State agency considering Medicaid copayments

Advocates fear move by Human Services would hurt low-income New Mexicans

The cash-strapped state of New Mexico is hoping to save between $500,000 and $1.5 million per year by imposing copays and fees on certain recipients of Medicaid, the state- and federally funded health insurance program for low-income people.

The Human Services Department is considering charging certain Medicaid beneficiaries $5 for an outpatient office visit, $50 for a hospital stay and $50 for an outpatient surgery.

Some patients also would be charged $2 per trip for medical transportation, $2 per prescription, $8 for nonpreferred prescription drugs and $8 for a nonemergency visit to an emergency room.

Abuko Estrada, staff attorney for the New Mexico Center on Law and Poverty, said the proposed copays and fees amount to a penalty on low-income families, especially those with members suffering from chronic health conditions.

“Copays just amount to a hidden, regressive tax on the poorest New Mexicans,” Estrada said.

Human Services, which is looking to institute the copays and fees by July 1, points to language in the budget that directed the Medicaid program to “include additional cost sharing requirements” on beneficiaries, “including copayments for certain services and monthly premiums for certain individuals.”

Kyler Nerison, a department spokesman, said in an email that copays have existed for years in government health

care programs for children and the working disabled. The proposal levels out copays across those programs, he said, meaning some copays would decrease.

The proposal comes amid a protracted budget crisis on the state level and uncertainty on the federal level concerning Medicaid funding as a Republican Congress works with President Donald Trump to repeal the Affordable Care Act and replace it with a GOP-designed plan.

Gov. Susana Martinez in 2014 expanded Medicaid eligibility under President Barack Obama’s Affordable Care Act. The move sharply decreased the number of uninsured New Mexicans in the state, which accepted tens of thousands of additional adults onto Medicaid rolls under looser eligibility guidelines.

In February 2014, a month after New Mexico expanded Medicaid, 526,097 residents were enrolled in the program, according to Human Services Department data. As of January of this year, 898,976 New Mexicans had enrolled, the data show. That’s more than 40 percent of the state population of roughly 2 million.

The department’s proposal to impose new Medicaid copays and fees applies in most cases to beneficiaries with an income above 100 percent of the federal poverty level. That’s an individual earning more than $12,060 annually or a household of four with an annual income of more than $24,600.

Certain Medicaid beneficiaries would be exempt from the copay increases, such as Native Americans and individuals with intellectual disabilities. Certain types of care, such as prenatal visits, also would be exempt. Native Americans would be exempt because of the federal government’s trust responsibility. Contraceptives and “family planning supplies” are exempt under the state’s proposal.

With the comment period for the proposal closed as of last week, it’s now up to Human Services to review input on the plan and decide whether to move forward. The federal government must also approve the state’s plan.

Estrada, of the New Mexico Center on Law and Poverty, said the new copays and fees would discourage some Medicaid recipients from seeking care.

Asked how he would propose to find savings in Medicaid, Estrada cited improvements to the health care delivery system so it could do a better job of directing patients to the correct providers for their conditions.

But more broadly, he said, the governor should consider tax increases to ensure the program is fully funded.

Nerison, of the Human Services Department, said in an email that the Martinez administration’s reforms to Medicaid, known as Centennial Care, have kept costs under control.

“While health care costs typically grow a few percentage points each year, per member costs in Centennial Care are actually a point lower than a year ago,” he said. “This commonsense and bipartisan copayment initiative will help us continue that success by engaging members and encouraging them to be active participants in their own health care.”