New Mexico Medicaid History and Facts

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Initial Medicaid Implementation: New Mexico began their Medicaid program on December 1, 1966. In the early years of the program, the state legislature refused to fund even a bare bones version of the Medicaid program. The state decided to not cover the medically indigent category of coverage making the program significantly cheaper but the legislature still would not fully fund it. Despite these limitations, the cost of the program continued to rise in the initial years. The state cut provider payments by 25% but these cuts were not enough to control spending in the program. On May 1, 1969 New Mexico became the first and only Medicaid program to shut down their program. For nine days the state ended their Medicaid program while the state tried to withdraw their current program and create a less generous program. This tactic was not allowed by federal law but was later added by New Mexico Senator Clinton Anderson. The provision would allow states to reduce benefits and ended the requirement that states extend benefits to all medically needy individuals by 1975. The amendment passed with little debate in the House but was eventually amended to require states to cover medically needy individuals by 1977, giving states two additional years to comply with this requirement. The amendment outlined services that the state could reduce and services that it had to maintain. This began the distinction of the mandatory and voluntary set of benefits. Prescription drugs were delineated as voluntary benefits and continue to not be mandatory to this day. This was the first major contraction of eligibility and benefits in the Medicaid program. Later it came out that the state’s Medicaid financial problems that led to these reforms and contraction of benefits available to beneficiaries was caused by profit seeking doctors and a lack of control over providers bilking the system. New Mexico politicians argued that the requirement to cover the medically needy would put significant strain on the budget of the state yet the state provided generous benefits to individuals who would have qualified for the medically needy provision including home health, vision and dental, benefits that are rarely covered for these populations.

Key Medicaid Political Issues: New Mexico has one of the highest portions of the population covered by Medicaid. Combined with Medicare and the Indian Health Service, only 41% of the population is covered by private insurance. Medicaid covers 31% of the population, the highest rate in the country. This is likely due to the fact that the state has a large number of low-income residents and New Mexico has a high number of Native Americans, many of who may receive both Medicaid and Indian health care services. Native Americans are not automatically enrolled in the Medicaid program but may enroll if they meet the income criteria. The state has struggled with mental health contracts and network adequacy around mental health care services for Medicaid beneficiaries. In 2013 the state ended contracts with 15 behavioral health providers over allegations of Medicaid fraud.

Medicaid Expansion Implementation: New Mexico implemented Medicaid expansion as part of the Affordable Care Act with enrollment beginning in October of 2013 and coverage beginning in January 2014. Republican Governor, Susan Martinez was the second Republican governor to accept the Medicaid expansion six months following the Supreme Court decision. As part of the Medicaid expansion, the state renamed their Medicaid program “Centennial Health” beginning on January 1, 2014. The renaming was accompanied by a shift from fee-for-service Medicaid to a more capitated program through integration of some pay for performance measures.The state was the first to pass a bill establishing a study committee on Medicaid Buy-In and may be going forward with the policy in future years. The state’s new governor, Michelle Lujan Grisham introduced legislation at the federal level that would allow states to elect to run Medicaid Buy-In programs. The state is also exploring avenues that would allow for auto-enrollment in Medicaid through eligibility in other state programs.

General facts about New Mexico Medicaid:

Medicaid program name: Centennial Health

CHIP Program name: New Mexikids/Mexiteens

Separate or combined CHIP: Medicaid expansion

Medicaid Enrollment: 727,000 (2018 estimate)

Total Medicaid Spending: $4.8 billion

Share of total population covered by Medicaid: 31%

Share of Children covered by Medicaid: 50% (estimate)

Share of Medicaid that is Children and Adults: 80%

Share of Spending on Elderly and people with disabilities: 36%

Share of Nursing Facility Residents covered by Medicaid: 66% (estimate)

FMAP: 72.26%

Expansion state: Yes

Number of people in expansion: 253,000 (2018 estimate)

Work Requirement: No

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New Jersey Medicaid History and Facts

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Initial Medicaid Implementation: New Jersey initially implemented Medicaid in January 1970, the deadline for states to begin their Medicaid programs if they wanted to maintain their funding for low-income individuals. In the early years of Medicaid, Congress debated the funding level of the FMAP after it was determined that the cost of the Medicaid program was higher than anticipated. A measure was passed that would have reduced the federal share of the payments to as low as 25 percent for some wealthier states. Since New Jersey would likely fit that definition of states that would receive a lower federal match, their senator was the only one to object to the bill and it passed as part of a tax bill in the Senate. At the time, New Jersey was also a very fiscally conservative state and waited until the “deadline” of the end of the Kerr Mills federal dollars in order to accept the Medicaid program. At the implementation of the program, the state elected not to provide for medically indigent category of eligibility.

Key Medicaid Political Issues: In the early to mid-1990s the state went through a retrenchment in its Medicaid program with reductions in hospital spending accompanied with deregulation and mandatory managed care enrollment for cash assistance beneficiaries. These changes were largely due to a change in the political makeup of the legislature and economic conditions in the state. Republicans took control of the legislature at the same time that periodic recessions affected the state budget. This created a climate for reductions in Medicaid spending. New Jersey has taken many steps to address more public health and social determinants of health through its Medicaid program. The state has run programs to provide supportive housing which benefits the Medicaid program. In 2012 the state passed a waiver that created several integrated managed care programs addressing behavioral and social factors that affect health. Maternal mortality and the racial differences in maternal mortality rates have been a concern for the state in recent years.

Medicaid Expansion Implementation: New Jersey began their Medicaid expansion with enrollment beginning in October of 2013 and coverage beginning in January of 2014. New Jersey was one of the five states that decided to expand Medicaid coverage prior to 2014 using a flexibility within the law that allowed states to expand coverage early. However, the state only extended coverage for adults up to 23% of the federal poverty level beginning in April of 2011. Chris Christie was the governor of New Jersey at the time and there was some concern that he may not implement the program as a Republican governor. In the early days of the Medicaid expansion in New Jersey, the state had significant issues redirecting the Medicaid applications from the federal HealthCare.gov website to the state Medicaid program which led to delays in Medicaid beneficiaries receiving a determination of whether they were able to enroll in Medicaid.

General facts about New Jersey Medicaid:

Medicaid program name: Medicaid

CHIP Program name: NJ Family Care

Separate or combined CHIP: Combination

Medicaid Enrollment: 1.8 million (2018 estimate)

Total Medicaid Spending: $15 billion (FY 2017 estimate)

Share of total population covered by Medicaid: 17%

Share of Children covered by Medicaid: 33% (estimate)

Share of Medicaid that is Children and Adults: 79%

Share of Spending on Elderly and people with disabilities: 64%

Share of Nursing Facility Residents covered by Medicaid: 57% (estimate)

FMAP: 50%

Expansion state: Yes

Number of people in expansion: 563,000 (2018 estimate)

Work Requirement: No

New Hampshire Medicaid History and Facts

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Initial Medicaid Implementation: New Hampshire began their Medicaid program in July of 1967. The state had run programs that helped people with limited incomes since the 1930s, prior to the implementation of the Social Security Act. The state had some issues with determining the correct payment rates and ensuring that there was little fraudulent payments, like many other states were experiencing at the time.

Key Medicaid Political Issues: New Hampshire, like other states in New England, has a low rate of uninsurance. New Hampshire extends CHIP coverage up to 300% of the poverty level, making it one of the most generous programs in terms of extending coverage to higher income families. The eligibility in these programs is divided into several levels of income eligibility and generosity of benefits. New Hampshire has a system that allows counties to contribute toward the cost of nursing facility services. New Hampshire has historically had high per-beneficiary spending, particularly for the aged, blind, and people with disabilities. Of that, the dual eligible population has driven a majority of those costs. After an attempt by the governor’s office to implement a waiver program that would move payments out of nursing facilities and into the home the legislature began requiring Medicaid waivers be approved by the legislature before submission. In recent years the focus of the Medicaid program has been on addressing the treatment of people with opioid dependency as the state has been on the forefront of the opioid epidemic.

 Medicaid Expansion Implementation: New Hampshire passed their Medicaid expansion in March of 2014. The state legislation required the governor to expand Medicaid using an 1115 waiver but allowed the state to expand through a state plan amendment while the 1115 waiver was being approved. This meant that enrollment for Medicaid expansion began in August of 2014 but the 1115 waiver was approved in November of 2014. Meaning that for a few months people enrolled in coverage without the stipulations of the waiver. The state governor flipped to being controlled by a Republican governor in 2016. In 2018 the state became the fourth state to have a work requirement plan approved by CMS. The plan is set to be implemented in January of 2019.

General facts about New Hampshire Medicaid:

Medicaid program name: Medicaid

CHIP Program name: Healthy Kids

Separate or combined CHIP: Medicaid Expansion

Medicaid Enrollment: 182,000 (2018 estimate)

Total Medicaid Spending: $2.1 billion (FY 2017 estimate)

Share of total population covered by Medicaid: 13% (estimate)

Share of Children covered by Medicaid: 33% (estimate)

Share of Medicaid that is Children and Adults: 80%

Share of Spending on Elderly and people with disabilities: 59%

Share of Nursing Facility Residents covered by Medicaid: 33% (estimate)

FMAP: 50%

Expansion state: Yes

Number of people in expansion: 54,000

Work Requirement: Yes (Beginning in January 2019)