Legislative Report: Medicaid Costing More, Delivering Less In New Mexico

Nov. 19--The coronavirus pandemic has driven Medicaid enrollment to nearly 900,000 patients, prompting an all-time high in state spending on the health insurance program for low-income people, a new legislative report says.

But patient visits to providers are stagnating, the study adds, and there appear to be no oversight procedures in place to determine if outcomes are improving for patients in the program.

Jacob Rowberry, a program evaluator for the Legislative Finance Committee, which reviewed the study Wednesday, said Medicaid enrollment has increased since March, when the pandemic began, by nearly 54,000 patients to 891,192.

In 2014, when new eligibility rules allowed more people in the state to participate in the federal health program, 570,000 New Mexico patients were enrolled.

Meanwhile, Rowberry said, spending has increased from $3.9 billion in 2014 to $5 billion in 2019, and it is expected to rise to $5.8 billion in the current fiscal year. About $1 billion will come from the state's general fund, he said, while the federal government will cover a much larger share.

Catherine Dry, another program evaluator for the committee, also noted the study found the state spends $100 million annually coordinating Medicaid patient care but conducts "little tracking on savings and outcomes."

The percentage of adults who had access to preventive and ambulatory care in the program remained at 76 percent between 2016 and 2019, the report said. Among children ages 1 to 6, access remained equally flat, at about 85 percent, over the same time period.

The report recommended a number of actions for the New Mexico Human Services Department, such as reducing payments to managed care providers and updating data-collection procedures to track the program's effectiveness.

Human Services Department officials took issue with some of the findings, arguing analysts were focusing in some cases on a single data point to paint a broad portrait of the Medicaid program.

Human Services Secretary David Scrase said an increase in provider payments and a decrease in services "may not be the whole story."

A data analysis from his department suggests the gap is "much smaller than you might think," Scrase said.

He added the agency is taking steps to track the cost-effectiveness of the program.

He told lawmakers on the Legislative Finance Committee another report showed behavioral health visits through the Medicaid program are increasing -- rising to over 1.5 million in 2020 from about 1 million in 2016.

"We need to look at them over time and understand them over time before making a judgment," he said.

Federal regulations make it difficult to decrease reimbursement payouts to medical providers or to provide data updates more frequently than mandated -- which is once every 12 months, he said.

Any analysis of Medicaid should examine state efforts to leverage federal funding, Scrase said, adding New Mexico's share has decreased to 13.3 percent from over 21 percent.

"That's a pretty good deal for everyone in New Mexico," he said.

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