N.M. Medicaid changes in the works have wide implications [The Santa Fe New Mexican]

Jun. 1—New Mexico is about to roll out a revamped Medicaid system — a massive undertaking that could change the way state government attacks some of the most difficult problems facing its most vulnerable citizens.

State workers have been hitting the road, trying to get patients the info they'll need under what will be called the Turquoise Care program that goes into effect July 1. At the same time, a number of major structural and policy changes also are in the works, including an expansion to an existing housing support program, a major shift in the way the state handles Medicaid for children in state custody and a proposal to streamline the process for getting back on health care benefits after a period in prison or jail.

Medicaid at its most basic level provides health insurance to low-income people, a category in New Mexico that encompasses some 876,000 of its 2.1 million residents. The way the state administers the program, and special offerings made possible by program waivers obtained from the federal government, allow agency leaders to shape a significant part of New Mexico's overall social safety net.

Dana Flannery, New Mexico's Medicaid director, said the proposed and locked-in changes coming with Turquoise Care are a reflection of a growing desire for a more holistic view of health care.

"Thinking about health care ... the country continues to evolve in integration," Flannery said in an interview. "So not only physical health and behavioral health, but really looking at social determinants of health and what that does to impact a person's ability to engage in health care."

Helping people get used to being housed again

One existing Medicaid program poised to expand under Turquoise Care involves using Medicaid dollars to help formerly homeless people stay in housing.

Taylor Bomek, a peer support specialist who works as part of the statewide Linkages program at Amador Health Center in Las Cruces, said the supportive housing money helps organizations like his assist people who recently lived on the streets.

People who get housing vouchers from other government programs may be eligible to find a rent, but Bomek said they still need a lot of help.

"It's not necessarily like, 'They're in the house. Now it's done; we finished the job,' " Bomek said. "It's a long process of acclimating in that situation."

The Medicaid program can pay to help people get used to everything that goes along with being a tenant, being responsible for a rental property or having to get along with a landlord.

For Linkages clients, who have serious mental illnesses, those skills can seem basic, but the needs are great, Bomek said.

The program also can include helping people search for housing on the front end, Flannery said.

The existing program allows 180 New Mexicans to qualify for help, Flannery said. That number is expected to increase to 450. The expansion also allows more provider agencies to bill Medicaid for those services and for more types of staff roles within those agencies to participate.

The federal government is currently finalizing approval for the expansion, which will cost an estimated $2.4 million per year. Flannery said the state does expect to see "an offset of some other costs" as a result, though — the evidence of an effective Medicaid waiver.

"In theory, if you provide people housing when they're receiving their physical and behavioral health care, you should see a decrease in emergency department utilization, in-patient utilization, medical unnecessary emergencies," she said.

Rachel Biggs, chief strategy officer for Albuquerque Health Care for the Homeless, another provider that uses the waiver program now, said the expansion will complement local and federal housing help. She said she thinks it will be a great help, but she'd like to see even more.

"The need outpaces the resources for any type of housing support right now, locally, at [the state level] or federally," Biggs said. "So any increases are needed, and we can certainly benefit from more increases in the state as well."

One managed-care roof for CYFD youth

When a kid in foster care needs to go to the doctor, the last thing they need is confusion about their insurance plan.

That's the thought behind a change the state is making in the way it handles Medicaid for children in state custody through the New Mexico Children, Youth and Families Department. In the past, young people in the agency's care might have been members of any one of several managed care organizations contracting with the state.

The managed-care model — the model that Turquoise Care follows, replacing the old Centennial Care — relies on insurance companies that contract with the state to manage benefits directly. 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.

But this year, a single, exclusive provider — Presbyterian Health Plan — will handle care for all those children, Flannery said. Native American children in state custody may be under Presbyterian but also may be under a fee-for-service mode.

The change is supposed to make things smoother when kids are in a new setting and need medical or behavioral health care.

But the state also is hoping to lean more heavily on Presbyterian to figure out health care needs affecting foster children and start to address them.

The rationale is that with all those children under one insurer, Presbyterian and the state will be able to track all sorts of metrics to determine how well the state is serving them, Flannery said.

Then, Presbyterian and the state can try to fix what isn't working.

"Children in state custody sometimes have unique network needs," Flannery said. "I think the state's vision really is looking at focusing one MCO's efforts on that network development."

The logic dovetails with comments recently made by state Human Services Department Secretary Kari Armijo, who told lawmakers in May the state is dialing up pressure on managed-care organizations to do more to address behavioral health issues in particular.

Maralyn Beck, executive director of the advocacy nonprofit New Mexico Child First Network, said she's "really excited and hopeful" about the idea and the approach to what she termed a "deeply broken, bureaucratic system."

"We're trying to remove a barrier and figuring out which MCO the kid in foster care is on," Beck said. "The dream idea is that we're putting onus onto the MCO provider ... to take better care of our kids."

Gary Housepian, CEO of Disability Rights New Mexico, said there are good provisions in the new contract but he has some skepticism over how much improvement there will actually be.

"The devil's in the details as to whether this will really show a broader network of services," he said.

Housepian said, in his opinion, much will depend on whether the state will be holding the MCOs to their contracts.

"The worst-case scenario is same old, same old," he said.

Beck said she's also concerned about communication with foster parents and providers.

"I don't think there's been a lot of education or outreach," she said. "I'm praying it's happening behind the scenes."

CYFD spokesman Andrew Skobinsky wrote in an email Friday there has been "significant communication, planning and organization" ahead of the change.

"HSD, CYFD and BHSD have worked collaboratively engaging in community and virtual events," he wrote. "Additionally, the three departments are currently producing collateral marketing materials and MCO specific training sessions that will be available for resource foster families, staff, and stakeholders."

The department did not provide further specifics about outreach efforts.

Beck said overall, she hopes having all the CYFD children under a single MCO provider makes a difference.

"I do really hope that it is a positive change," she said.

Corrections waiver 'would eliminate so many barriers'

Medicaid is government-run. So is the criminal justice system. But that doesn't mean the two work hand-in-hand.

Right now, when Medicaid patients go to prison or jail, their coverage gets put on hold, and it can't get reactivated until they're released.

That's a problem, said Natasha Garcia, executive director of the New Mexico Reentry Center, because often people coming out of prison or jail need to go directly into a in-patient treatment program. Those programs typically need Medicaid to be in order before they'll accept a new client," she said.

"We have to put them in a hotel until their Medicaid's active," said Garcia.

It's a problem Flannery said could be solved if the federal Centers for Medicare & Medicaid Services approves a request from New Mexico to allow Medicaid to be reactivated several weeks before an individual's release from incarceration.

Flannery said in a May interview she was optimistic negotiations on the waiver would wrap up in next two months. The department originally requested permission to get people on Medicaid up to 30 days before release, she noted said there's a possibility of an even longer timeframe, subject to funding.

"Keep in mind, any of these services, just like all Medicaid services, require a state fund to draw down the federal participation, and we need to have that state funding," she said. "That's something that we will work with our constituents on as to the options that we have and the budget that we need."

Garcia said even a slight delay for someone coming out of prison can discourage them from following through on treatment programs.

"I see so many men and women come through here and they're trying, but all these ... barriers and no support systems," she said. "It's easy to fall back into those same old habits."

Garcia said she hopes the change comes through comes through.

"Oh, God, it would eliminate so many barriers for people, especially for people that are court ordered to get into treatment or a recovery program," she said. "It would allow people to not be waiting around."

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