Report to committee details state's Medicaid access problems [The Santa Fe New Mexican]

Dec. 14—A new report says New Mexicans' access to the state's Medicaid program is hampered by a shortage of providers, low provider pay rates and outdated contact information that frustrates those seeking care.

Such problems create "barriers for consumers," Legislative Finance Committee program evaluator Ryan Tolman told lawmakers on the committee Tuesday morning.

Medicaid is the state-managed federal health care program targeted at low-income residents. It serves about 47 percent of New Mexico's population.

Tuesday's presentation before the influential committee centered on several pressing issues for the program — including low compensation rates for medical companies that provide services.

"There are a lot of health care providers who won't take Medicaid because it pays so poorly," said nursing lobbyist Linda Siegle after the meeting. "We have to have that rate increase to help providers."

The committee report said a survey by committee staff members of about 500 primary care and behavioral health Medicaid providers showed access to services is not always easy to come by. The survey — modeled on a "secret shopper" program at a store — said efforts to book appointments led to them being made just 13 percent of the time. It took a lot of time to book appointments, as well.

Based on that data, "an average patient would typically have to make six to seven calls to book a new patient appointment with a [primary care] provider and 10 calls to book a new patient appointment with a [behavioral health] provider," the report says.

Adding to the problem, the survey found many outdated and inaccurate provider directories within Medicaid's managed care organizations — with one in four providers "unreachable," according to the report.

Upon hearing that item, Sen. Nancy Rodriguez, D-Santa Fe, said, "I'm surprised that any of the four were reachable."

The state's Human Services Department administers the Medicaid program, which is funded with about $8.8 billion of state and federal funds every year.

The 72-page evaluation and report came with a number of recommendations for providing oversight and accountability to the program.

Among the suggestions:

* The state Human Services Department should develop a comprehensive statewide network adequacy assessment and report on Medicaid and share the information with the Legislature on an annual basis.

* The Legislature should appropriate funds for provider rate increases.

* The department should require the managed care organizations under the Medicaid umbrella to regularly update their provider directories.

* The department should find ways to determine if managed care organizations are not meeting adequacy requirements and clarify how to penalize those that fail to meet standards.

In a letter of response to the report, state Human Services Department Secretary Dr. David Scrase agreed with most of the recommendations. He cautioned in the letter Medicaid could not be held solely responsible for the shortage of health care workers in the state.

He wrote any actions to improve the shortage situation "should be squarely centered in public policy and legislative action."

The issue of workforce shortages in the health care industry should come as little surprise to anyone following the issue as the state and nation emerge from the coronavirus pandemic. A 2021 legislative report cited numerous gaps: the state is short 328 primary care doctors, 238 certified nurse practitioners, 249 physician assistants, 524 physical therapists, 2,510 emergency medical technicians, 521 pharmacists and 117 psychiatrists.

Siegle said in an interview after the hearing nursing shortages remain "huge" — somewhere between the 6,000 and 9,000 range.

Nicole Comeaux, Medicaid director for the Human Services Department, told committee lawmakers one of the report's recommendations — to have her department work with the state Office of the Superintendent of Insurance to oversee some aspects of the program — cannot be followed without violating federal Medicaid requirements.

But she said her agency would welcome working with the insurance office in some capacity to improve access issues within the program.

Enrollment in the Medicaid program grew during the coronavirus pandemic. Between fiscal years 2019 and 2023, the report says "average monthly enrollment is projected to grow from approximately 837,000 to 966,000."

Much of the growth comes from "low workforce participation and programs serving newborn, mother and elderly populations," the report says.

___

(c)2022 The Santa Fe New Mexican (Santa Fe, N.M.)

Visit The Santa Fe New Mexican (Santa Fe, N.M.) at www.santafenewmexican.com

Distributed by Tribune Content Agency, LLC.