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

SPONSOR Lopez

ORIGINAL DATE

LAST UPDATED

2-4-06

HB

SHORT TITLE

CHILD HEALTH INSURANCE & MEDICAID

ELIGIBILITY

SB 482

ANALYST Lucero

APPROPRIATION (dollars in thousands)

Appropriation

Recurring

or Non-Rec

Fund

Affected

FY06

FY07

300.0

Recurring

General Fund

(Parenthesis ( ) Indicate Expenditure Decreases)

Relates to Appropriation in the General Appropriation Act

SOURCES OF INFORMATION

LFC Files

Responses Received From

Human Services Department (HSD)

Department of Health (DOH)

Public Education Department (PED)

Health Policy Commission (HPC)

Children, Youth and Families Department (CYFD)

SUMMARY

Synopsis of Bill

Senate Bill appropriates $300.0 from the general fund to Children, Youth and Families for the

purpose of developing a process to determine whether children are covered by health insurance

and if they are not, to provide Medicaid eligibility information as follows:

1.

$200.0 to public education department for students in the public schools

2.

$100.0 to Children, Youth and Families Department for children in licensed day-

care centers.

FISCAL IMPLICATIONS

The appropriation of $300.0 contained in this bill is a recurring expense to the general fund. Any

unexpended or unencumbered balance remaining at the end of fiscal year 2007 shall revert to the

general fund.

Senate Bill 482 – Page

2

Administrative and outreach expenditures qualify for matching Medicaid funds. This appropria-

tion could yield additional $300.0 federal funds for a total of $600.0.

SIGNIFICANT ISSUES

This bill does not require either the Public Education Department or CYFD to actually identify

the insurance status of children or provide information about Medicaid. Also, the legislation

does not require either department to actually enroll or take affirmative steps to assure the en-

rollment of potentially eligible Medicaid children. The only requirement is that a process for

those functions is developed.

Currently the Human Services Department is working with both departments to enroll children

and provides federal matching funds for these efforts. The legislation appears to duplicate those

efforts. School districts that have agreements with HSD receive information on the Medicaid

status of their students. Schools then take the initiative to enroll those not on Medicaid that are

potentially eligible. CYFD also takes the initiative to see that children in their custody are en-

rolled in Medicaid if potentially eligible. Should funding be appropriated it will be necessary to

coordinate current activities of the three departments with any new programs to assure the un-

necessary expenditure of funds. Also, these funds may be eligible for matching funds thus dou-

bling the available amount.

HSD has learned through experience that many children potentially eligible but not enrolled are

in that status because of family choice not to enroll. Often parents choose not to enroll in Medi-

caid until there is an identifiable necessity such as a birth, a medical emergency or a requirement

for school physical or vaccinations.

In New Mexico more than one in five of the state’s population, or 21.1 percent, lack any type of

health insurance coverage. This figure, which represents nearly 400,000 New Mexicans, is sub-

stantially above the national average of 14 percent and ranks New Mexico second in the nation

for the rate of uninsured. Eight-two percent of the children who are uninsured in New Mexico

are eligible for Medicaid (New Mexico Medicaid Facts, American Academy of Pediatrics July,

2005). Medicaid is a safety net, providing necessary medical care to children from birth through

age 19.

Currently, the Public Education Department has a Joint Powers Agreement that allows for billing

for administrative Medicaid costs, including outreach. According to the Human Services De-

partment, the public schools have in place a system to determine whether a child is enrolled in

the Medicaid program. School districts send Medicaid a list of their students that is then

matched against the Medicaid enrollment. Medicaid sends the school district back a list of stu-

dents who are enrolled in Medicaid. This does not address whether or not the student has com-

mercial or other health insurance.

The New Mexico Department of Health provides services to children through its Women Infants

and Children Supplemental Nutrition Program, the provision of childhood immunizations, and

other program services. Children are assessed for insurance status, provided with Medicaid eli-

gibility information, and their families are assisted to enroll in Medicaid through Medicaid On-

site Application Assistance and Presumptive Eligibility services.

Senate Bill 482 – Page

3

PERFORMANCE IMPLICATIONS

None

ADMINISTRATIVE IMPLICATIONS

Depending on the type of process that is developed, there may be a need for information system

modifications within the Medicaid Management Information System and between the three de-

partments. No funding is provided for the analysis, design or implementation of system changes.

CYFD and PED would absorb any additional administrative costs related to implementation.

TECHNICAL ISSUES

The appropriation contained in this bill targets children enrolled in public schools and licensed

day care centers only – it would not target those children in child care homes registered by

CYFD.

Medicaid eligibility for public school students is determined yearly by the Medicaid School

Health Office of the Health and Human Services Division (HSD).

Presumptive Eligibility/Medicaid on Site (at school) Application Assistance can be made every

six months in accordance with the Medicaid recertification rule.

PED does not determine health insurance coverage or Medicaid eligibility.

According to the Medical Assistance Division Medicaid staff, determination of heath insurance

coverage or eligibility for Medicaid does not occur at licensed day care centers.

OTHER SUBSTANTIVE ISSUES

Many of the client children and families involved with CYFD service systems have medical and

behavioral health needs, are low-income, and have no insurance. Maximizing access to Medi-

caid services for these children and families is a critical support. The state also maximizes

health funding through the federal Medicaid match of direct service dollars.

Health Policy Commission provided the following information:

Prevalence of Uninsured Children in New Mexico

According to the 2004 Uninsured Household Survey, only 10% of New Mexico children under

the age of 6 are uninsured. This number grows to 13% among 6 to 10 year olds, and to 16%

among 11 to 17 year olds.

The Health Policy Commission’s (HPC) Quick Facts 2006 report sets forth the following ten-

year trends on the percent of uninsured children under 18 in New Mexico:

1995 17.5%

1996 20.1%

1997 17.1%

1998 27.7%

Senate Bill 482 – Page

4

1999 26.3%

2000 18.5%

2001 15.0%

2002 14.5%

2003 13.2%

2004 15.3%

Children Enrolled in Medicaid

According to the HPC’s Quick Facts 2006 report, as of July 31, 2005, approximately 260,128

children under the age of 21 were enrolled in Medicaid. This number accounts for approxi-

mately 62.86% of total Medicaid enrollment. Nearly 63% of all Medicaid recipients in New

Mexico are under the age of 21.

New Mexikids & Eligibility Requirements

The New Mexikids program, a no cost or low cost health coverage for children under 19 years

old, is part of a national $47 million program of the Robert Wood Johnson Foundation to help

insure children across the United States. If household income is less than 185% of the Federal

Poverty Guidelines, health care services are provided to the child at no cost. If household income

is between 185% - 235% of the Federal Poverty Guidelines, some of health care services may

require a co-payment at the time each service is provided.

ALTERNATIVES

The appropriation of $300.0 should be allocated to Medical Assistance Division, HSD, as it de-

termines the Medicaid eligibility of children.

WHAT WILL BE THE CONSEQUENCES OF NOT ENACTING THIS BILL

Funding may not be provided to develop a process to determine whether children are covered by

health insurance, and if they are not, to provide Medicaid eligibility information. It is estimated

that there are still several thousand uninsured children in New Mexico who are eligible for

Medicaid assistance but are not enrolled. Not enacting this bill could result in the continued un-

insured status of these children.

AMENDMENTS

If the intent of the language is to perform the enumerated functions then on Page 1, Line 19 de-

lete “to develop a process to” and insert “shall”

Also, on Page 1, Line 21 after “information” delete “:” and insert “and provide necessary assis-

tance to enroll in the Medicaid program:”

DL/mt