‘Overwhelming support’ for Medicaid Forward will lead to bill in upcoming legislative session
November 25, 2024New Mexico lawmakers are proposing a groundbreaking expansion of Medicaid that, if passed this legislative session, could extend affordable comprehensive health care coverage to most New Mexicans under 65.
That proposed plan, Medicaid Forward, could decrease the uninsured population by 48%. It has gained increasing support from health professionals and has been championed by the coalition New Mexico Together for Healthcare.
The incoming administration of President-elect Donald J. Trump added urgency to the issue. The incoming House Majority Leader, Reena Szczepanski, D-Santa Fe, told lawmakers on the Legislative Health and Human Services Committee that she plans to introduce a bill for the Medicaid Forward program — which could add a projected $88 million in administrative costs in state and federal dollars — in the upcoming 60-day session.
Responding to Szczepanski and other health care officials speaking at the event, committee member Albuquerque Democratic Rep. Liz Thomson lamented that they “don’t know anything” about what to expect from Trump’s “nontraditional administration” on Medicaid.
Medicaid Forward would remove income requirements and use a sliding-scale system for premiums and out-of-pocket costs for those above a certain percentage of the federal poverty level. Like the state’s existing Medicaid program, it would be funded largely by federal dollars.
How the program works
The program could extend Medicaid coverage to 59% of uninsured New Mexicans, some of whom forgo coverage because of associated costs. That can lead to one of the lowest uninsured rates in the country, with estimates ranging from 5.4% to 6.1% of residents who would be without coverage if Medicaid Forward were enacted, according to a fact sheet from the health coalition.
That would also mean that residents priced out of the state’s current Medicaid program — particularly those above 200% of the federal poverty level — could join on a sliding-scale system that would cap premiums and out-of-pocket costs at 5% of income depending on a household’s financial status.
The proposed program is partly a byproduct of the Affordable Care Act, which gives states the option to set income eligibility, according to a recent Medicaid Forward study commissioned by the New Mexico Health Care Authority.
The study, conducted by New York-based Mercer , came out last month and looks at the feasibility of implementing such a program in New Mexico. Made possible through legislation signed by Democratic Gov. Michelle Lujan Grisham, in 2023, it follows another study released late last year commissioned by the state Office of the Superintendent of Insurance.
Both reports offer a bullish outlook for the implementation of Medicaid Forward.
The latest HCA report noted that with increased Medicaid Forward enrollment, BeWell, the state’s ACA health insurance marketplace, would see corresponding reductions of up to 89% and up to 22% for employer-sponsored insurance if workers choose to waive insurance plans offered by their companies.
But the report also “anticipates that some people will remain uninsured, including individuals ineligible for Medicaid based on immigration status.”
About 200,000 New Mexicans can’t afford health insurance and half of the state’s population forgoes needed care and medication because of associated costs, health officials said Friday.
Those numbers are “dangerous statistics,” Szczepanski said. “With Medicaid Forward, we can take real action today to bring down the cost of living for New Mexicans and provide them coverage that will have health and financial benefits for their entire lives.”
While the program will take some time to get set up, officials estimate Medicaid Forward could cost up to $88 million in recurring administrative costs. The state share would account for about $44 million of those costs, according to the recent HCA report, which includes staffing, contracting and IT system changes. If passed next year, the program would start to phase in coverage by 2028.
That may seem like a lot of money, but reduced spending by the state for employee coverage, amongst other matching funds and subsidies, could offset that, said Arika Sanchez, health care director for the New Mexico Center on Law and Poverty.
‘Overwhelming support’
The program has gained popular approval from health officials in the state, who acknowledged reimbursement rates for providers in the past have not always been up to par.
The program could land New Mexico in the top two or three states in the U.S. “looking at taking the income cap off of Medicaid,” Dr. Anjali Taneja, executive director of Casa de Salud, told lawmakers.
The reimbursement rate for Medicaid right now is 120% of Medicare and in January will increase to 150%, Taneja said, which helps “cover costs and break even for clinicians.”
“Medicaid Forward could increase that even more,” Taneja said, adding that there is “overwhelming support from on-the-ground health care providers for this bill and for the idea of expanding health insurance overall to all New Mexicans.”
“This is a very creative bill that helps health care, that helps patients, that helps the economy, that helps the state,” Taneja said.
Dr. Caryn McHarney-Brown, a retired family practitioner who has worked in rural New Mexico and high-poverty areas in Albuquerque, told lawmakers that Medicaid Forward would make insurance “more equitable, more affordable and more accessible.”
Provider burnout could decrease under Medicaid Forward, noting it is “an expansion of a trusted and established system,” McHarney-Brown said. “There’s decreased paperwork … fewer prior authorizations and a more stable drug formulary.”
Looking forward
The proposed state program could face an uphill battle in the upcoming session because of fears about how Trump’s team might handle Medicaid — like slashing the program’s budget — at the federal level. A main concern from lawmakers is how federal funds — if they somehow changed — could impact the program in the coming years.
The committee’s chair, Sen. Gerald Ortiz y Pino, an Albuquerque Democrat, and Rep. Alan Martinez, R-Bernalillo, both questioned if federal funds could cover enrollees above 200% of the federal poverty level.
“What I’m afraid of is the sustainability of a program like this,” Martinez said. “I think in a perfect world, is it a great idea that we can just give insurance to everybody but insurance costs, and somebody’s going to have to pick up that cost.”
But for the bill’s supporters, Trump’s potential reaction is a driving impetus to see the bill passed, not in the least because of a recent Supreme Court decision striking down Chervon Inc. v. the Natural Resources Defense Council that largely strips federal agencies from interpreting laws.
“We’re actually coming forward with the bill to establish this in part because the federal authorization is in statute. It is not in regulation,” Szczepanski said. “In this case, I think this will be a benefit to actually making this program happen.”
Originally published in Albuquerque Journal.