Less than 5% of New Mexicans who lost Medicaid during ‘unwinding’ switched to private insurance

First Choice Community Healthcare South Broadway Medical Center on Sept. 7, 2023. First Choice Community Healthcare and other federally qualified health centers in New Mexico are attracting attention from state lawmakers. (Photo by Anna Padilla for Source New Mexico)

The “unwinding” of COVID-19 protections contributed to interruptions in care at local health centers in New Mexico, adding to their financial struggles that are attracting attention from state lawmakers.

Federally qualified health centers are community clinics located in high-need areas or serving high-need communities.

Medicaid is New Mexico’s safety-net health insurance program for the very poor.

The health centers are “the backbone of New Mexico’s primary care safety net,” said Yvette Ramirez Ammerman on Wednesday.

Without Medicaid, the people served by these health centers often cannot afford any private insurance. One of the federal requirements the facilities must meet is to provide care to anyone who needs it, whether or not they can pay.

Some federally qualified health centers in New Mexico have faced accusations of financial mismanagement and overworking staff, most prominently First Choice Community Healthcare in Albuquerque and La Familia Medical Center in Santa Fe.

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They provide preventive care and treat chronic diseases, keeping people out of expensive trips to hospitals and emergency rooms, Ramirez Ammerman said.

“We are in places where no one else is,” she said. She leads the New Mexico Primary Care Association, which represents the more than 200 federally qualified health centers in all but one of New Mexico’s 33 counties.

Ramirez Ammerman gave her analysis to the New Mexico Legislative Health and Human Services Committee, which is considering legislation that would allow state officials to have more oversight over these federally qualified health centers.

Part of the problem, she said, is clinics are losing income and patients, for multiple reasons, including the end of the continuous enrollment requirement which kept Medicaid recipients on the rolls, regardless of their eligibility.

That requirement was part of the federal government’s formal public health emergency in response to SARS-CoV-2, the virus that causes COVID-19.

After May 2023, when President Joe Biden’s administration declared the public health emergency over, the Centers for Medicare & Medicaid Services required the states to re-evaluate everyone enrolled in the program over the course of a year.

As a result, about 219,100 New Mexicans lost the health insurance they were getting through Medicaid, according to KFF Health News .

Data compiled by KFF show that out of all completed Medicaid redeterminations, 85% of the people in New Mexico who lost their health insurance were dropped because of procedural reasons, and not because they were determined ineligible for coverage.

“When people lost their Medicaid eligibility, sometimes they didn’t know until they showed up in the clinic, so they were going to get services no matter what, whether or not we got paid by Medicaid,” Ramirez Ammerman said.

In July, New Mexico said it reinstated Medicaid coverage for about 21,000 children, giving their families a second chance to renew their coverage.

“We knew children were a group more at risk of losing coverage due to a lack of response than due to financial ineligibility,” said the state’s Medicaid director Dana Flannery.

Children ages six to 19 would be reinstated for at least a year, state officials said, unless they already turned 19 when they were reinstated.

However, federally qualified health centers also serve hundreds of thousands of other patients each year, including migrant seasonal farm workers, homeless patients, veterans, and people with mental health issues and substance use disorders, according to Ramirez Ammerman’s presentation to the committee.

“These are our most vulnerable New Mexicans that we are serving,” she said.

When people were losing their Medicaid, outreach and eligibility workers at the federally qualified health centers have been signing them back up if they’re eligible, Ramirez Ammerman said.

Despite those efforts, over the last year, most of New Mexico’s clinics Ramirez Ammerman oversees have lost Medicaid patients, she said, and there are fewer people on Medicaid coming into the clinics now than there were in 2019.

Rep. Eleanor Chavez (D-Albuquerque) asked where people go after they lose their health insurance. Ramirez Ammerman said she visited clinics and spoke with people who handle Medicaid enrollments who told her, “We’re not really sure where they go.”

They do not necessarily move over to New Mexico’s private insurance exchange BeWell NM, and they don’t necessarily return to the clinics without their Medicaid coverage, Ramirez Ammerman said.

Out of the hundreds of thousands of people who were kicked off Medicaid over the yearlong unwinding, 10,483 of them — or roughly 4.7% — ended up moving to the private exchange, a BeWellNM spokesperson said.

“We’re just worried that they’re not getting care, and are they ending up in emergency rooms?” Ramirez Ammerman said. “That is one of the things we don’t have a complete answer about but we’re working on it.”

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