Medicaid buy-in

Initiative would help narrow coverage gap, but price tag could be obstacle in Legislature

New Mexico legislators consider the sale of state insurance plans to help close the gap in coverage. Price could be an obstacle.

As many as 20,000 New Mexicans may sign up within a year if the state allows the sale of some sort of Medicaid health insurance plans to people who do not currently qualify for the program.

A new legislative study has found that allowing New Mexicans to buy into Medicaid could help close a gap in coverage for patients who make too much to sign up for the program but too little to afford other insurance.

It remains unclear exactly how much such an initiative would cost, though early estimates suggest tens of millions of dollars. And it is likely to meet with opposition from some health care providers who argue they are already paid too little to care for patients insured under Medicaid.

Still, the idea of a Medicaid buy-in initiative has gained support in recent years — culminating in a study that suggested a narrow iteration of such a policy could reach thousands caught in what is often a tough no-man’s-land of health insurance.

Gov. Susana Martinez expanded access to Medicaid under the Affordable Care Act, and it now includes more than 800,000 people. But New Mexicans are not eligible if they earn over 138 percent of the federal poverty level. For example, a family of four earning roughly $34,600 would not be eligible.

Coverage remains unaffordable for many on limited incomes, and some in that group also aren’t eligible for federal subsidies to buy insurance.

The study, approved earlier this year by Democrats and some Republicans in the Legislature, found 88 percent of uninsured New Mexicans in 2017 earned less than four times the federal poverty level.

Prepared by the consulting firm Manatt, the study laid out four different options for a Medicaid buy-in program.

Under a basic option, the state would offer a Medicaid-like insurance plan to New Mexicans who are not eligible for the program, for Medicare or for subsidized health insurance coverage. The state would help cover costs for patients earning less than 400 percent of the federal poverty level.

The study suggested that by drawing on the purchasing power and provider network of the Medicaid program, a buy-in plan would prove more affordable than private coverage.

Lawmakers may be wary of the price tag to the state while any such program is unlikely to satisfy proponents of expanding Medicare to everyone.

The study suggested other options, too, including letting anyone buy a Medicaid plan.

“We think all of these options are viable for New Mexico to consider,” said Chiquita BrooksLaSure, managing director at Manatt Health.

But, she added, the state also needs to gather more data.

Proponents, such as the New Mexico Center on Law and Poverty, are expected to support some sort of legislation setting up the narrower option laid out in the study while also pushing to continue research on the issue.

If approved, buy-in plans would not be available at least until 2020.