pg_0001

.165647.1

SENATE JOINT MEMORIAL 20

LEGISLATURE

- STATE OF NEW MEXICO -

FIRST SESSION

, 2007

INTRODUCED BY

Linda M. Lopez

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

pg_0002

.165647.1

- 2 -

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

pg_0003

.165647.1

- 3 -

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;

pg_0004

.165647.1

- 4 -

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

pg_0005

.165647.1

transmitted to the secretary of human services and the

governor.

- 5 -