Lawmakers urged to ensure New Mexico hospital benefit from health care plan, not out-of-state owners

May 8—Leaders of New Mexico hospitals this year agreed to pony up a tax that's expected to help shore up health care around the state, particularly in struggling rural areas.

Now, a state analyst told lawmakers during a Wednesday hearing in Santa Fe, it's time for the state to figure out how it's going to offset its own contribution to the cause.

The bipartisan Health Care Delivery and Access Act, passed earlier this year, set up a mechanism that will take money contributed by most hospitals in New Mexico, pool it, leverage those funds for a federal Medicaid match and some state money, and then bring all those dollars — a projected $1.1 billion — back to the contributing hospitals using a formula that especially favors small, rural facilities.

Eric Chenier, principal analyst for the state's Legislative Finance Committee, told members of the Legislative Health and Human Services Committee the program is promising, but its success will depend in part on how the details are handled.

"Since we're doubling the amount of money to hospitals, essentially, that Medicaid is paying ... can the state look at offsets in other places in terms of costs?" Chenier asked. "That's something that we're going to look at as far as employee benefits, maybe how much the schools are paying for their health insurance benefits."

Sen. Jerry Ortiz y Pino, an Albuquerque Democrat and chairman of the Legislative Health and Human Services Committee, said one of the largest concerns with the new program is ensuring funds directly boost New Mexico hospitals.

"A lot of these hospitals are part of national chains, corporate chains," he told The New Mexican. "... We want to make sure that whatever payments we make to the hospital gets used by the local hospital that may be struggling, and doesn't just get siphoned off into corporate headquarters or inflated salaries for executives."

The Wednesday comments came amid a wide-ranging discussion about New Mexico's Medicaid and behavioral health services systems, and of a massive overhaul underway within the bureaucracy that oversees those services.

The state is ramping up to the July 1 debut of Turquoise Care, a beefed-up version of its old system for providing Medicaid through managed care organizations — insurance companies that contract with the state to organize and manage benefits for enrolled Medicaid patients.

Turquoise Care will bring with it a number of changes from the old program, Centennial Care, such as inclusion of food and housing initiatives alongside health care.

Chenier cited another change: Presbyterian Healthcare Services, one of four managed care organizations contracting with the state, will be the exclusive insurer for children in state custody through the New Mexico Children, Youth, and Families Department.

Sen. Antoinette Sedillo Lopez, D-Albuquerque, questioned whether that will be a headache for people providing care to foster kids, some of whom may have to switch their Medicaid enrollment.

"For foster parents, getting these children to health care is one of the biggest hassles they have, and so to have to deal with insurance and changing all of their doctors and everything all over again, seems problematic," she said.

Ortiz y Pino said his understanding is the goal is to avoid having to reenroll children in different managed care organizations when children move to different homes.

He said he thinks the larger problem isn't which insurer children in state care are enrolled with, but with the providers they're allowed to see as a result.

"It shouldn't be a big problem, except that we still ... allow each individual MCO to have their own list of providers instead of saying, 'Look, you're a Medicaid provider; you gotta take any Medicaid patient that comes to you,' " Ortiz y Pino said. "I've never understood why we have separate lists."

New Mexico's four managed care organizations under Turquoise Care will be Blue Cross and Blue Shield of New Mexico, Molina Healthcare of New Mexico, Presbyterian Turquoise Care and United Healthcare Community Plan of New Mexico.

In an interview after the meeting, Ortiz y Pino said down the line, he'd like to see a "different way of handling" managed care.

"What lot of us are leaning toward would be to contract with a single MCO the state would pay a flat fee to for managing the paperwork," he said. "But the state would be the ones to set the policies and decide ... who gets credentialed as a provider, and the state would be responsible for making adequate provisions for a network."