New Mexico residents enrolled in Medicaid may have to cough up more money for their health care costs by the end of the year or early next year under a proposal that aims to offset state spending on the program.

The state Human Services Department is proposing copays and even monthly premiums for patients in the state’s Medicaid program, which provides coverage for low-income people. Patient advocates say the expenses will create a hardship for some of New Mexico’s poorest residents, but officials argue the patient contributions would be a reasonable way to control costs in a health care system that requires a growing share of the state budget.

Under the Human Services Department’s proposal, New Mexicans enrolled in Medicaid who earn more than the federal poverty level would have to pay monthly premiums amounting to about 1 percent of their annual income. And the department would get the flexibility to double that rate over time.

A single patient earning $12,060 a year could end up having to pay as much as $20 a month for the coverage.

Native Americans would be exempt from the premiums, and the department would allow exceptions for the homeless and others in particular hardship.

The proposal also includes copays for Medicaid patients, which the department is planning to institute later this year or in early 2018, despite opposition from some medical professionals who say the relatively small amounts of money would cost more to collect than the fees would raise in revenue.

Under the plan, patients would pay $8 for prescriptions, for example, $5 for outpatient doctor’s office visits and $50 for hospital stays.

At a hearing Wednesday in Albuquerque, Human Services Secretary Brent Earnest told lawmakers on the Legislative Health and Human Services Committee that such fees are common under private insurance. And copays already apply to some patients enrolled in state health insurance programs.

“What we have proposed is a copay and premium structure we believe will drive better use of health care,” Earnest said.

A copay, for example, could discourage patients from visiting an emergency room for an illness or condition that does not require emergency care, he said.

But the National Health Law Project has found that copays do little to address the reasons that patients may be turning to emergency rooms for nonemergency care.

And state Rep. Liz Thomson, a Democrat from Albuquerque, argued the fees would add up quickly for New Mexicans barely living above poverty, particularly when they are regularly refilling prescriptions.

“These are the poorest of the poor. If they could afford private insurance, they wouldn’t have Medicaid,” Thomson said.

New Mexico’s Medicaid rolls have swollen since Gov. Susana Martinez expanded low- or no-cost health insurance in 2014 to cover adults with incomes slightly above the federal poverty level, up to about $16,600.

As of July, more than 250,000 New Mexicans had enrolled in Medicaid under the program expansion.

The future of the program remains uncertain, however, as Republicans in the U.S. Senate push a plan to end the expansion altogether and cut funding for Medicaid programs like New Mexico’s.

Patient advocates raised concerns Wednesday that the state Human Services Department’s proposal, which is all part of a revamped version of the state Medicaid program known as Centennial Care 2.0, will include a broader regime of cuts to services affecting low-income families.

For example, the plan would roll back the range of services available to parents and caregivers of children earning only 45 percent of the federal poverty level.



The plan also would end transitional insurance that covers adults for about a year after they are no longer eligible for Medicaid, such as after receiving a higher income or when dependent children grow older.

And the proposal would end a program that covers bills for the three months before a patient enrolls in Medicaid. About 10,000 New Mexicans requested that service last year, and patient advocates describe it as key to keep hospital bills from piling on top of those who are newly insured.

“Retroactive coverage goes back and ensures families won’t be crushed by medical debt. This is absolutely critical for families,” Abuko Estrada, a lawyer for the New Mexico Center on Law and Poverty, told lawmakers. “I think what you see out of these provisions are cuts that will cause financial hardship.”

Patient advocates have cheered other pieces of the plan.

Advocates for reproductive health favor a part of the proposal that would encourage more health care providers to stock long-acting, reversible contraceptives.

And the plan would promote health literacy, outreach to new parents and better transitions to health care for inmates released from prisons and jails.

The plan would cover the five years from 2019 to 2024. And the Human Services Department plans a series of public meetings around the state before submitting its final draft to the federal government in November.

The department plans a meeting for public comment in Santa Fe from 1 to 4 p.m. Oct. 16 at the New Mexico State Library, 1209 Camino Carlos Rey.

Contact Andrew Oxford at 505-986-3093 or aoxford@sfnewmexican.com. Follow him on Twitter @andrewboxford.

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