[MM Curator Summary]: NM officials think about half the members will go to exchanges with zero premiums to pay.
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An estimated 85,000 New Mexicans will see their Medicaid coverage end when the federal government lifts the public health emergency that’s been in place during the coronavirus pandemic.
State officials are working to ensure nearly all of them are shifted to other medical plans, including subsidized policies offered through the state’s health insurance exchange.
“Our goal is to keep all the folks covered,” said Nicole Comeaux, New Mexico’s Medicaid director.
Like other states, New Mexico received extra federal dollars for Medicaid through a COVID-19 relief plan in return for keeping new patients enrolled until the declared health emergency was officially called off.
State health officials estimate 85,000 patients will be deemed ineligible for Medicaid when the health emergency ends, but they’re confident about half will move to employer-sponsored medical plans and half will enroll in plans offered through the health exchange, known as beWellnm.
About 5,000 pandemic enrollees will qualify for reduced Medicaid coverage.
Nationally, health authorities call the upcoming transition an unwinding. State officials refer to it as the Medicaid roll-off.
Before the pandemic, the state received $3.50 in federal money for every dollar it invested in Medicaid; the federal match increased to about $4.70 under the emergency declaration, Comeaux said.
The two largest groups who joined the rolls during the pandemic are families with “very low” incomes and adults whose earnings are 138 percent or less of the federal poverty level, she said.
The Biden administration is signaling it will make one final 90-day extension of the health emergency in mid-April, so the transition of ineligible Medicaid members must be underway by summer, Comeaux said.
At a beWellnm board meeting Friday, Jeffery Bustamante, the health exchange’s CEO, said the goal is to get all patients who lose Medicaid coverage and qualify for plans through the exchange enrolled in insurance policies. The exchange largely serves self-employed workers and their families and others who don’t receive medical coverage through their employer. It also offers group coverage for workers at some small businesses.
“This is without a doubt an aggressive goal,” Bustamante said. “But this is a once-in-a-lifetime moment for the exchange, where we have people who are eligible and willing to sign up for a public program.”
The exchange, which offers plans from six carriers, has more than 40,000 patients enrolled this year.
Many patients who signed up for policies are now benefiting from subsidies through the federal American Rescue Plan Act, which has drastically reduced premiums. BeWellnm officials said in December that 4 in 5 New Mexicans eligible for the exchange could enroll for less than $10 a month.
A few board members on Friday expressed skepticism about trying to hit the 100 percent target in enrollment, however.
“I’d really like to see a more realistic goal … and not ‘let’s hope we get there’ goal,” board member Teresa Gomez said. “I think 100 percent is completely unrealistic.”
Bustamante said no one offered membership should refuse, given most who are dropped from Medicaid will qualify for plans with zero premiums. It’s simply a matter of meeting with the people and ensuring they know what’s available to them, he said.
States’ Medicaid enrollment swelled by 22 percent to about 78 million people by September, the highest participation since the program was created as a cornerstone of President Lyndon B. Johnson’s War on Poverty, according to a Washington Post story, which noted New Mexico has the highest proportion of residents on Medicaid in the country.
States face a deadline for moving ineligible members off Medicaid. Federal subsidies will continue for only three months after the emergency ends, and afterward a state must pay the full costs of the rolls containing unqualified enrollees.
In effort to create a buffer to give states more time, some proposed funding was added to the Build Back Better bill for that purpose, but the legislation has stalled in the U.S. Senate.
Comeaux said the overall roll-off will go 14 months and will require vetting all of the state’s Medicaid recipients to determine who’s eligible to receive benefits.
The plan is to identify those who no longer qualify for Medicaid by Aug. 1 and transfer as many as possible to the health exchange, she said.
People won’t be without a lifeline if they fall off the rolls before beWellnm’s official enrollment period begins in the fall, officials say.
They can sign up for a health exchange plan in a special enrollment period designed for those who lose Medicaid coverage, and many can receive financial aid for their insurance premiums from the state’s Health Care Affordability Fund, said Colin Baillio, project manager for the state insurance superintendent.
At the meeting, Bustamante said in-person meetings with Medicaid recipients and a clear message about what is happening and what they need to do will help ensure no one is left without coverage.
Comeaux said it also will be imperative that Medicaid recipients update their personal information, such as addresses, to ensure a smooth transition to the health exchange if they are removed from the rolls.
“That only works if people have kept us updated about where they are,” Comeaux said. “Get us your information. It gets you to a different source of coverage.”