I am writing today to announce the closure of the New Mexico Independent. After three and a half years of operation in New Mexico, the board of the American Independent News Network, has decided to shift publication of its news…
While environmental activists played their part yesterday during demonstrations at the capitol building, going so far as to dress up as solar panels and to sing the tune of “You Are My Sunshine,” their counterparts, the anti-cap-and-trade contingency who has…
Roughly one quarter of University of New Mexico students are unimpressed with the state’s flagship public school, according to a survey that questioned college students about their higher education experiences.
After a little-known report found the New Mexico’s for-profit hospitals were making more profit than their peers in neighboring states and more than the national average, the state is taking steps to cut costs. For starters, New Mexico hopes to save millions by reducing what Medicaid pays hospitals for outpatient X-rays, CT scans and MRI’s. It’s also considering asking the poor to pay $75 monthly premiums.
State officials say they don’t know what they’ll do if Congress doesn’t send more money to help the state pay for Medicaid. Congress is currently debating whether to approve extra dollars for the government’s low-income health insurance program, but if the extra funds don’t come, New Mexico will be stuck with a $160 million hole in the state budget that starts next week—July 1.
Like New Mexico, Maine crafted a state budget expecting that Congress would pass a six-month extension of extra funding for Medicaid, the government’s low-income health insurance program. Without the extension Maine would be looking at a $85 million budget hole. Now Maine’s top budget official hopes President Obama’s letter urging Congress to extend extra Medicaid funding another six months will carry some weight in the nation’s capital, according to the Kennebec Journal.
But New Mexico is in a worse position than Maine. If Congress doesn’t extend the federal Medicaid stimulus dollars, New Mexico will have a $160 million budget hole for the year that starts July 1. More …
President Obama joined the chorus of governors and state officials across the country Saturday as he urged Congress to extend the boosted rate of federal government spending on Medicaid, the government’s low-income health insurance program. More …
The state is thinking about giving tens of thousands of New Mexicans living at or below the poverty line a choice: pay $75 monthly premiums currently paid by the state or risk losing their health care coverage.
State officials conceded this week if the cost-saving measure were adopted it could push some of the more than 45,000 low-income adults making $903 or less a month off New Mexico’s health care rolls.
“They would lose coverage,” Human Services Department (HSD) spokeswoman Betina Gonzales McCracken said of individuals who might find paying monthly premiums financially out of reach.
The proposal, one of dozens under consideration, would apply to a program once viewed as a way to lower the state’s high uninsured rate, which is second only to Texas –the State Coverage Insurance (SCI) initiative, which New Mexico started several years ago.
The idea already is running into opposition from state lawmakers who say demanding $75 a month from individuals who might not be able to afford it would limit access to health care.
“I know we have a tough budget,” said Rep. Danice Picraux, D-Albuquerque, and chairwoman of the Legislative Health and Human Services Committee. The panel is charged with studying health care issues between legislative sessions.
“I can’t tell them where they should be cutting or re-directing money, but it’s not my first choice,” Picraux said.
Ideas to cut costs
The idea of making low-income residents pay their own premiums is part of the New Mexico Human Services Department’s ongoing attempt to address ongoing budget pressures.
It also is a reminder of how harrowing the state’s path over the next three years is as it struggles to provide health care for its poorest residents before 2014, when the federal government swoops in to assume most of the costs under the new federal health care law.
While the individuals targeted by the proposal live at or just below the federal poverty level, they currently make too much to qualify for Medicaid, the government’s low-income health insurance program. Under the new health care law, they would automatically qualify for Medicaid in 2014, when the new law expands eligibility to individuals who earn 133 percent of the federal poverty level.
State Medicaid director Carolyn Ingram told the Independent on Tuesday that the idea of doing away with premium assistance for this population is only a suggestion, and that no final decisions have been made.
But she acknowledged that the state is considering that idea and others, including charging low-income residents nominal co-pays for emergency room services, because the state’s Medicaid program is under severe budget pressures. Medicaid is a primary funding source for the SCI program.
New Mexico’s budget crunch
A confluence of factors is creating the financial pressure.
First, state officials project that the number of New Mexicans, adults and children, using Medicaid and Children’s Health Insurance Program (CHIP) will grow by 8 percent between this past December and June of next year, from 479,000 to 518,000 individuals. CHIP provides health care for low-income children from families that make too much to qualify for Medicaid.
Currently New Mexico pays roughly 20 percent of Medicaid costs, thanks to federal stimulus dollars. The federal government picks up the other 80 percent. But paying one fifth of the costs is a struggle because of lagging revenues, state officials say.
Add to that the fact that federal stimulus dollars now helping New Mexico pay for Medicaid run out in December, unless Congress extends the deadline. If Congress doesn’t extend the federal Medicaid stimulus dollars, New Mexico will have a $160 million budget hole for the year that starts July 1. That’s because the state budget the Legislature passed in March assumed congressional approval of an extension and budgeted $160 million in the anticipated dollars to help cover costs.
It’s unclear whether Congress will pass that extension.
So, in essence, New Mexico faces a double whammy: find money to replace the lost federal dollars while trying to figure out how to address the growing enrollment in Medicaid and CHIP.
Financial strain on SCI
All those budget pressures are placing a strain on the State Coverage Insurance program, which is funded both by federal and state dollars, Ingram said.
The program was always envisioned as a way to extend health care coverage to New Mexicans who either didn’t have it because their employers didn’t provide it or because they made too much money to qualify for government programs.
Because it’s not an entitlement program, the federal government caps how much New Mexico can spend in federal dollars on the program. At the same time the state is running short of money.
“Unfortunately with the state budget, we are running out of both pots of money,” Ingram said.
Currently the state picks up the $75 monthly premiums for more than 45,000 adults across the state, making them eligible for New Mexico’s State Coverage Insurance program.
But the budget pressures are making the state’s assistance increasingly difficult, she said.
The identity of an elderly New Yorker, June Smith, was used for fraudulent Medicare claims in New Mexico, Florida, California and Arizona, the New York Daily News reported Tuesday.
Several of the exams and tests for which the government was billed defied common sense. Smith, a 72-year-old woman, supposedly received up to $50,000 worth of exams, including a pregnancy test, semen analysis and prostate cancer tests. More …
A national debate is brewing over how much the new health care law will cost states and the sticking point is how many uninsured individuals will sign up for Medicaid.
A central reform of the new federal law calls for…
In late March, an employee of a subcontractor for the company that processes claims and provides dental benefits for the State’s Medicaid program, filed a stolen car report for a vehicle whose trunk contained an ”unencrypted” laptop loaded with patient…
Will Congress extend federal stimulus Medicaid dollars another six months like New Mexico, and a host of other states, are counting on?
The New Mexico state budget signed into law in March assumes $85 million in additional Medicaid stimulus…
In 2014, the federal government will pay 100 percent of health care costs under Medicaid, the government’s low-income health care program, thanks to the new federal health care reform law. But between now and then the health care portion of New Mexico’s state budget could soar as more people enroll in the government program and federal stimulus dollars disappear.
The state Human Services Division (HSD) and Attorney General’s office will sign a new memo of understanding about data sharing and the coordination of Medicaid fraud investigations, officials at both agencies told The Independent Monday.
The AG’s office
Hundreds of placard-waving Tea Party activists in Albuquerque weren’t sheepish Thursday about sharing ideas on where to trim government fat. Eliminate the federal Department of Education. Reduce foreign aid. Starve the defense budget. Cut back or phase out big domestic spending programs like Medicaid, Medicare and Social Security. They all came up as potential cost-savings measures.
The new federal health care reform law may add millions of Americans to the ranks of the insured. Much less unheralded, says a national consumers group, is the law’s attempt to reduce the number of hospital-acquired infections, a problem that has garnered scrutiny over the past decade. The new act, signed into law by President Obama last month, also will require more public reporting of medical errors, such as infections, at hospitals, something that is not yet occurring in New Mexico.
The state wants the public to weigh in to help shape the next behavioral health contract before seeking proposals in June from firms interested in bidding for the contract. A series of sessions around the state to take public comments…
A provision of the newly passed health reform bill that raises doctors’ payments under Medicaid is both temporary and limited in the scope of medical services it covers. The restrictions have left a number of health care advocates and doctors’ groups concerned about patients’ long-term access to care under the reform legislation.
Several states stand to benefit financially from the new federal health care reform legislation, according to a story today in the Christian Science Monitor. And New Mexico could be one of them.
The potential windfall is based on these states’…
The 465,000 New Mexicans without health care coverage will be most affected by health care reform, as it mandates that they obtain coverage, either through purchasing it or through the Medicaid program. At least 100,000 of them will likely become eligible for Medicaid, while many with moderate incomes will get help buying insurance.
In a series of three formal Medicaid program improvement recommendation letters sent to the state Human Services Department (HSD) in 2009, the Attorney General’s Medicaid Fraud & Elder Abuse Division laid out how better HSD compliance with Medicaid rules and regulations could have saved taxpayers up to $31 million.
It is unclear how much of the $31 million would represent a one-time savings, and how much represents potential repeating, annual gains. The Attorney General’s office did not respond to repeated emails requesting comment about the letters and HSD’s responses.
The state Senate voted last week to override Governor Bill Richardson’s veto last year of SB 531, which would have required state agencies to share confidential data from Medicaid and other state programs with the Legislative Finance Committee.
Rep. Paul Bandy, R – Aztec, yesterday charged Speaker Ben Lujan with attempting to block a similar override vote in the House.
“It’s important that we connect our issues with Medicaid fraud, and the associated tens of millions of dollars in fraud, and our current budget challenges,” Sen. Tim Keller, D-Albuquerque, said of the override effort. “The challenge here is how to handle confidential information between different parts of government. This has long been a sticking point when it comes to program evaluation. We’ve seen similar impasses with prison contracts, Salud and public schools in the past.”
The Medicaid Fraud Division’s 2009 letters to HSD and HSD’s response letters were disclosed to The Independent in response to public records requests.
Out of State Medicaid Recipients: $16.2 million lost
According to state law, Medicaid is for “eligible New Mexico residents who otherwise would not have the financial resources” to obtain medical care.
But, according to a Sept. 30, 2009 letter from the Medicaid Fraud Division to HSD, a Tulsa, Oklahoma lawyer earning $231,000 a year secured $135,000 in New Mexico Medicaid assistance — $9 ,000 a month — to place his 9-year-old daughter in a residential behavioral health center in Los Lunas by listing her as a New Mexico resident and a “head of household” with no income.
Up to $16.2 million could be saved by denying New Mexico Medicaid benefits to non-residents, the letter claims.
The HSD does require New Mexico residency for Medicaid eligibility, HSD Medical Assistance Division Director Carolyn Ingram said in an October 29, 2009 response to the Fraud Division’s letter. Ingram’s letter was disclosed to The Independent Feb. 8 in response to a public records request.
In the letter, Ingram discounted any widespread problem with Medicaid benefits going to non-residents.
“In certain rare instances, a child can be placed in a New Mexico substitute living arrangement pending the transfer of guardianship or adoption by a New Mexico resident,” Ingram wrote. “(Regulations) allow a child to be considered a household of one, after the first month of placement in a substitute living arrangement. After the first month in a private facility, a parent or legal guardian who meets the residency requirement, may apply for Medicaid based on the child’s income alone. It appears that an attempt to get around the residency requirement by both the parents and the facility was successful in this situation. The worker failed to look at the legal standing of the Power of Attorney in this case. …Our examination of current policy does not inidcate a revision is needed; we believe the policy is clear on residency.”
Not Disclosing Medicaid Contracts to Investigators: $13.7 million lost
HSD’s failures to disclose Medicaid providers’ contracts to the Medicaid Fraud Division cost taxpayers up to $13.7 million, according to a June 29, 2009 letter from the Fraud Division to HSD.
The Medicaid Fraud Division frequently sues health care providers for over-billing Medicaid using breach-of-contract law, arguing the Provider has not complied with the terms of its Medicaid Provider Agreement with the state. But because HSD has failed to disclose these agreements “many” times, investigators have been unable to seek recoveries for fraudulent over-billing, the letter states.
“Additionally, criminal prosecutions may be adversely impacted if the state is unable to present proof a defendant is a contracted Medicaid Provider subject to the terms of the agreement,” the letter states.
Responding to the letter, Ingram pointed out that other agencies held provider agreements and said HSD was working with those agencies to revise internal policies and procedures to maintain entire contract documents.
“Currently, the (Health) Department maintains all pages with provider specific data including signature pages,” Ingram wrote in the July 15, 2009 letter. “However, we do not retain standard text pages.”
But the Health Department also failed to disclose requested records to the Medicaid Fraud Division, according to the Fraud Division’s June 30, 2009 annual report to the Inspector General of the U.S. Department of Health and Human Services. Both the HSD and Health Department “review and, on occasion, redirect the (Fraud) Division’s data or document requests,” the Fraud Division’s annual report stated. “The Division repeatedly has requested copies of the contracts between the Medicaid agency and the Medicaid managed care organizations to no avail.”
HSD posted signed Medicaid managed care organization contracts on its Salud website earlier this year.
Informal Review Conferences: $1.5 million lost
HSD grants providers gratuitous informal administrative hearings when no right to a hearing exists, costing Medicaid up to $1.5 million, according to a Dec. 23, 2009 Medicaid Fraud Division letter to the HSD.
For example, Cuidando Las Familias in Rio Rancho failed to properly screen 75 care providers, in violation of the state’s Caregivers Criminal History Screening Act, the letter states.
Because the facility charged Medicaid $3.69 million for services provided by unscreened caregivers, the Medicaid Fraud Division recommended that HSD implement a check hold for overpayment, citing federal Medicaid regulations. But the facility requested and was granted an administrative hearing to challenge the check hold.
The Fraud Division letter does not contest the legitimacy of the bills for the care provided to patients, however — just the eligibility of the caregivers in question to receive Medicaid funds.
The Fraud Division letter attributes HSD’s granting of the “gratuitous” and “unjustified” hearings to ambiguities in the state’s Medicaid regulations and recommended that “administrative review” be more clearly defined.
In a January 21, 2010 response letter, Ingram disagreed that the recommended clarification would yield savings for the Medicaid program.
Indeed, the additional responsibility would likely cost HSD time and money, Ingram suggested.
“(T)his recommendation would have significant fiscal implications to the (HSD) since it would essentially require HSD to implement a completely new process for the remaining (Fee For Service provider) population,” Ingram wrote.
The federal Medicaid Integrity Group plans to investigate allegations reported in The Independent that the HSD stonewalled Medicaid Fraud Division investigators during 2008 and 2009.
The Senate voted Monday to overrideGov. Bill Richardson’s veto of a 2009 bill that would have required state agencies to share confidential data with the Legislative Finance Committee. The tension between the LFC and state agencies over lack of sharing data has simmered for years. But last month, The Independent revealed, in an exclusive story, that an Attorney General’s report shows the state had hindered Medicaid fraud investigations.
The state’s stonewalling of the Attorney General’s Medicaid fraud investigations violates federal regulations, Attorney General’s office spokesman Phillip Sisneros said Friday.
“HSD’s compliance with the federal Program Integrity regulation could be improved,” Sisneros told The Independent. “That regulation requires that (the Fraud Division) has access to any records or information kept by HSD or its contractors and providers.”
Sisneros cited 42 C.F.R. § 455.21, a federal Medicaid regulation requiring states’ cooperation with State Medicaid fraud control units. The regulation requires states to provide fraud investigators with access to any records, information and computerized data kept by the agency or its contractors.
But according to a report by the Attorney General’s Medicaid Fraud & Elder Abuse Division, the state Human Services Department and Health Department have hindered numerous investigations into fraud and elder abuse by refusing to disclose records to investigators.
Human Services Department spokeswoman Betina Gonzales McCracken rejected those allegations earlier this week, claiming investigators had direct access to patient encounter data, describing patient care for which providers charged Medicaid.
“Regarding encounter data, the (Fraud Division) has the same access our Medicaid staff has, and can receive this information directly,” McCracken said.
But Sisneros said McCracken’s claim was “incorrect.”
“(The Fraud Division) does not have direct access to that data,” Sisneros said. “HSD requires the Division’s investigators and attorneys to submit requests for the information to the HSD Medical Assistance Division, which must give authorization…before the data is released. The Division does not have the ability to ascertain whether the data that is received has been filtered in some way.”
Direct access to Medicaid data would be “a significant step forward,” Sisneros said.
Fraud Division Director Elizabeth Staley did not answer emailed questions and was too busy with the legislative session to discuss the allegations, Sisneros said.
McCracken also said earlier this week that the Fraud Division’s allegations had never been raised at monthly inter-agency Medicaid meetings. But minutes from a May 19, 2009 meeting seem to refute that claim, making clear reference to the Fraud Division “having a hard time obtaining some provider agreements (and) files.”
McCracken had initially said there were not any transcripts or meeting minutes for the monthly inter-agency gatherings, but subsequently disclosed summary minutes from six meetings to The Independent — three meetings in 2008 and another three from 2009, the most recent from a meeting held May 19, 2009.
Minutes were not kept from all of the inter-agency meetings, McCracken said of the 18 months for which no meeting minutes were disclosed. Some meetings had been canceled due to holidays and legislative sessions, McCracken added.
