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SPONSOR: |
Wilson-Beffort |
DATE TYPED: |
|
HB |
|
||
SHORT TITLE: |
Limit Medicaid Eligibility |
SB |
512/aSPAC |
||||
|
ANALYST: |
Weber |
|||||
APPROPRIATION
Appropriation
Contained |
Estimated
Additional Impact |
Recurring or
Non-Rec |
Fund Affected |
||
FY03 |
FY04 |
FY03 |
FY04 |
|
|
|
|
|
($35,182.0) |
Recurring |
General
Fund |
(Parenthesis
( ) Indicate Expenditure Decreases)
REVENUE
Estimated Revenue |
Subsequent Years Impact |
Recurring or
Non-Rec |
Fund Affected |
|
FY03 |
FY04 |
|
|
|
|
($106,135.0) |
|
Recurring |
Federal |
(Parenthesis ( ) Indicate Revenue Decreases)
Responses
Received From
Agency
on Aging
Human
Services Department
Department
of Health
Children,
Youth and Families
SUMMARY
Synopsis of SPAC
Amendment
The Senate Public Affairs Committee amended Senate
Bill 512 as follows:
On
page 3, line 5, after "guidelines" insert "; provided that a
person eligible for a medicaid program on the basis
of a disability or who has met the screening criteria and been identified as
needing treatment for breast or cervical cancer through medicaid
pursuant to the federal Breast and Cervical Cancer Prevention and Treatment Act
is exempt from the income restriction in this subsection".,
POSSIBLE QUESTIONS
Synopsis
of Original Bill
Senate Bill 512
prohibits Medicaid coverage under Title 19 or Title 21 to a person of any age
who is a member of a benefit group if the benefit group’s income is above 200
percent of the federal poverty level (FPL).
Significant
Issues
Currently, some persons in the following coverage
groups qualify for Medicaid under income guidelines that exceed 200 percent of FPL.
Approximately
7,000 individuals currently receiving
Medicaid benefits in these categories have incomes in excess of 200% FPL. The Department of Health estimates at least
5,000 of those losing coverage are children.
A
significant number of children receiving coverage under Medicaid/SCHIP get
their services from community-based primary care centers. The New Mexico Primary
Care Association estimates that as many as 1,000 of the 5,000 who would lose coverage
under the provisions of SB 512 are enrolled in these centers. The loss of
health coverage for these children would significantly increase the costs of
uncompensated care at these centers, increasing demand for financial support
under the Department's Rural Primary Health Care Act Program.
Medicaid has no income
criteria for women in the Breast and Cervical Cancer program. However, to be eligible for the program, one must
have been screened under the Centers for Disease Control (CDC) and Prevention
Breast and Cervical Cancer Early Detection Program which requires that the
individual’s income not exceed 250% FFP.
The 200% level may contradict the
federal regulation for the Breast Cervical Cancer program and an exception for
this category may be needed or the service eliminated.
FISCAL
IMPLICATIONS
The Human Services
Department estimates the fiscal impact as reducing expenditures by a total of
$141,317.0 with $35,182.0 in general fund and a loss of $106,135.0 in federal
revenue. The estimated 7,000 persons
that will lose coverage if SB 512 is enacted.
ADMINISTRATIVE IMPLICATIONS
The changes proposed in
SB 512 would require regulatory changes with public hearings and input, as well
as the submittal of state plan amendments to the Centers for Medicaid and Medicare
Services (CMS). In addition, the SCHIP
state plan and 1115 waiver must be amended.
These program changes would require major changes to all data systems
used to determine eligibility.
OTHER SUBSTANTIVE ISSUES
Many of those who
currently qualify for Institutional Care Medicaid only do so because they have
executed income diversion trusts. If the
threshold is dropped to 200% of the federal poverty guidelines, we can expect
an increase in the number of such applicants with income diversion trusts is
expected which would create an increased administrative burden on the Medical
Assistance Division and the Office of General Counsel. In addition, the expected decreases in
Medicaid costs the bill envisions would be offset.
With respect to the Home
and Community-Based Waivers, the bill would have an impact on the Lewis lawsuit
in which plaintiffs allege a failure to provide DD and D&E services with
reasonable promptness. Limiting coverage
to those whose income does not exceed 200% FPL would reduce waiting lists and
waiting times but would likely result in alternate legal action.
MW/yr:prr:njw