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Op-ed by Kim
Posich, Executive Director, NM Center on Law and Poverty
Appeared in The Albuquerque Journal
Saturday July 29, 2006
Abolish Automatic Closing of Medicaid Cases
By Kim Posich,
N.M. Center on Law and Poverty Executive Director
I applaud Gov. Bill Richardson on each of the five points of his
plan to expand health coverage. I applaud in particular, the expansion of both
Medicaid and State Coverage Insurance. These parts of his plan can provide
immediate relief to thousands of poor New Mexicans who cannot access health
care. They can relieve much of the pressure of uncompensated care. And, the
state dollars spent on the program will draw about three times as many federal
Medicaid dollars into New Mexico.
There is however, a fundamental conflict between the Richardson's intentions
and the actions of the state Human Services Department which administers
Medicaid.
In the past two years, we have been witnessing what may be the single biggest
disruption of health care to low-income people in the history of Medicaid in New
Mexico. Massive numbers of low-income people— mostly children— are being
terminated from Medicaid every month.
From May 2004 through July 2005, Human Services terminated more than 120,000
Medicaid cases. I cannot quote you the number of cases terminated since July of
2005 because the department stopped tracking that information. What I can tell
you, based on Human Service records before the department went silent, is that
approximately 75 percent of the cases were re-opened within six months because
the children had been eligible for Medicaid all along.
Because of the break in coverage, vaccination schedules were disrupted,
acute care appointments canceled, well-child check ups missed and children went
without their medication. Additionally, once reinstated, many people were
re-assigned to a new primary care physician, thereby breaking any continuum of
care.
But it has been much worse than this for some— those who still remain off of
Medicaid.
Medicaid participation in key categories fell by approximately 60,000 from
May 2004 to May 2006. This decline— mostly involving children— occurred despite
new outreach efforts by the Human Services Department.
To be sure, some of these lost families are simply no longer eligible for
Medicaid and should have been terminated. Many though, are women and children
who were terminated even though they remain eligible for coverage.
How could this be happening? In May 2004, Human Services implemented a
"cost-containment measure" of programming computers to close Medicaid cases
automatically every six months. When a family recertifies that it is eligible, a
caseworker is supposed to go into the individual case file and instruct it not
to close.
But, because caseworkers are overburdened— they carry caseloads two to three
times those of caseworkers in many other states— they are not getting to the
cases in time to prevent automatic closure by the computer. This and other
problems related to closing cases without human review, has been causing the
termination of more than 10,000 Medicaid cases— that's more than 20,000 New
Mexicans— every month.
The department has been perennially understaffed and unable to get a budget
approved that allows for the significantly higher number of caseworkers that it
requires. Without enough funding and staff to handle one of its core
responsibilities as well as it should, it has wrangled efficiencies out of
administrative measures for years.
This procedure of closing Medicaid cases automatically is one more
administrative measure that was expected to ease some of the pressure of onerous
caseloads. But it has been a colossal mistake, and everyone except the
Department's policy-makers seem to know this.
The Legislative Health and Human Services Committee, the Medicaid Coalition,
the New Mexico Pediatric Society and many health care providers have called on
the department to cease computerized purging of Medicaid rolls.
The governor's Health Care Summit made it one of the primary
recommendations. The Center on Law and Poverty and the Sargent Shriver National
Center on Poverty Law have filed a federal lawsuit to stop the practice. Yet the
department stubbornly refuses to reverse itself and is not just disrupting the
health care of tens of thousands of New Mexicans but is also threatening the
success of the governor's new plan before it even begins.
Human Services should immediately cease the practice of automatically
closing Medicaid cases. The Legislature and governor should approve adequate
funding of the department, including funding for at least 60 caseworkers above
what is currently approved.
The governor's plan to expand Medicaid and State Coverage Insurance stands a
chance of meeting its enormous potential— if these changes become its sixth
point.
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