Money Crunch ImageNew Mexico is bracing for the worst but hoping for the best.

And right now all the hope appears to be focused on Washington, D.C., although it’s way too early to tell if it’s a mirage or the real thing.

Health reform legislation approved last week by the U.S. House includes $23.5 billion to extend by six months federal stimulus funding to help U.S. states pay for Medicaid, the government’s low-income health insurance program.

New Mexico’s share would come out to roughly $147 million, almost exactly the amount of federal funds the state must replace in the latter half of fiscal 2011 — Jan. 1 to June 30, 2011 — to keep services at their current level, said Carolyn Ingram, director of the state Human Services Department’s Medical Assistance Division.

Such a windfall could put off, for a time, decisions few in the Legislature or in Gov. Bill Richardson’s office seem thrilled to make: how deeply to cut Medicaid services, and where.

“It’s a hopeful sign,” Ingram said Monday of the U.S. House legislation. “It gives us a little bit of room.”

In recent months, New Mexico officials have fretted over where to find about $140 million in state dollars to replace federal stimulus funding for Medicaid for that time period.

As part of the federal $787 billion stimulus package, Washington injected dollars into states’ Medicaid budgets, which have grown as more and more people enroll in the program due to the sour economy and lost jobs. But that money runs out Dec. 31, 2010, halfway through the state’s budget year, leaving a “revenue cliff.”

The specter of losing so much federal Medicaid funding in a single pop has led to projections of a $300 million shortfall in Medicaid next year, which, in turn, has fueled speculation that the state could confront a $1 billion shortfall in next year’s state budget.

Such big dollar gaps has led the state’s Human Services Department to contemplate steep cuts in services and to adopt some cost-saving measures.

But the possibility of more federal aid is suddenly seeming more possible.

Ingram spent most of last week on Capitol Hill lobbying the staffs of New Mexico’s U.S. senators to support inclusion of a similar provision in whatever health care reform bill makes it to the Senate floor in coming weeks.

Ingram did that lobbying as vice chair of National Association of State Medicaid Directors, a group that is pushing hard in the nation’s capital for extra Medicaid funding.

A spokeswoman for U.S. Sen. Jeff Bingaman said Monday that he supported extending extra Medicaid funding to the states for a full year, rather than the six-month period in the House legislation.

But the senator thinks there’s a better way to extend that funding than on a health care reform proposal, where rules require Congress to offset the cost of the extra funding with cuts elsewhere, spokeswoman Jude McCartin said.

“That would take away from other aspects of health care reform,” McCartin added. “Sen. Bingaman is urging one of the quickest ways in dealing with these issues is direct funding to states.”

Congress could “consider doing a jobs bill that could include aid to states,” which could include Medicaid, McCartin said.

New Mexico isn’t the only state worried about such a Medicaid ‘revenue cliff.’ Many states are concerned about the consequences, according to the Kaiser Commission on Medicaid and the Uninsured.

Any help for the states likely faces many hurdles.

For example, if the U.S. House and Senate pass different health reform bills, a likely scenario, the competing bills would go to a conference committee composed of House and Senate lawmakers.

And then there’s the possibility of the additional funding landing up on a totally separate proposal, where it likely would stoke a vigorous debate.

In the end, however, even if additional Medicaid funding is found to help states out, it doesn’t fix the underlying budgetary problem, which is that Medicaid continues to grow at a rapid rate as more and more people enroll due to the bad economy.

As Raymond C. Scheppach, executive director of the National Governors Association, told the Washington Post about the six-months of additional Medicaid funding in the House legislation:

“It’s sort of like a cliff,” he said. States “get the funding for two more quarters, but we would prefer that it ratchet down over a couple more. The cliff is just moved back.”