HOUSE MEMORIAL 66

51st legislature - STATE OF NEW MEXICO - second session, 2014

INTRODUCED BY

James Roger Madalena

A MEMORIAL

REQUESTING THE HUMAN SERVICES DEPARTMENT, THE NEW MEXICO HEALTH INSURANCE EXCHANGE AND THE OFFICE OF SUPERINTENDENT OF INSURANCE TO REPORT HEALTH CARE COVERAGE DATA RELATING TO MEDICAID AND THE NEW MEXICO HEALTH INSURANCE EXCHANGE.

     WHEREAS, on January 1, 2014, more than three hundred fifty thousand uninsured New Mexicans became eligible for health coverage through expanded medicaid coverage and qualified health plans through the New Mexico health insurance exchange; and

     WHEREAS, the New Mexico health insurance exchange and the expansion of medicaid will bring billions of federal dollars into the state's economy each year, creating thousands of jobs; and

     WHEREAS, health care coverage through medicaid and the New Mexico health insurance exchange provides financial security and helps New Mexicans access primary care, preventive care, behavioral health services and other medically necessary care; and

     WHEREAS, there continue to be persistent enrollment barriers that prevent people from getting the health care coverage for which they are eligible and that result in administrative waste; and

     WHEREAS, although individuals and families may apply for medicaid coverage through both the New Mexico health insurance exchange as well as the human services department, the exchange cannot sign someone up for medicaid coverage and must refer those whom it deems eligible to the human services department for a later determination; and

     WHEREAS, as a result of having to be referred to the human services department from the New Mexico health insurance exchange, applicants for medicaid may be susceptible to losing coverage or never getting enrolled if their applications are transferred between medicaid and the exchange; and

     WHEREAS, low-income families who apply for coverage through the New Mexico health insurance exchange are at risk of not finding coverage on the exchange or of lacking the information necessary to choose a cost-appropriate qualified health plan, which may result in them choosing low-premium plans with very high out-of-pocket costs and little actual access to health care; and

     WHEREAS, New Mexico should ensure that health plans through medicaid or the New Mexico health insurance exchange offer an adequate network of health care providers and needed services; and

     WHEREAS, both the human services department and the New Mexico health insurance exchange are developing new computer systems to enroll New Mexicans in health care coverage, providing an unprecedented opportunity to collect data on enrollment trends and health care disparities; and

     WHEREAS, accountability for public health care dollars is necessary to ensure that more New Mexicans have access to the health care they need and that millions of federal and state dollars are not wasted;

     NOW, THEREFORE, BE IT RESOLVED BY THE HOUSE OF REPRESENTATIVES OF THE STATE OF NEW MEXICO that the human services department and the New Mexico health insurance exchange be requested to publish a monthly report that is available to the public in print and on an internet web site and that includes the following data on health care coverage enrollment:

          A. the number of applicants who applied for coverage through the New Mexico health insurance exchange;

          B. the number of applicants who applied for coverage through the human services department;

          C. the number of applicants who successfully enrolled in either medicaid or a qualified health plan after applying for coverage through the New Mexico health insurance exchange;

          D. the reasons why coverage in a qualified health plan was denied to unsuccessful applicants;

          E. the reasons why coverage in medicaid was denied to unsuccessful applicants;

          F. the number of applicants who the New Mexico health insurance exchange referred to the human services department and the number of these applicants who have successfully enrolled in medicaid;

          G. the number of applicants who applied for coverage through the human services department, who the human services department referred to the New Mexico health insurance exchange and who were successfully enrolled in a qualified health plan;

          H. relating to applications for renewal of medicaid coverage:

                (1) the number of applicants whose medicaid enrollment was successfully renewed; and

                (2) the number of applicants whose applications for medicaid renewal were unsuccessful, including the reasons for denying each renewal application;

          I. the number of applicants who applied for a qualified health plan coverage through the New Mexico health insurance exchange and who were unsuccessful, including the reason for denying the application;

          J. the point-in-time number of individuals disenrolled from medicaid coverage, listed according to each medicaid health plan from which the individuals were disenrolled, the reasons for their disenrollment and how many of those individuals were re-enrolled in medicaid coverage within the succeeding six-month period;

          K. the point-in-time number of individuals disenrolled from qualified health plan coverage, listed according to each qualified health plan from which the individuals were disenrolled, and the reasons for their disenrollment;

          L. the number of New Mexicans who qualified for financial assistance through the New Mexico health insurance exchange;

          M. according to income bracket, enrollment in each of the offered levels of coverage, by actuarial value;               N. the number and types of exemptions the New Mexico health insurance exchange has granted to applicants for exemption from the requirement to obtain health care coverage;

          O. information comparing provider network adequacy for each qualified health plan and medicaid health plan;

          P. data on how many individuals who enrolled in medicaid and in qualified health plans accessed preventive care;

          Q. the number of individuals who have received early prevention, screening, diagnosis and treatment services for children; and

          R. the number of adverse actions against medicaid enrollees; and

     BE IT FURTHER RESOLVED that the office of superintendent of insurance be requested to provide quarterly reporting on the number and types of grievances and appeals of adverse determination made against carriers offering qualified health plans; and

     BE IT FURTHER RESOLVED that all data requested pursuant to this memorial be reported on a quarterly basis by race and ethnicity, gender, age bracket, zip code and the following income brackets:

          A. zero to one hundred thirty-eight percent of the federal poverty level;

          B. one hundred thirty-eight percent to two hundred percent of the federal poverty level;

          C. two hundred percent to two hundred fifty percent of the federal poverty level; and

          D. two hundred fifty percent to four hundred percent of the federal poverty level; and

     BE IT FURTHER RESOLVED that the human services department, the New Mexico health insurance exchange and the office of superintendent of insurance be requested to report on their progress in collecting and analyzing data at least twice during the 2014 interim and each interim thereafter; and

     BE IT FURTHER RESOLVED that copies of this memorial be transmitted to the governor, the superintendent of insurance, the secretary of human services, the executive director of the New Mexico health insurance exchange, the legislative finance committee and the legislative health and human services committee.

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