NM retools Medicaid with eye on cost, wellness

SANTA FE, N.M. (AP) — As New Mexico prepares to provide medical services to more uninsured residents, Gov. Susana Martinez’s administration is retooling the state’s largest health care program in hopes of achieving two difficult goals: making people healthier while reining in Medicaid costs.

Nearly 90,000 uninsured New Mexicans are expected to enroll in Medicaid next year under terms of the federal health care law that allowed states to expand eligibility for the program while having the federal government initially pay the tab.

Also starting in January, the state Human Services Department will roll out a revamped Medicaid program known as “Centennial Care” that’s intended to better coordinate the services provided to needy New Mexicans by doctors, dentists and nurses as well as mental health and substance abuse therapists.

Medicaid also will offer gifts such an electric toothbrush to recipients as incentives for good health practices ranging from having an annual dental checkup to completing a prenatal care program. Copays will be imposed to encourage patients to take responsibility for some of their medical treatment. For instance, people will pay a fee if they go to an emergency room for medical problems that aren’t emergencies.

Costs of Medicaid will continue to rise because of expanding enrollment and inflation for medical services, but state officials hope to better control the growth rate over the long haul.

“What we’re trying to do with Centennial Care is slow that rate by identifying people with the most need and coordinating care around them so that they get … the right care at the right place at the right time rather than just getting very sick and ending up with avoidable in-patient stays, avoidable emergency room visits,” said Julie Weinberg, director of the Medical Assistance Division in the Human Services Department.

Health care spending in New Mexico increased an average of 7.7 percent a year from 1991 to 2009, according to the Kaiser Family Foundation. The national average was 6.5 percent and only six states — Alaska, Arizona, Idaho, Nevada, North Carolina and Utah — had higher average annual growth rates than New Mexico.

Medicaid provides health care to more than a fourth of New Mexico’s population, with children in uninsured lower-income families accounting for the largest share of recipients. The program is expected to cost nearly $4 billion this year, with almost $1 billion of that coming from the state and the rest from the federal government.

Under the Medicaid overhaul, managed care companies will hire care coordinators who monitor the health care provided to each recipient.

“This care coordinators job is to make sure that things get done as opposed to all these doctors or whatever just doing their own thing … and just having a patient that’s in the middle of that that’s not getting better,” Human Services Secretary Sidonie Squier said last month when the federal government approved the state’s Medicaid revisions.


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