ABQ news article "Medicaid Deal Too Important To Pass Up"

http://www.abqjournal.com/main/2012/10/05/opinion/medicaid-deal-too-important-to-pass-up.html

Medicaid Deal Too Important To Pass Up

By Kelsey McCowan Heilman / Staff Attorney, NM Center on Law and Poverty on Fri, Oct 5, 2012

Gov. Susana Martinez is facing one of the most important choices in the history of our state – whether to take the “Medicaid opportunity,” the chance to extend health care coverage to 170,000 of New Mexico’s uninsured. If she says yes, her decision will reduce poverty and change the economic landscape in New Mexico. If she says no, it will leave tens of thousands of us uninsured and without access to health care.

The Albuquerque Journal recently recognized the importance of the Medicaid opportunity in an editorial urging the governor to say yes. Starting in 2014, Medicaid can be made available to nearly everyone earning less than about $15,000 for a single adult or $32,000 for a family of four. With the Medicaid opportunity, for the first time, almost all New Mexicans living in or near poverty would have access to a stable source of health care. This includes tens of thousands of parents, low-wage workers, the homeless, veterans and the recently jobless who, until now, have had no viable health coverage option.

While policymakers had initial concerns about how much this would cost, New Mexico’s Legislative Finance Committee recently projected that the Medicaid opportunity will actually save the state over $300 million in the next seven years. This is because the federal government pays all of the costs for three years and then continues to pay at least 90 percent of costs in future years. That federal investment will generate new revenues without increasing taxes. The state will receive premium taxes paid by insurance companies, gross receipts taxes levied on federal dollars moving through the health care sector and income taxes generated by the more than 7,000 new jobs the University of New Mexico Bureau of Business and Economic Research estimates will be created with the federal funds.

With that kind of savings, nothing should stop us from moving forward. Anyone who has ever struggled with losing a job, worked for minimum wage or tried to raise a child on a limited income knows what it is like to live with the anxiety of not having health care coverage. And that anxiety is well-founded.

A 2009 Harvard study found that 300 New Mexicans die each year because they are uninsured. Countless more suffer from conditions that go untreated or have medical bills they will never be able to pay off. Medical debt is now the leading cause of bankruptcy nationwide.

Having health insurance means having financial security. It means less time off work from being sick and a more productive workforce. People with coverage have better access to doctors, get more timely care, and have fewer complications that result in serious conditions and even death. Children are also up to three times more likely to see a doctor if their parents see a doctor.

Some are concerned about what happens if the federal government doesn’t hold up its end of the bargain. But federal Medicaid funding is likely to remain stable. Last year, a Kaiser Family Foundation poll found that a majority of Americans oppose making any cuts to Medicaid as a way to reduce the federal deficit. Over two-thirds of Americans want to protect Medicaid when they are told a change could leave more people without access to health care services. Because of this strong public support, compared to other federal funding initiatives, Medicaid funding has a long, reliable history – and it’s likely to stay that way. And refusing federal funds would just result in sending our tax dollars to other states rather than keeping them here.

As New Mexicans, we feel a deep and personal responsibility to contribute to our children, our families and our communities. Last month, an Albuquerque Journal poll found that a majority of New Mexico voters favor making Medicaid available to 170,000 more people. So do numerous policymakers, community leaders, health care providers and advocates who recognize that it is simply the right thing to do. It is time for the governor to take this important step toward securing a healthier and more prosperous future for New Mexico.

From the Medicaid Coalition regarding the elimination of Retroactive "ligibility

Just in case you haven't seen this already, New Jersey's waiver was just approved but their elimination of retroactive eligibility request was not approved, as CMS stated that this would be a maintenance of effort violation. The language is below. We thought that we should let you know given New Mexico's similar request.

xThe elimination retroactive eligibility for most populations would constitute a more restrictive eligibility procedure than those in place on March 23, 2010 and thus would violate the Maintenance ofEffort (MOE) provisions of the Affordable Care Act. The demonstration does not include this authority.

Medicaid Expansion question

 

The following letter was emailed to me from Cynthia Lacounte, I met her at the NICOA conference here in Albuquerque NM, she sat in on my presentation.  After the presentation she offered to ask the following of her supervisors and CMS TTAG Reps.

 

Cynthia LaCounte

Director

Office for American Indian, Alaska Natives and Native Hawaiian Programs

Administration for Community Living

Administration on Aging

 

"Dear Erik,

Cyndi Gillespie has responded to the Medicaid Expansion questions from NICOA below. Please note that she has asked for clarification on your second question.

Does the Expansion of Medicaid first require the Governor’s office to consult Tribes before any action is taken?

The Medicaid and CHIP programs require States to solicit advice from Indian health providers and urban Indian organizations on any changes that have a direct effect on Indians, Indian health programs or urban Indian organizations. In order to comply with this requirement, NM submitted a State Plan amendment outlining a process for seeking advice from I/T/Us. In New Mexico’s State Plan, they also include consulting the federally-recognized tribal governments, as well as the health providers. When the NM tribes and I/T/Us worked with the State on the process, they defined direct effect as those items reducing eligibility, coverage or payment to the I/T/Us. Since the Medicaid expansion would increase eligibility, they would not have to consult or solicit advice for the expansion, although they certainly could choose to do so or tribes could request they do so.

Does the Governor’s office have the authority to make the decision on behalf of NM Sovereign Tribes?

I am not sure what you mean about this question. Medicaid is administered by States because of the Statutory requirements that a single state agency administer the program. Can you clarify the question?

I will be out of my office until October 9, but Cyndi’s contact information is given below. I will be working remotely, however, so I will be available.

Cyndi Gillespie, Technical Director"

 

 

After receiving this response I am unsure where "they" are getting thier information from because it is clear that some tribes where consulted with but not all, and the comments, position, views, of the Tribes weren't really reflected in the "State Plan Amendment"

 

the next portion is from CMS TTAG reps.

 

 

Subject: Questions regarding Medicaid Expansion

Dear John, Richard and Cindy,

I hope this finds you all doing well.

I attended the National Indian Conference on Aging last week in Albuquerque, which is always such an exciting event. I attended a session on Medicaid in New Mexico that was presented by Mr. Erik Lujan who works at the Native American Healthcare Alliance in New Mexico. It was an excellent session, and I was very impressed with Mr. Lujan’s working knowledge of the Medicaid Program.

With the decision that Governor Martinez is facing on whether or not to expand Medicaid statewide, two of the concerns noted for Tribes in New Mexico were:

· Does the Expansion of Medicaid first require the Governor’s office to consult Tribes before any action is taken?
· Does the Governor’s office have the authority to make the decision on behalf of NM Sovereign Tribes?

Please include Mr. Lujan in your response and contact him with any additional questions or for additional information.

Thank you so much for your assistance.

Cynthia

Cynthia LaCounte

Director

Office for American Indian, Alaska Natives and Native Hawaiian Programs

Administration for Community Living

Administration on Aging

 

I have not recieved a response from CMS TTAG to make a comment on.

I have also not received any response from CMS Dallas Region on the first document submitted in August 2012.

AIPC the Leadership institute and NMCLP Medicaid Expansion

THE ALL INDIAN PUEBLO COUNCIL,
THE LEADERSHIP INSTITUTE AND THE
NEW MEXICO CENTER ON LAW AND POVERTY

Invite you to a convening to discuss the

MEDICAID EXPANSION -  What would it mean for Tribal health care services?

October 17th -  9:00am to 1:00pm at the Indian Pueblo Cultural Center, Silver & Turquoise Room

Registration form and agenda will be sent to you next week.

            In the next months Governor Susana Martinez will decide if the State of New Mexico will take advantage of a provision of the Affordable Care Act (ACA) to expand Medicaid services that will provide health care for 170,000 low-income citizens who now have no health care coverage.  Of the 170,000 uncovered persons are approximately 24,000 adult Native people and 13,000 Native children.  The All Indian Pueblo Council, the Leadership Institute and the New Mexico Center on Law and Poverty are convening a discussion to examine the impact of Medicaid Expansion on Native communities.  The convening will be held at the Indian Pueblo Cultural Center on October 17 at 9:00am to 1:00pm.
            Medicaid expansion would strengthen the Indian health care system.  The ACA included the permanent authorization of the Indian Health Care Improvement Act (IHCIA).  It updates payment systems so that Indian health facilities can get reimbursement from private insurance, Medicaid and Medicare without losing other federal appropriations.  The expansion of the Medicaid program in our State would be a real boon to IHS, tribal and off-reservation health care facilities.  Services to our people are often limited by scarce Contract Health Services (CHS) dollars and Medicaid can cover the costs of services that many do not get from clinics and CHS.  Increased Medicaid funds flowing into Indian facilities will also provide a stronger foundation for health care.  The IHCIA requires IHS to expand new programs for behavioral health, prevention and treatment, and authorizes hospice, long term care, and home and community based care, and provides new grant opportunities to expand services, improve primary care, and increase workforces through new funds for recruitment, retention, and training.
            Enrollment of children in Medicaid is not dependent on the expansion of the Medicaid program. However, serious disparities in children’s enrollment can be greatly reduced if their parents become eligible for the program through the Medicaid expansion.  The Medicaid program mandates services that include physician services, hospital services, laboratory and ex-ray services, family planning services and supplies, pregnancy-related services, pediatric and family nurse practitioner services, nurse midwife services, nursing facility services for individuals 21 and older, home health care for person eligible for nursing facility services, transportation services, and medical and surgical services of a dentist.  The program also mandates Early and Periodic Screening and Diagnostic Testing (EPSDT) for individuals under 21 which include screening, preventive and early intervention services and diagnostic services and treatment determined to be necessary to correct or ameliorate children’s acute and chronic physical
and mental health conditions.  The EPSDT is a significant resource for our children and tribal health care efforts to promote children’s healthy development.
            Expansion of Medicaid presents an opportunity for tribal and off-reservation health care facilities to expand and strengthen services to our people.  It is important that all of us understand these opportunities so that tribes and off-reservation communities can build upon the gains that have been made in recent years.  We hope that you will convene with tribal officials and health care workers to examine this important opportunity.  Registration form and agenda will be sent to you next week.


Kim Posich
Executive Director
New Mexico Center on Law and Poverty
505-255-2840
www.nmpovertylaw.org

Medicaid Opportunity FAQ Sheet from Center on Law and Poverty

Request for Documentation from Tribes to CMS

Head Councilman Joe Garcia of Ohkay Owhengeh, former Governor and current Southwest Representative to the National Congress of American Indians (NCAI)  Has requested any and all documentation that your Tribe may have sent to the State of NM, IHS or CMS, regarding Tribal Consulation, Health care reform, Medicaid reform (pre 2010), and Centennial Care (Medicaid post 2010) be collected and cataloged.

He has offered to compose a resolution for AIPC and for NCAI to bring attention to CMS about NM Tribes opposition to Centennial Care and the State of NM lack of "collabotation and Consutlation"

Please send documents to the Blog website nahainformation@gmail.com

News Article SF New Mexican "State still wrestling with Medicaid decision"

This article has the questions that the state has asked of CMS.
http://www.santafenewmexican.com/Local%20News/091412medicaid


State still wrestling with Medicaid decision
Kate Nash | The New Mexican
Posted: Thursday, September 13, 2012 - 9/13/12


The administration of Gov. Susana Martinez, who has yet to decide whether New Mexico will expand Medicaid coverage to more residents under the federal Affordable Care Act, is seeking answers to a list of questions before making the decision.
A letter sent by the state Human Services Department to federal health officials this week says the state has five key questions as it mulls whether to extend coverage to hundreds of thousands in the state.
“The decision on whether or not the state will expand its Medicaid program is one that is significant and that we do not take lightly,” Human Services Secretary Sidonie Squier wrote. “We must thoroughly assess the fiscal implications of Medicaid expansion, and consider them in terms of our ability to maintain current services for those New Mexicans most in need.”
For states that choose to expand Medicaid coverage to adults who live at up to 138 percent of the federal poverty level, the U.S. government would pay the entire bill, starting in 2014. By 2020, the federal share would drop down to 90 percent.
State officials estimate the number of newly eligible residents in New Mexico, where about one in five residents lacks health insurance coverage, is between 130,000 and 175,000.
As the state sorts through its options, it has these questions of U.S. Health and Human Services Secretary Kathleen Sebelius:
• Would New Mexico need to enroll everyone who is newly eligible at once, or could the state phase them in over time?
• For how long will the federal government guarantee the match it is expected to provide for states to help pay for the expansion of the program?
• If the feds provide a lower match, can states then adjust their eligibility requirements for the program?
• Could the state pay premiums for people who enroll in exchange programs instead of in the traditional Medicaid program and still receive federal matching funds? (Exchange programs are new health care plans that will be regulated by states and will be eligible for federal subsidies.)
• Could the state expand eligibility to a lesser level than 138 percent of the federal poverty level?
The department would like to hear back from federal officials in a “timely” manner, but the state hasn’t publicly set a deadline for deciding on Medicaid expansion.
Kennicott said department employees have spent countless hours on the issue. “It’s a constant topic of conversation for us,” he said. “It takes up a good deal of discussion time on any given day.”
The state for years has had among the highest rates of uninsured residents, although new census figures indicate that has eased a bit.
About 22 percent of New Mexicans were without health insurance in 2010, a figure that dropped to 19.6 percent in 2011. The uninsured rate is a problem that both Republican and Democratic officials in the past have worked to reduce.
The Martinez administration has kept its inclinations about whether to expand the program under wraps, although the first-term Republican governor has said she supports the provision that allows for children up to 26 to stay on a parent’s insurance plan and a requirement that pre-existing conditions be covered.
Without knowing more about which way Martinez is leaning, advocates of expansion are left waiting.
Veronica Garcia, executive director of New Mexico Voices for Children, in a statement this week called the expansion “an opportunity that the state simply can’t pass up in good conscience.”
So far, more than half the states have decided against expanding their Medicaid programs or are leaning against doing so, according to a report by MSNBC.com.
Contact Kate Nash at 986-3036 or knash@sfnewmexican.com. Follow her on Twitter at @katenashnm.