SANTA FE, N.M. (KRQE) – A new report reveals Medicaid issues facing thousands of New Mexicans. Nearly 100,000 locals have been unenrolled due to changing eligibility requirements and issues plague remaining customers, according to a report by the Legislative Finance Committee (LFC).
Medicaid is the state’s largest single expenditure and serves almost half of all the people in New Mexico, according to the LFC. During the COVID-19 pandemic enrollment grew to a peak of about 1 million locals enrolled. But since the start of 2023, that enrollment has dropped.
From August 2023 to April 2023, about 98,000 New Mexicans were disenrolled, according to the New Mexico Human Services Department. Some are no longer eligible due to the federal government resuming income-based requirements. The Human Services Department has been working to reach out to eligible-but-disenrolled individuals for re-enrollment. For more information on how to re-enroll, you can read this story.
New Mexico has a particularly high rate of “procedural” disenrollment, the LFC says. That’s when individuals may be eligible for Medicaid but are disenrolled because they failed to submit paperwork or connect with the Medicaid system. With high call wait times over the last few months, procedural disenrollment has likely impacted many New Mexicans – something the LFC calls “especially concerning.”
Some of the fault seems to lie with the federal Centers for Medicare & Medicaid Services (CMS). They reached out to New Mexico acknowledging that they may have made it difficult for Medicaid enrollees to remain enrolled, according to the LFC. But state-run call centers may also have been an issue, with average wait times ranging from 16 minutes to 25 minutes over the last few months, according to the LFC.
New Mexicans who remain enrolled in Medicaid, may face other issues as New Mexico works out kinks within the system. For example, the state was supposed to renew the managed care program at the start of 2024. That program handles the majority of all Medicaid enrollees in the state, according to the LFC. But the contracting process was delayed, which the LFC says will also push back the implementation of planned accountability measures.
New Mexico is also working to implement a new Medicaid information system. In 2021, the plan was for a $349 million upgrade to the new system. Now, that cost has risen to $418 million, according to the LFC. Federal matching will help cover most of that, but the project has still been slow to develop. It was supposed to be done in 2019 but 2026 or 2027 is the news estimated completion date, according to the LFC.
