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.165897.2
HOUSE JOINT MEMORIAL 17
48
TH LEGISLATURE
- STATE OF NEW MEXICO -
FIRST SESSION
, 2007
INTRODUCED BY
Luciano "Lucky" Varela
A JOINT MEMORIAL
REQUESTING THE HUMAN SERVICES DEPARTMENT TO IMPLEMENT QUALITY
CONTROL OF ITS MEDICAID RECERTIFICATION PROCEDURES.
WHEREAS, in May 2004, the human services department
changed the way it processes medicaid recertifications and
implemented "automatic closure", a practice by which the number
of medicaid recipients is routinely reduced by the automatic
disenrollment of participants; and
WHEREAS, automatic closure occurs when a period of
medicaid certification expires and the entry of information to
recertify the participant has not taken place, thereby
activating a computer process that automatically disenrolls the
participant; and
WHEREAS, there are many legitimate reasons why
recertification information is not entered on a timely basis
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.165897.2
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that are not the fault of the medicaid recipient, including
caseworkers' inability to complete the paperwork due to
extremely heavy caseloads, participant or caseworker illness,
lost recertification paperwork and lack of understanding of the
requirements of recertification; and
WHEREAS, with automatic closure, there is no human review;
instead, a computer automatically closes a medicaid case if the
paperwork is not timely processed, regardless of whether the
recipient actually submitted the required paperwork; and
WHEREAS, when the department first implemented automatic
closure, it tracked the number of families that were
automatically disenrolled and found that approximately ten
thousand families were disenrolled each month; and
WHEREAS, during the first fifteen months of automatic
closure, more than one hundred twenty thousand families were
automatically disenrolled from medicaid and approximately
seventy-five percent of these families were subsequently
reinstated, indicating that they were financially eligible all
along; and
WHEREAS, during the first two years of automatic closure,
more than thirty thousand families lost their medicaid and were
not re-enrolled; and
WHEREAS, the automatic closure practice affects children,
pregnant women and very-low-income families; and
WHEREAS, the resulting loss of medicaid coverage results
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in children missing their scheduled immunizations; babies going
without medication; children missing appointments to see
specialists; mothers going without prenatal care; and other
interruptions in health care; and
WHEREAS, in June 2005, the department stopped tracking
both the number of families that were automatically disenrolled
each month and the number that were subsequently reinstated;
and
WHEREAS, the department does not analyze why families are
terminated from their medicaid coverage nor why they are
subsequently reinstated; specifically, the department has not
attempted to determine whether children and families are losing
their medicaid due to recipients' failure to bring in their
recertification paperwork, or whether the loss of medicaid is
due to the department's errors in failing to process paperwork
in a timely manner; and
WHEREAS, the department currently conducts no quality
control of its medicaid recertification procedures; and
WHEREAS, the department's current method of collecting
case data does not capture whether recipients are experiencing
a lapse in their benefits; and
WHEREAS, the current performance measures of the
department do not include measures that capture the quality of
recertification procedures or the percentage of eligible New
Mexicans receiving services from the department;
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NOW, THEREFORE, BE IT RESOLVED BY THE LEGISLATURE OF THE
STATE OF NEW MEXICO that the human services department be
requested to implement quality control of its medicaid
recertification procedures, including the tracking of the
number of cases closed and subsequently reinstated, as well as
an analysis of why medicaid recipients are terminated from
their health care coverage, and that the department do "point
in time" tracking of the number of people on medicaid so that
it can determine how many families are experiencing a lapse in
their services; and
BE IT FURTHER RESOLVED that the department be requested to
ensure that eligible medicaid recipients continue to receive
medicaid coverage without a lapse and that the department
resolve any problems it uncovers concerning eligible medicaid
recipients experiencing a lapse in or an end to their medicaid
coverage; and
BE IT FURTHER RESOLVED that the department be requested to
report to the interim legislative health and human services
committee on its findings and any corrective action taken in
November 2007 and again in November 2008; and
BE IT FURTHER RESOLVED that the department be requested to
implement performance measures that include the quality of
medicaid recertification procedures and the percentage of
eligible New Mexicans receiving medicaid; and
BE IT FURTHER RESOLVED that copies of this memorial be
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.165897.2
transmitted to the secretary of human services and the
governor.
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