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Emergency Room co-pays ‘just one idea’ for N.M. Medicaid overhaul, HSD spokesman says

8 August 2011 Written by:

Imposing new patient fees is “just one idea” being considered by the Governor’s Medicaid overhaul team, New Mexico Human Services Department (HSD) spokesman Matt Kennicott said Monday.

Possible new fees include “co-pays” for some emergency room visits, sparking concern among tribal representatives who met August 8 with HSD officials.

Patient fees would create new barriers to American Indians’ access to health care, they fear — and run counter to government treaty obligations to provide health care to tribal members.

“Due to the lack of available medical care, American Indians shouldn’t be penalized for using emergency room services,” said Paul Pino, of the Pueblo of Laguna’s health committee.

“This is just one idea that we are considering as we work towards Medicaid Modernization and building a program that we can sustain now and into the future,” Kennicott said in an e-mail to Veritas New Mexico.

Medicaid provides health insurance for people with low incomes and disabilities, and their children.

The federal government covers 75 percent of the program’s costs.

But HSD officials say cost controls are necessary because the state’s portion of the program’s $3.9 billion tab will grow to represent 16 percent of the state budget next year.

Co-pays, if adopted, would be imposed on a sliding scale, Kennicott said.

HSD’s Medicaid overhaul consultation with tribes, required by state law, was scheduled during a week of traditional seasonal Pueblo Indian ceremonies and unrelated tribal meetings with state lawmakers — preventing most of the state’s tribes from attending.

But scheduling conflicts were not HSD’s fault, Kennicott said Monday.

“We consulted with our Native American Liaison prior to scheduling the meeting,” Kennicott said. “Not only that, but HSD scheduled the tribal consultation prior to the legislature placing a redistricting meeting on their agenda. With so many agencies and other meetings occurring around the state, it is always difficult to find a time where everyone can attend.”

Indian health experts said a single three-hour meeting represented an insufficient effort to involve the tribes in the state’s Medicaid overhaul effort.

“They need to hold meetings all over the state and meet with all of the tribes,” Dr. Ron Lujan, a retired Indian Health Service physician, said prior to HSD consultation meeting.

While the Albuquerque meeting was HSD’s only scheduled formal consultation with the tribes, the agency also heard from Native Americans at many of its six other public meetings around the state, Kennicott noted.

“As with most of the meetings around New Mexico, we received valuable input from the tribal leaders in attendance,” Kennicott said. “Establishing the dialogue on Medicaid Modernization with the tribal leaders was an important step in the process.”

No additional HSD meetings are currently scheduled with the tribes. But additional meetings are possible, Kennicott and HSD Secretary Sidonie “Sidney” Squier have told Veritas NM.

“Nothing’s set in stone,” Squier told tribal representatives Wednesday.

“I think we’ll have an opportunity to get together again as we put it out so you can comment on it,” she said. “If there is something you don’t like, then you’ll have the opportunity to object.”

The U.S. Indian Health Service (IHS), should have been invited to HSD’s consultation with the tribes, N.M. Department of Indian Affairs Secretary Arthur P. Allison said at the meeting. Together, the federal IHS and state Medicaid program cover most tribal members’ health care expenses.

But HSD is not consulting with the U.S. Indian Health Service (IHS) “at this time” because IHS “mainly communicates with the (N.M.) Department of Health,” Kennicott said Monday.

HSD has offered few details about its emerging Medicaid overhaul plan, other than an intention to apply for a “global waiver” from the federal government, which Squier said would allow the state Medicaid program more flexibility and less federal oversight.

Access to health care is a treaty right for all tribal members, tribal representatives said at their meeting with HSD officials Wednesday.

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