Fiscal impact reports (FIRs) are prepared by the Legislative Finance Committee (LFC) for standing finance committees of the NM Legislature. The LFC does not assume responsibility for the accuracy of these reports if they are used for other purposes.

 

Current FIRs (in HTML & Adobe PDF formats) are available on the NM Legislative Website (legis.state.nm.us).  Adobe PDF versions include all attachments, whereas HTML versions may not.  Previously issued FIRs and attachments may also be obtained from the LFC in Suite 101 of the State Capitol Building North.

 

 

F I S C A L    I M P A C T    R E P O R T

 

 

 

SPONSOR

Smith

DATE TYPED

01/26/04

HB

 

 

SHORT TITLE

Brain Injury Medicaid Waiver Program

SB

113

 

 

ANALYST

Chabot

 

APPROPRIATION

 

Appropriation Contained

Estimated Additional Impact

Recurring

or Non-Rec

Fund

Affected

FY04

FY05

FY04

FY05

$2,000.0

 

 

See Narrative

Recurring

General Fund

(Parenthesis ( ) Indicate Expenditure Decreases)

 

REVENUE

 

Contingent upon approval of the Medicaid Wavier by the Center for Medicare and Medicaid Services.

 

Estimated Revenue

Subsequent

Years Impact

Recurring

or Non-Rec

Fund

Affected

FY04

FY05

$6,000.0

 

Varies according to FMAP and expenditures

Recurring

Federal Funds

(Parenthesis ( ) Indicate Revenue Decreases)

 

FMAP is the Federal Medical Assistance Percentage set by the federal government for Medicaid reimbursement.  For FFY05, the rate is 25.56 percent state and 74.44 percent federal.

 

Duplicates HB 58

 

SOURCES OF INFORMATION

 

LFC Files

 

Responses Received From

Department of Health (DOH)

Developmental Disabilities Planning Council (DDPC)

New Mexico Health Policy Commission (HPC)

 

SUMMARY

 

Synopsis of Bill

 

Senate Bill 113 appropriates $2 million from the general fund to the Department of Health (DOH) for the purpose of establishing a brain injury Medicaid wavier program in cooperation with the Human Services Department (HSD).  The bill contains an emergency clause.

 

Significant Issues

 

The New Mexico Brain Injury Association reports brain injury is the leading cause of death and disability for people under the age of 45.  In 2001, there were 1,745 hospitalizations for treatment of traumatic brain injury, 455 deaths, and 618 people now living with a long-term disability due to brain injury.  DOH reports that 9.7 percent of hospital discharges in 2000 had a primary diagnosis of traumatic brain injury.

 

DOH manages the Traumatic Brain Injury (TBI) program which provides short-term services.  It is the payer of last resort and funding per individual is limited to no more than $25,000 per year and $75,000 maximum per individual.  Services are limited to those with the most urgent needs.  The TBI fund receives approximately $1.7 million annually from a portion of fines for speeding tickets.

 

House Joint Memorial 52, Forty-Sixth Legislature, First Session, 2003, Track Brain Injury Information, recommended a community-based brain injury wavier be requested for Medicaid to help defer the cost of long-term care.  The New Mexico Brain Injury Association estimates annual cost for treatment can approach $40 thousand and that approximately 3,500 individuals may be eligible for a waiver program.  DDPC estimates the $2 million appropriation could provide services to 200-250 people on a waiver program.

 

The New Mexico Brain Injury Association states the Developmental Disability and Disabled and Elderly Medicaid waiver programs do not provide the services needed by individuals with brain injuries.  In addition, the eligibility requirements often exclude people with brain injury.  As a result, 23 states have developed Medicaid brain injury waivers.

 

FISCAL IMPLICATIONS

 

The appropriation of $2 million contained in this bill is a recurring expense to the general fund. Any unexpended or unencumbered balance remaining at the end of fiscal year 2005 shall revert to the general fund.

 

As part of the Medicaid wavier process, use of the TBI fund as a match source should be considered which could reduce the initial general fund amount required.

 

As shown in the Revenue table, above the $2 million could result in an additional $6 million in federal funds.

 

This waiver program could result in significant general fund cost increases in the out-years.  Using the New Mexico Brain Injury Association estimate of 35 individuals yearly being eligible for the waiver and a cost of $10 thousand in general fund per individual results in an estimated annual cost growth of $350 thousand to the general fund.  Since Medicaid programs are generally

considered as an entitlement and use of waiting lists are discouraged, the cost growth potential in this program could be considerable as has occurred in the Medicaid developmental disability (DD) waiver and in the Medicaid personal care options. 

 

TECHNICAL ISSUES

 

DOH points the bill does not specify how much of the appropriation may be used for administrative expenses related to developing the wavier. 

 

OTHER SIGNIFICANT ISSUES

 

The TBI program administered by DOH will transfer on January 1, 2005 to the Aging and Long-Term Services Department if Senate Bill 141 or a similar bill is enacted during the Second Session of the 46th Legislature.

 

POSSIBLE QUESTIONS

 

  1. What other options are available to provide care for individuals with brain injury?
  2. What cost containment mechanism can be built into the wavier program?
  3. What are the consequences of not enacting this bill?
  4. Can the TBI fund be used to reduce the initial appropriation from the general fund?

 

GAC/prr:lg:yr