[Editor's Note: The Beat thanks Grant County Community Health Council Director Cari Lemon for taking notes and providing this information.]

Monday, June 19 at the Besse-Forward Global Resource Center on Western New Mexico University's campus, New Mexico Human Services Department: New Mexico's Medicaid Managed Care Program, “Centennial Care,” held one of four public meetings around the state. The small panel consisted of Centennial Care staff and Dr. Wayne Lindstrom, Director of the Behavioral Health Services Division of the Human Services Department. The purpose of the public meetings is to explain the proposed changes to the new waiver, “Centennial Care 2.0,” and take public input. The department is also accepting written comments. Comments are due by July 15.

 

Currently, Centennial Care has a deficit of 32.9 million going into 2018 Enrollment despite the fact that over 900,000 people of January 2017 – almost half of the population of the entire state – have enrolled since the Affordable Care Act (ACA) was implemented. Medicaid has had a huge impact in reducing those uninsured in NM.

Before Centennial Care, there were multiple health plans that managed Medicaid in the state. Now, health care needs are met by four Management Care Organizations (MCO). Centennial Care operates under a five-year federal “waiver” that will expire at the end of 2018 and must be renewed to continue after that date. The Human Services Department (HSD) has released a concept paper explaining how it plans to change the program when it’s renewed. The “Issues of Concerns” summarizes some of the highlights of the proposal. If you would like to review the full concept paper, it is available on the HSD website at http://www.hsd.state.nm.us/uploads/files/CC%202%200%20Concept%20Paper_FINAL.pdf.

Issues of Concern

* Monthly premiums for people with incomes above the federal poverty level (FPL), which this year is $12,060 for an individual and $24,600 for a household of four. Medicaid doesn’t currently charge premiums (monthly charges for insurance coverage). Proposed amounts are $20/month for people with incomes 101-150% FPL, $30 for 151-200% FPL, and $40 for 201-250% FPL. Experience in other states has shown that even small premiums cause many people to drop off or not to enroll in Medicaid because they can’t afford to pay. Although HSD says premiums would promote personal responsibility and reduce program costs by shifting those costs to recipients, savings to the state will come primarily from people losing coverage because they can’t afford the premium.

* Co-pays when services are received. HSD has already asked for federal approval to add co-pays for many Medicaid recipients, and plans to continue those co-pays in the Centennial Care renewal. Co-pays are problematic because they discourage people from getting the services they need. And HSD's proposal to change to annual calculation of the cap on the amount of co-pays someone has to pay (no more than 5% of income) means that someone who uses services frequently – as many people with disabilities must do – might have to pay a very high percentage of their income in the first few months of the year before the cap on these charges kicks in.

* Fees for missed appointments. The department proposes to let providers charge fees when a recipient misses three or more appointments, but gives few details on how this would work. It appears that even when there’s a good reason the appointment was missed (like the van not picking up a person as scheduled), it would be counted and could subject the person to a penalty. It’s not clear how much the fee would be or what the consequences of not paying it would be.

* Changes to covered benefits. The proposals in the concept paper would:
** Reduce some benefits for adults (although it’s not clear which ones) and eliminate others entirely because they’re not used very much. The department specifically mentions habilitation services as one of the services to be eliminated.
** Drop Early and Periodic Screening, Diagnostic and Treatment (EPSDT) coverage for 19- and 20-year-olds, other than those considered “medically frail.”
** Possibly drop the limited current coverage for dental and vision services for adults and allow people to purchase this coverage by paying an added premium.
** Limit costs of some services in the self-directed community benefit (SDCB) – related goods and services would be capped at $2,000/year, non-medical transportation at $1000, and specialized therapies such as acupuncture, chiropractic, hippo-therapy and massage therapy at $2,000.

* Eliminate retroactive eligibility that covers medical bills for health care services received in the three months before a person applies for Medicaid. It’s a long-standing rule of Medicaid that the program pays for services in the three months before applying for Medicaid – this protects individuals from medical debt and providers from unpaid bills. HSD justifies this change by claiming that it will begin “real-time” approvals of applications this year so retroactive eligibility won’t be needed. However, retroactive coverage is for the three months before the date of application so it doesn’t make any difference how quickly the eligibility determination is made.

* Check income eligibility more frequently than once a year. HSD would review the income of Medicaid enrollees every six months or even quarterly. This would lead to people losing coverage, which interferes with continuity of care and increases “churn” on and off the program as people’s income rises and falls during the year. That means more administrative burden for HSD as people move on and off the program, plus loss of coverage for people who are deterred from reapplying for Medicaid after they’re kicked off.

Positive elements of the proposal

* Automatic renewal of eligibility for “nursing facility level of care” (NFLOC) in some cases. NFLOC is the standard used to determine eligibility for home- and community-based services as well as facility care. We’ve argued to HSD for years that full annual reassessments of NFLOC for persons whose condition won’t change or improve is personally burdensome for the individual and an unnecessary administrative burden for the state. We’re pleased that the department has finally come to see that this change in procedure makes sense.

* Increased focus on social factors that affect health, such as housing, nutrition, etc. There’s little detail on how this would actually work but HSD’s recognition of the importance of addressing these issues is welcome.

* Promoting use of peer support and community health workers.

* Increasing the number of hours of respite for caregivers of kids with special needs, from the current 100 hours per year to 300 hours.

* Providing a one-time $2,000 allowance for start-up goods when a person moves to the self-directed community benefit (SDCB) from the agency-based model (ABCB), to cover things like a computer and printer that are needed to self-direct successfully.

* Improving care for justice-involved individuals by starting care coordination 30 days before the person is released from jail or prison, to ensure a smooth transition to care upon release. Many of these individuals have mental health or other chronic conditions and making sure they have prompt access to services upon release is important.

* Streamlining income eligibility determinations by using information already available to the state rather than putting the full burden on the individual to prove their income. This also will reduce administrative burdens for the state
The Human Services Department is still accepting public comments on their proposed changes to NM Centennial Care (Medicaid). If you were unable to attend a community input meeting with HSD staff, please read the proposed changes on the website and comment.
http://www.hsd.state.nm.us/centennial-care-2-0.aspx or email: HSD-PublicComment@state.nm.us

Highlights of proposal written by Ellen Pinnes and The Disability Coalition. You can contact Ellen atEPinnes@msn.com

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