New Mexico reverses course on Medicaid charges for patients
SANTA FE, N.M. (AP) — New Mexico reversed course Wednesday on its plans to charge some patients covered by Medicaid a monthly insurance premium of $10 and co-payments of $8 on certain brand-name drugs and visits to the emergency room for routine medical care.
Democratic Gov. Michelle Lujan Grisham announced in a new release that the state will seek federal approval to reverse cost-sharing and enrollment provisions instituted by her Republican predecessor that were designed to conserve state spending on Medicaid.
Lujan Grisham, who took office Jan. 1, said that federally approved cost-sharing measures and changes to Medicaid enrollment procedures threaten to limit access to emergency services and disrupt health coverage for hundreds of thousands of state residents covered by Medicaid insurance for the poor and disabled.
Without a rapid reversal, an $8 co-payment would go into effect March 1 for Medicaid patients who use certain brand-name drugs or visit the emergency room to receive routine medical care. The potential charge applies to about 675,000 people who receive Medicaid coverage in a state of 2.1 million.
Ten-dollar premiums had been scheduled to begin July 1 for about 50,000 adult residents who enrolled under provisions of the state’s 2014 Medicaid expansion.
The state’s Medicaid expansion cut in half the number of residents without health insurance, with the federal government providing 90 percent or more of subsidies.
The new administration also wants to restore retroactive Medicaid coverage that can pay for three months of medical expenses if a patient was eligible for Medicaid immediately before enrollment. On Jan. 1, retroactive eligibility was reduced to one month, and elimination of the provision has been scheduled at the start of 2020.
Patient advocates say the retroactive coverage offered protections against unforeseen medical charges that can bury individuals or family in medical debt — as well as bureaucratic delays in enrollment when medical bills may stack up.
A letter was sent Tuesday to the health care regulators at the federal Centers for Medicare and Medicaid Services that seeks advice on how to roll back the policy changes.
“Lujan Grisham is very concerned about the financial strain that this policy change will have on low-income New Mexicans and an already fragile health care workforce,” wrote Nicole Comeaux, the state Medicaid director.
She said the state does not intend to eliminate retroactive Medicaid coverage next year as previously planned.
Separately on Wednesday, proposed legislation that would expand the state Medicaid program to paying customers received its first committee endorsement.
The measure from Democratic Rep. Deborah Armstrong of Albuquerque aims to create a Medicaid buy-in option for state residents who make too much to qualify for Medicaid coverage or marketplace subsidies under the Affordable Care Act but still may struggle to afford adequate care. Medicare recipients would not be eligible.
Medical insurance companies are concerned that a buy-in system eventually could erode the market for individual health insurance for those without access to subsidies or an employer-sponsored plan.