Health care worker shortage delaying care for people using Medicaid

Almost half of all New Mexico residents depend on Medicaid for their health needs. But a yearslong health care worker shortage means those patients aren’t getting timely care — especially in rural areas.

New Mexico’s health care workers are aging out of the workforce, and the shrinking number of providers is making care harder to access for a lot of Medicaid patients. Nearly 1 million New Mexicans are enrolled in the program.

Legislative Finance Committee Program Evaluator Ryan Tolman on Tuesday laid out a series of problems Medicaid patients face.

He said legislative staff conducted a “secret shopper survey” to see first-hand what Medicaid patients are experiencing. After trying to call almost 500 providers, he said nearly half had incorrect information listed online and were unreachable. They weren’t able to make an appointment about 13% of the time, he added.

Tough ratios

Primary care providers have too many Medicaid patients, Tolman said. 

Contracts in New Mexico require that there must be at least one primary care provider for every 2,000 Medicaid patients. That’s not hard to meet, he said, because it’s such a wide ratio.

By comparison, Michigan requires one provider for every 500 patients.

“If patients still have trouble getting an appointment in a timely fashion, then our current standards for number of providers are insufficient,” Tolman said.

The rules need to be changed, he said.

He proposed modifying some of the contractual obligations that health care companies have to meet, like lower provider-to-patient ratios.

Nicole Comeaux is the Medicaid director at the Human Services Department. She said HSD lowered some of those ratios already. But she voiced concerns about changing them too drastically. Health organizations can’t be expected to enlist so many more providers when there’s a worker shortage, she said.

“We cannot hold them to an impossible standard where there simply are no providers,” she said.

Gaps in service

The situation is worse for people in New Mexico seeking certain kinds of health care. Someone using Medicaid might have to make six phone calls to find a primary care provider. But when it comes to behavioral health, that number jumps to 10, Tolman said.

Tolman said there are service gaps for behavioral health and other specialists, especially in rural counties. And behavioral health needs doubled since the pandemic started, he said.

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The use of telemedicine also shot up during the pandemic, and Comeaux wants to take advantage of that for counties that lack OB-GYN care. She said there’s a pilot telemedicine program for prenatal care in northeast New Mexico that she hopes will expand to other areas of the state.

Tolman said lawmakers should allocate more funding so Medicaid providers can be paid more, and they should enact legislation that would let the state set up more licensing agreements for specialists.

There should be statewide assessments of provider networks, he added.

Holding onto the workforce

Sarah Dinces, another Legislative Finance Committee program evaluator, said the state will need an additional 2,000 providers by 2030 to match the number of health care workers New Mexico had in 2017.

But, she said, New Mexico retains 12% fewer medical residents than the national average. 

“Ensuring New Mexico’s health care workforce stays in state could help improve provider networks and access to care,” she said.

Comeaux said HSD is increasing the number of residency programs in the state. She said the department started a five-year initiative in 2019 to double the amount of residencies in the state, so there will be 16 programs by 2024.

And, she said, the number of medical students in the state has been increasing for years.

But more work still needs to be done, Comeaux said.

“Despite these investments and strides,” she said, “New Mexico has an undeniable provider shortage.”