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A MEMORIAL

CALLING ON THE HUMAN SERVICES DEPARTMENT TO IMPLEMENT QUALITY-

CONTROL PROCEDURES IN ITS MEDICAID RECERTIFICATION PROCESS

BEFORE CLOSING A MEDICAID FILE AND TO AUDIT ITS NEW AUTOMATIC-

CLOSURE PROCESS.

WHEREAS, an estimated twenty-one thousand children have

lost medicaid health coverage over the past two years; and

WHEREAS, the number of persons on medicaid in New Mexico

is the lowest it has been since 2002; and

WHEREAS, the human services department implemented a new

program to close medicaid cases automatically without review

if clients have not properly recertified; and

WHEREAS, over one hundred twenty thousand medicaid cases

have been automatically closed since the new policy was put in

place; and

WHEREAS, an estimated seventy-five percent of the closed

cases were reinstated; and

WHEREAS, thus far, there has been no adequate

explanation of why such a high percentage of cases that were

automatically closed were reinstated; and

WHEREAS, when a medicaid file is automatically closed,

children as well as parents lose medicaid benefits; and

WHEREAS, children cannot ensure that their parents

properly recertify or reapply for them; and

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WHEREAS, between the automatic closure of a medicaid

case and its reinstatement, a child's health care is

disrupted; and

WHEREAS, such disruption of the doctor-child

relationship may cause interruption in vaccination regimens;

and

WHEREAS, there is no process in place for auditing

whether cases are appropriately closed;

NOW, THEREFORE, BE IT RESOLVED BY THE HOUSE OF

REPRESENTATIVES OF THE STATE OF NEW MEXICO that the human

services department be encouraged to track the numbers of

cases terminated on a monthly basis and to institute an audit

process in order to determine the percentage of terminated

cases and whether those cases are later reinstated; and

BE IT FURTHER RESOLVED that the human services

department be encouraged to track a representative sample of

cases assigned for automatic termination, reviewing such

sample cases before actually terminating clients; and

BE IT FURTHER RESOLVED that the human services

department be encouraged to weigh whether a case in the

representative sample was accurately assigned for termination,

whether the case involved a child who should not be penalized

for a parent's failure to recertify and whether the disruption

caused by a wrongful termination was justified by the

administrative-cost savings of an automatic closure; and

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BE IT FURTHER RESOLVED that copies of this memorial be

transmitted to the governor and to the secretary of human

services.