The coronavirus pandemic has driven Medicaid enrollment to nearly 900,000 patients, prompting an all-time high in state spending on the health insurance program for low-income people, a new legislative report says.

But patient visits to providers are stagnating, the study adds, and there appear to be no oversight procedures in place to determine if outcomes are improving for patients in the program.

Jacob Rowberry, a program evaluator for the Legislative Finance Committee, which reviewed the study Wednesday, said Medicaid enrollment has increased since March, when the pandemic began, by nearly 54,000 patients to 891,192.

In 2014, when new eligibility rules allowed more people in the state to participate in the federal health program, 570,000 New Mexico patients were enrolled.

Meanwhile, Rowberry said, spending has increased from $3.9 billion in 2014 to $5 billion in 2019, and it is expected to rise to $5.8 billion in the current fiscal year. About $1 billion will come from the state’s general fund, he said, while the federal government will cover a much larger share.

Catherine Dry, another program evaluator for the committee, also noted the study found the state spends $100 million annually coordinating Medicaid patient care but conducts “little tracking on savings and outcomes.”

The percentage of adults who had access to preventive and ambulatory care in the program remained at 76 percent between 2016 and 2019, the report said. Among children ages 1 to 6, access remained equally flat, at about 85 percent, over the same time period.

The report recommended a number of actions for the New Mexico Human Services Department, such as reducing payments to managed care providers and updating data-collection procedures to track the program’s effectiveness.

Human Services Department officials took issue with some of the findings, arguing analysts were focusing in some cases on a single data point to paint a broad portrait of the Medicaid program.

Human Services Secretary David Scrase said an increase in provider payments and a decrease in services “may not be the whole story.”

A data analysis from his department suggests the gap is “much smaller than you might think,” Scrase said.

He added the agency is taking steps to track the cost-effectiveness of the program.

He told lawmakers on the Legislative Finance Committee another report showed behavioral health visits through the Medicaid program are increasing — rising to over 1.5 million in 2020 from about 1 million in 2016.

“We need to look at them over time and understand them over time before making a judgment,” he said.

Federal regulations make it difficult to decrease reimbursement payouts to medical providers or to provide data updates more frequently than mandated — which is once every 12 months, he said.

Any analysis of Medicaid should examine state efforts to leverage federal funding, Scrase said, adding New Mexico’s share has decreased to 13.3 percent from over 21 percent.

“That’s a pretty good deal for everyone in New Mexico,” he said.

General Assignment Reporter

Robert Nott has covered education and youth issues for the Santa Fe New Mexican. He is assigned to The New Mexican's city desk where he covers a general assignment beat.

(3) comments

Eric Blair

Since this is a VERY important topic to all New Mexicans’ health and wallets, it is a shame and disservice that this appears to me a shoddy piece of reporting. Where is the editor with “sense” and content-checking? Why does the reporter not provide a deeper and more encompassing report on the situation? Or at very least make the facts as they are known abundantly clear and avoid logical disconnects?

While I am not privy to the study, this is what I glean from the article:

Since 2014 Medicaid enrollment is up 56.4%, yet total program cost has risen significantly less at 48.7%.

In 2014 New Mexico spent $6,842 per enrollee. In 2020 the expectation is we will spend $6,508 per enrollee - a 4.9% DECREASE in cost per enrollee.

The article is also incomplete in not clarifying what is meant by “access” to care. Does it mean that only 76% of the patients who needed care could actually see a doctor when needed or does this mean that only 76% of enrollees utilized their benefit (with 24% not needing to see a doctor)? The reporting is unclear and provides us no information to support the headline assertion of “delivering less [care]”. The reporting does give us the useful info that “access” rate (meaning usage rate?) has remained flat over the years. So, contrary to the poor reporting, total health care visits apparently are not “stagnating”, but only the percentage rate of who visit has. Is this a bad thing? Sounds to me that this only means that people are not sicker this year than they were in 2014.

So with the cost per enrollee down about 5% and (presumed) usage staying the same it seems that the program, at least financially, is a success — an opposite finding from the sensationalistic message of the headline.

Now, quality of care and health results are entirely different from financial measures and far more important points of why the Medicaid program exists in the first place, yet the article could not give us some perspective on these. We need that to better assess the full picture of the Medicaid program and whether or not the legislative report is as useful as “one hand clapping”.

So, yeah, total costs are up. So what? Costs per person are down. And the article takes no effort to give us info on health outcomes. By the way, the data is clear world wide: a major way to increase the health of a people is to decrease poverty….something the Medicaid program cannot fix.

Further, a knee-jerk response to less than full reporting and lack of full information can only be harmful. In Summer 2019 Medicaid reimbursement increased, I’m told, for the first time in almost 2 decades! I couldn’t go 20 years without a raise, no wonder it’s harder and harder to find someone who accepts Medicaid. The recent raise put Medicaid rates at only 90% of Medicare though (actually only about 82% of Medicare because practices must pay back to the State the sales tax on Medicaid payments received). And ask any senior how hard it is to find someone who accepts Medicare because Medicare rates don’t even cover the full cost of care at independent practices (however hospital systems and hospital-owned practices are paid higher under a different Medicare system, so Medicare is reportedly profitable for them…perhaps something to report to us on Mr. Nott?). Cutting state spending on Medicaid will cause less Federal matching funding for our Medicaid program and even more restricted access to care.

Perhaps far better would be to look at how our Medicaid program spends its money. Why do we need insurance companies administering it? Do we have insurance companies administering our fire and police services? Do we have insurance companies administering our road maintenance and charging tolls? Can we not administer our Medicaid program ourselves, and more cost effectively, without layering on outside operators who of course participate only because they can make more than they spend? If we can’t, then why the blazes not?!

I’ve certainly seen no credible reports of “Managed Care Organizations” providing better health outcomes vs state-administered Medicaid programs. Perhaps Mr. Nott could investigate and report back on that?

Perhaps Mr. Nott should regale us with the copious reports out there about how “Managed Care Organizations” are reaping record returns nation-wide in administering Medicaid and Medicare Advantage programs and how the Federal government is attempting to recoup tens of billions of dollars in overcharges. Let’s not kid ourselves. MCO’s would not be involved in our Medicaid program if it were not profitable to them — those companies do not operate at a loss. How about we seriously look at at least saving the “middle man” fees?

I heartily applaud and support Dr. Scrase for pushing back on selective and shoddy reporting and advocating for programs to operate and make decisions only after having in-depth and full information. This demonstrates grown-up leadership, insightful intelligence and wisdom — qualities that we need much more of in all walks of life — including our press.

Patricio R. Downs

I can't speak to how the Medicaid program determines access to care, but I have a family member who used to work for the department. As I understand the thinkin behind the MCO model, NM Medicaid ostensibly saves money by paying a monthly "capitation" payment to the MCO for each enrolled patient signed up with that MCO's flavor of Medicaid. (When she worked there, a Medicaid enrollee could choose Presbyterian, Molina, or BCBS as their Medicaid MCO.) If the enrollee didn't see his or her doctor, great! The MCO got to keep the capitation for that member for that month. On the other hand, if the patient had lots of medical issues and had to be seen for a lot of stuff that month, the MCO had to pay out more. (If memory serves, I think the patients also had co-payments to meet, as if Medicaid was like a regular insurer. I'll have to ask her if that's right.) This was supposed to cost less to the state of NM than having NM Medicaid paying for stuff directly as a fee-f0r-service type deal. Medicaid is also considered a "payor of last resort", meaning that if the person had any other guarantor - such as Medicare, for example - the other guarantor would pay as much as possible before Medicaid kicked in (if Medicaid kicked in at all). An example of this is, let's say a Medicaid/Medicare patient saw a doctor, and the charge for a procedure was $100. Let's say Medicare's reimbursement rate for that procedure was $65 and Medicaid's was $50. The doctor would be paid $65 from Medicare and nothing from Medicaid, since Medicare's reimbursement rate was higher. Sorry for the overly-long reply, but it's pretty well Byzantine if you don't see all (or most) of the moving parts.

Patricio R. Downs

So let me see if I'm reading that right: nearly half the population of New Mexico is enrolled in Medicaid - with a big surge of that enrollment coming since the pandemic started - but the LFC is saying "it costs too much; let's try to find a way to reduce spending, whether by paying even less than the pittance we do now or by some other means"? People are hurting right now. Is that the best idea?

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