Part of the Santa Fe field office of the New Mexico Human Services Department is shown on July 11, 2023. (Photo by Austin Fisher / Source NM)
In the first two months since New Mexico started disenrolling people from the state’s safety-net health insurance program for the very poor, nearly 60,000 New Mexicans lost their health insurance.
And almost every one of them lost their only way to afford health care, not because their income changed and they became ineligible, but because of paperwork.
That’s according to data for April and May released by the New Mexico Human Services Department (HSD), which oversees the state’s Medicaid program.
A requirement for continuous health care coverage during the public health emergency helped stop the periodic Medicaid “churn,” where people get kicked off the rolls but quickly reapply because they still need care.
What to look for
After a Medicaid application has been processed, people will receive a Notice of Case Action letter, which lets them know the status of their application. The letter is in a plain white envelope with the HSD logo on the outside.
That requirement ended when state and federal officials declared the public health emergency for SARS-CoV-2 over. At that time, there were 990,982 New Mexicans enrolled in Medicaid.
The federal government gave the state one year to check whether all of those people still qualify for Medicaid.
In the first two months, the state human services department processed renewals for 138,080 people, deemed 79,258 of them still eligible, and let them keep their health insurance.
In that same period, HSD purged 58,822 people from the rolls, leaving them uninsured.
Importantly, out of all the renewals the human services department reviewed, it found only 768 people to actually be no longer eligible. In general, Medicaid eligibility is based on income, residence and citizenship.
The remaining 58,054 people — more than 98% — had their benefits “terminated for failure to respond,” according to data provided by the NM Human Services Department.
All of those people have been disenrolled from Medicaid, said HSD Spokesperson Timothy Fowler.
However, if someone who has been disenrolled resubmits their application within 90 days, they can get retroactive benefits to pay for any health care they got after their effective termination date, Fowler said.
For example, someone who lost their health insurance effective May 1 has until July 31 to resubmit, and they will get retroactive benefits for any health care they receive after May 1, he said.
But if those people do not resubmit by July 31, then they will pay out of pocket for any of that health care they received after May 1, he said.
Update: July 12, 11:28 a.m.
After publication New Mexico Human Services Department officials emailed a link to where Medicaid enrollment data can be found online. To access the data the public should visit HSD’s website, then scroll to and click the link that reads “Learn more about HSD’s Social Impact Measures.” From there access the data by clicking “PHE Undwinding.” The link to the data is also available here.
The department released data for April and May in response to a request from Source New Mexico. Fowler said he would send the June data “as soon as it is published.”
The number of people losing their health insurance is unprecedented in the history of New Mexico’s Medicaid program, according to Gabriella Rivera, policy and communications director for Health Action New Mexico.
“I don’t think we’ve seen anything like this,” Rivera said. “It’s an unprecedented drop of people being covered, it really is.”
Nationally, at least 1.6 million people have been purged from the rolls as of July 5, according to data from 28 states and the District of Columbia collected by KFF.
As many as 17 million people could eventually lose coverage, KFF has projected.
“HSD’s customers are our highest priority, and we are processing renewals as quickly as possible,” Fowler said. “Any individual who has submitted a renewal maintains their coverage until their application is fully processed.”
Some wiggle room from the feds
New Mexico’s Medicaid program is overseen by the federal government through the Centers for Medicare and Medicaid Services (CMS).
A CMS spokesperson said the agency is working with states to ensure they comply with all federal rules and keep people on their insurance, based on eligibility.
So far, CMS has approved six waivers for New Mexico’s Medicaid program, allowing for people to keep their health insurance if they already receive food benefits, have no income, have no verifiable assets, are also enrolled in a managed care plan, have moved and their address can be verified through USPS, or ask for a fair hearing.
“CMS cares about keeping all people covered through any health insurance option for which they are eligible,” the spokesperson said. “The agency will not hesitate to take compliance action and to use all the levers that Congress has given to ensure compliance with federal Medicaid requirements.”
Breakdown of those who kept their insurance
In April and May, HSD renewed 57,382 people’s benefits automatically by using existing data from the Social Security Administration and the state Department of Workforce Solutions. Another 21,876 people renewed their benefits by sending in their applications.
U.S. Health and Human Services Secretary Xavier Becerra wrote to governors on June 12 urging them to do everything they can to minimize avoidable insurance losses.
“CMS remains deeply concerned with the numbers of individuals losing coverage due to red tape, and is calling upon states to adopt the full range of strategies CMS has offered to prevent or mitigate avoidable coverage losses,” the agency said.
Churn harms people
Medicaid is the public health insurance program of last resort. It is meant for the poorest residents of the United States who otherwise cannot afford coverage.
Besides the fact that COVID-19 continues to hospitalize, disable and kill people, how many are purged from the rolls and why are important because numerous studies, before and during the pandemic, have shown a gap in health care coverage has disastrous social effects.
Researchers last month found when more people are enrolled in Medicaid, fewer who get out of prison end up back in a cell, more have jobs and people use more health care. Earlier research has shown getting kicked off Medicaid results in delayed medical care, fewer preventive visits and periods of uninsurance.
New Mexicans dropped from the rolls will now have to pay for their own medications, said Barbara Webber, executive director of Health Action New Mexico.
“We’re right in the middle of a heat crisis, where people need their asthma inhalers more than ever,” she said. “If you’ve got three kids with asthma, and you’re having to pay full price for three inhalers, you can’t do it.”
Fewer people going to private plans than anticipated
Webber said she met with staff from BeWellNM, the state’s Affordable Care Act exchange, who told her that out of the 58,822 people purged from the rolls, only 1,000 have found new insurance plans through the exchange.
“They were anticipating much higher numbers,” Webber said. “That’s the other option, and that’s not being utilized as well.”
BeWellNM Spokesperson Alex Sanchez said that as of Wednesday, 1,400 people had found new insurance through the exchange.
Fowler said people who lost Medicaid coverage should contact the exchange by going to bewellnm.com or calling 1-833-862-3935 to learn what private health insurance is available to them.
Only 3% of people nationwide who were disenrolled from Medicaid or CHIP in 2018 enrolled in exchange coverage within a year, according to the Medicaid and CHIP Payment and Access Commission, a nonpartisan congressional policy and data analysis agency.
Backlog predates end of public health emergency
Rivera said she’s concerned the proportion of uninsured New Mexicans will spike, however, she said it is difficult to calculate because the redeterminations are ongoing and the state government was already behind.
There are 74,827 applications that the state could not get to in April and May, according to HSD’s data.
The agency has 153 contract staff processing Medicaid applications and renewals, Fowler said, with more in training.
“We are working to have 250 contract staff by the end of July to support the existing workload as well as exercising overtime for state employees to tackle the backlog,” he said.
New Mexico has been under a consent decree since August 1990 requiring it to process Medicaid applications accurately and on time.
A federal court assigned a special master who continues to monitor New Mexico’s Human Services Department for compliance. U.S. District Court Judge Kenneth Gonzales wrote on May 22 that the state agency “still has compliance issues in need of resolution.”
The state is supposed to renew people’s Medicaid without requiring paperwork to the very greatest extent possible, according to Sovereign Hager, legal director at the New Mexico Center on Law and Poverty, one of the plaintiffs in the case.
“We do think the state has made some strides in improving the automated renewal process,” Hager said in an interview.
However, she said before the public health emergency ended, the state was already behind in processing renewals, apparently because of a lack of caseworkers.
The state is understandably overwhelmed with the renewal processing, she said, but it did not cause the backlog.
“It predated any of this, even with the state being able to extend Medicaid and not process paperwork because of the public health emergency,” Hager said.
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