Health care advocates rally against Medicaid copayments

Spokesman: Plan would require higher-earning beneficiaries to pay fee

A broad coalition of groups from pediatricians to disability rights advocates is calling on the administration of Gov. Susana Martinez to ditch a proposal for requiring copayments by Medicaid patients.

At a public hearing in Santa Fe on Friday, critics of the proposal argued the fees would serve as a barrier to health care for some of the state’s poorest residents while creating an additional burden for the doctors and other medical professionals who serve them.

The one and only hearing on the topic marked an end to the public comment period on the copayments, which the Human Services Department first proposed in March. And while the department says the move would save about $1 million for the state’s strapped general fund, advocates for patients and health care providers counter that the policy would cost more to administer than it would raise in money for the state.

“Charging more fees isn’t going to save the state any more money,” said Abuko Estrada, a lawyer for the New Mexico Center on Law and Poverty. “The administrative costs are simply too high to justify charging copays.”

Instead, he argued the copays “really just end up amounting to a hidden and regressive tax on our poorest and most

vulnerable New Mexicans.”

Under the proposed rules, some patients enrolled in the state health insurance program would have to pay $5 to visit a doctor, $50 for a hospital stay or outpatient surgery as well as $2 per prescription and $8 per nonpreferred prescription.

Certain Medicaid beneficiaries would be exempt from the copays, which would go into effect Oct. 1. Many Medicaid beneficiaries would be exempt from most of the copays if they live below the poverty line. Native Americans would not have to pay either because of the federal government’s trust responsibilities. People with intellectual disabilities would be exempt, too. And copays would not apply for a range of services, such as family planning, medical care related to pregnancies or nursing home stays.

But Adam Shand, a family liaison for Parents Reaching Out, which serves the families of children who have disabilities, says the various exemptions are not clear enough and would still leave too many people on the hook for copayments that would add up fast.

“They already have so many obstacles against them. They don’t need one more,” said Shand. “By making them pay these copays, you are making them decide between ‘Am I going to eat today or am I going to get health care?’ ”

A spokesman for the governor said Friday that the copays would fall on higher-earning Medicaid beneficiaries.

“Lawmakers explicitly mandated that we seek federal approval for copayments for certain services,” spokesman Joseph Cueto said, referring to the budget passed by legislators in 2016. The budget calls on the Human Services Department to adopt “cost sharing requirements.”

The latest budget, which took effect July 1, does not include any similar language.

Nonetheless, by charging a few dollars to visit the emergency room for nonemergency care, for example, the state would be encouraging better use of the Medicaid system, Cueto argued.

“The Department’s goal is to encourage patients to see their doctor instead of going to the ER for non-emergent situations,” he said.

Calling on the administration to drop the proposal, the New Mexico Center on Law and Poverty submitted a letter signed by 23 other organizations, including the New Mexico Medical Society and the New Mexico Pediatric Society.

The groups argued that the administrative costs of attempting to collect the fees would further strain hospitals, doctors’ offices and clinics, resulting in fewer providers willing to take Medicaid patients.

The letter cites a 2004 study from Oklahoma that found providers collected only 29 percent of the copays owed by Medicaid recipients, “leaving the providers to bear the burden of providing uncompensated care.”

Meanwhile, savings of $1.5 million for the state would lead it to lose $6 million in federal matching funds that would have gone into New Mexico’s health care system, the groups’ letter says.