New Mexico's Medicaid costs and enrollment rise, in part thanks to pandemic

Sep. 22—Medicaid costs — and enrollment — in New Mexico have grown over the past few years, due in part to coronavirus pandemic-driven measures that cover more low-income people affected by the COVID-19 crisis.

About 978,000 New Mexicans were enrolled in the program as of August, David Scrase, Cabinet secretary of the state Human Services Department, told members of the Legislative Finance Committee on Wednesday in Taos Ski Valley.

He said Medicaid gave residents the chance to see doctors, buy medication and access immunizations — all necessities to stay healthy, particularly in a pandemic.

"Medicaid you need when you need health care," Scrase said.

A hearing brief on Medicaid prepared by Legislative Finance Committee analysts said between fiscal years 2017 and 2021, Medicaid spending increased 50 percent — from $5.6 billion to almost $8.4 billion. However, most of that increase came in fiscal years 2020 and 2021, the first two years New Mexico was grappling with the COVID-19 crisis.

Cost-driving factors in the rising expense rates include membership growth and increased managed care costs in both the physical and behavioral health categories, as well as managed care costs for long-term services, such as nursing homes.

All told, those managed costs make up more than 80 percent of all Medicaid expenditures, according to the report.

Not all the money comes from the state's general fund, as federal financial support also covers some services — including for hospitals on tribal and pueblo land. In addition, American Rescue Plan Act funding is available through a Medicaid home and community service-based waiver program.

The state's three managed care organizations — Presbyterian Health Plan Inc., Blue Cross and Blue Shield and Western Sky Community Care — all receive monthly payments to provide care for Medicaid enrollees. Representatives from all three groups spoke briefly about the value of Medicaid and how it helps those with limited services access continual health care.

Brandon Fryar, president of Presbyterian Health Plan, said Medicaid is vital as more New Mexicans in a post-pandemic era switch from either not seeing their doctors or using virtual telemedicine procedures to returning to hospitals and medical offices in person.

That's particularly true as the state's residents age and need more care, Fryar said, noting a recent report said by 2030, 25 percent of New Mexicans are expected to be 65 or older.

Scrase said pandemic-related emergency orders that have expanded Medicaid access for many, but not all, residents will run out early next year. He estimates at least 85,000 New Mexicans will have to be moved into an alternative health insurance plan. He said his agency will help those people navigate the state's health insurance plan as one possible option.

Though Scrase and the medical providers painted a mostly positive picture of how the state was handling Medicaid patients and spending, not all legislators were pleased with the report.

Rep. Patricia Lundstrom, D-Gallup, who is chairwoman of the committee, noted Scrase's agency had received some disappointing scores in a Legislative Finance Committee departmental report card.

That card gave Scrase's department low marks in areas related to the rates at which infants, children and youth under 21 who are enrolled in the Medicaid program make regular "well-child" visits to medical providers.

Lundstrom said lawmakers want to know more about how these Medicaid recipients are being tracked and treated.

She added, lawmakers attending a breakfast centered on Medicaid a month ago heard a lot about things that were "not working" in the system from constituents and others, though Lundstrom did not elaborate.

Nicole Comeaux, New Mexico's Medicaid director, said after the meeting Lundstrom is "not wrong" about declining child-wellness visit rates. But she said that is a national trend as parents remain wary of bringing their children to the doctor as the pandemic continues.

"It hasn't come all the way back," Comeaux said. "It seems to be one of the areas slowest to recover."

She said her division is working on ways to get parents to take their children to the doctor and penalize medical care providers who don't do their part to encourage the visits. The Legislative Finance Committee said Scrase's department is requesting a general fund increase of about $164 million for fiscal year 2024.