HSD) announced today that it is seeking additional public input and comment on the submission of the Centennial Care 1115 demonstration waiver to the Centers for Medicare & Medicaid Services (CMS).

“With the initial submission of our waiver to CMS, we have seen the opportunity to seek out further input from New Mexicans on our work on Centennial Care,” said Sidonie Squier, Secretary of the Human Services Department. “This input will help us further shape the future of a sustainable Medicaid program to provide services to those most in need while avoiding cuts in the program. It will also help guide our discussions with the federal government as approval of the waiver progresses.”

New Mexico is in the process of modernizing the Medicaid program to ensure its sustainability into the future. New Mexico intends to do that through a request of the 1115 Demonstration Waiver that will result in Centennial Care, which will continue delivering benefits for those most in need, now and into the future, while avoiding cuts. Centennial Care 1115 Demonstration Waiver will result in:

· Maximizing chances of a healthier population
· Purchasing quality care rather than quantity of care
· Slowing the rate of growth of the program costs by maximizing administrative simplicity and focusing on better outcomes, and
· Requiring that plans, providers, recipients and the State all move together to slow the rate of growth of the cost of the program while avoiding cuts, improving quality, and modernizing our Medicaid system.

The State’s full public notice, which describes the Centennial Care Demonstration Waiver proposal in more detail, can be found on the HSD website at http://www.hsd.state.nm.us/Medicaid%20Modernization/index.html.

The State continues to solicit comments on the Centennial Care Demonstration Waiver with several options for interested parties to submit comments.

· E-mail: Medicaid.Comments@state.nm.us
· Phone: 1-855-830-5252
· Regular Mail: Centennial Care comments – Human Services Department P.O. Box 2348, Santa Fe, New Mexico 87504

HSD will hold two public hearings, another Medicaid Advisory Committee (MAC) meeting, and will present before the Legislative Health and Human Services (LHHS) Committee to solicit comments from interested parties on the Centennial Care Demonstration Waiver on:

Date: Monday, June 25, 2012
Time: 1:00 p.m. to 5:00 p.m.
Location: Santa Fe
Legislative Health and Human Services Committee
State Capitol, Room 307 Corner of Old Santa Fe Trail and Paseo de Peralta, Santa Fe, New Mexico

Date: Tuesday, June 26, 2012
Time: 1:30 p.m. to 4:00 p.m.
Location: Albuquerque UNM Continuing Education Building
1634 University Blvd. NE, Auditorium
Albuquerque, New Mexico

Date: Wednesday, June 27, 2012
Time: 10:00 a.m. to 12:30 p.m.
Location: Las Vegas Las Vegas Middle School - Lecture Hall
947 Old National Road
Las Vegas, New Mexico

Date: Monday, July 16, 2012
Time: 1:00 p.m. to 5:00 p.m.
Location: Las Cruces NM Farm & Ranch Heritage Museum
4100 Dripping Springs Road – Ventanas Room
Las Cruces, New Mexico


Webinar and/or teleconference details will be forthcoming, and will be posted on the Centennial Care page of the HSD website at http://www.hsd.state.nm.us as well as the state website at http://www.newmexico.gov/.

If you are an individual with a disability and require an accommodation to participate in the meeting, please call (505) 827-6245 or email Betina.McCracken@state.nm.us as soon as possible.


------------------------------------------
Matt Kennicott
Communications Director | New Mexico Human Services Department | Office of the Secretary
O: (505) 827-6236 | M:(505) 819-1402