NM center on law and poverty
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End Medicaid Autoclosure We are witnessing what may be the single biggest disruption of health care to low-income people in the history of Medicaid in New Mexico. Large numbers of low-income people—mostly children—are being terminated from Medicaid every month by the poorly thought-out and illegal use of a computer program. Over a one year period, from May of 2004 through July of 2005, the Human Services Department used this computer program, called ‘autoclosure’ to terminate the Medicaid cases of over 120,000 New Mexican families. Approximately 75% of the cases were re-opened within six months because the children had actually been eligible for Medicaid all along. The break in coverage however, caused significant and unnecessary problems for the families. Some had to defer health care for their children. Others were denied care during their reinstatement period. Many were re-assigned to a new primary care physician, thereby breaking any continuum of care. And some parents lost wages while trying to get reinstated. But it has been much worse than this for some families. Since implementation of auto-termination, Medicaid participation in the affected categories in New Mexico has decreased by approximately 60,000 individuals. This decline 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. Others, though, are eligible families who have not pursued getting their coverage back. They either don’t know how, or would never question a formal letter from the state government or have been beaten back too many times to try again. Autoclosure is the practice of using computers to close cases automatically every six months unless a Human Services caseworker enters each individual case file and instructs it not to close. It is the Center on Law and Poverty’s contention that because the Department’s caseworkers carry caseloads two to three times those of caseworkers in many other states, they are not getting to cases in time to preempt them from closing. The Center believes this is why so many cases are automatically closing. The Center also contends that using autoclosure in the Medicaid program is illegal because under federal law, once a family is approved for Medicaid, they must remain on Medicaid unless and until a caseworker reviews their files and finds them to be ineligible. The Human Services Department has acknowledged that it is understaffed and its caseworkers overburdened. It has repealed the recent regulation that called for Medicaid recertification every six months, calling instead for annual recertifications. This is likely to help the situation because caseworkers will have to recertify participants only once per year and this should and make it easier for them to keep up with their work. It does not, however, resolve the problem. Caseworkers were unable to keep up two years ago, when there was an annual recertification requirement. Autoclosure will continue to improperly cut families off of Medicaid. 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 autoclosing Medicaid cases. Additionally, this was one of the primary recommendations coming out of the Governor’s UNMH Health Care Summit. Thus far, the Department has declined to comply and in the meantime, has stopped tracking the number of cases autoclosed every month, effectively hiding the continuing damage caused by this reckless policy. If you would like to weigh
in on this matter, call the
Lieutenant
Governor at 1-800-432-4406 or write her a letter. Donate to the Center Support the work of the NM
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