Fiscal impact reports (FIRs) are prepared by the Legislative Finance Committee (LFC) for standing finance
committees of the NM Legislature. The LFC does not assume responsibility for the accuracy of these reports
if they are used for other purposes.
Current FIRs (in HTML & Adobe PDF formats) are a vailable on the NM Legislative Website (legis.state.nm.us).
Adobe PDF versions include all attachments, whereas HTML versions may not. Previously issued FIRs and
attachments may be obtained from the LFC in Suite 101 of the State Capitol Building North.
F I S C A L I M P A C T R E P O R T
SPONSOR Lopez
ORIGINAL DATE
LAST UPDATED
02/22/07
HB
SHORT TITLE Medicaid Recertification Quality Control
SB SJM 20
ANALYST Weber
APPROPRIATION (dollars in thousands)
Appropriation
Recurring
or Non-Rec
Fund
Affected
FY07
FY08
NFI
(Parenthesis ( ) Indicate Expenditure Decreases)
Duplicates HJM17,
SOURCES OF INFORMATION
LFC Files
Responses Received From
Department of Finance and Administration (DFA)
Human Services Department (HSD)
SUMMARY
Synopsis of Bill
Senate Joint Memorial 20 requests the Human Services Department to implement a quality
control mechanism for its Medicaid recertification procedures, particularly related to the
automatic closure process. Automatic closure is a computer default so a Medicaid case that is
not updated by a caseworker by a specified date is electronically closed without action by the
caseworker. The quality control mechanism should include tracking the number of cases closed
and subsequently reinstated, providing an analysis of why Medicaid recipients are terminated
from the program, and performing a "point in time" tracking of the number of people enrolled in
Medicaid. Further, HSD is requested to implement performance measures that include the quality
of Medicaid recertification procedures and the percentage of eligible New Mexicans receiving
Medicaid.
HSD is asked to report on the results of its efforts to the Legislative Health and Human Services
Committee in November 2007 and again November 2008.
pg_0002
FISCAL IMPLICATIONS
HSD does not identify any fiscal implications. However, DFA estimates a cost of approximately
$70 thousand annually with half paid by the state and half by federal Medicaid funds to support
one full time FTE.
SIGNIFICANT ISSUES
DFA notes that by federal law, Medicaid eligibility must be recertified at lease once every twelve
months. Currently, in New Mexico the recertification period is the federal maximum of 12
months. At least 45 days prior to the end of a twelve month certification, HSD sends the
required recertification paper work to the Medicaid recipient asking that the documents be
returned within fifteen days.
Two events generally cause a Medicaid case to be closed during the recertification process.
Either the person being recertified does not respond or the response comes so late in the cycle the
case worker assigned to the case cannot finish the necessary paperwork by the close of the
twelve month period. There are many reasons why individuals may not respond; they have
moved, they do not wish to re-apply, they have died, etc. HSD has no realistic way of knowing
why an individual does not respond.
DFA continues that developing a quality control/ tracking system to determine why people drop
off the program simply is not feasible because more often than not, the "why" is simply not
identifiable. HSD performs extensive outreach to assure as much as possible that all individuals
eligible for Medicaid receive the services they need, but there simply is not much more the
agency can do to identify why people drop through the cracks. Only if the individual eventually
re-applies applies for certification will HSD be able to determine why there was a gap in
enrollment.
HSD offers a similar response.
OTHER SUBSTANTIVE ISSUES
A recent case was filed in United State District Court for the District of New Mexico regarding
the apparent same issues related to the HSD Medicaid re-certification process, specifically auto
closure. On September 29, 2006 the case against HSD was dismissed in its entirety and left
existing re-certification procedures, including automatic closure, intact.
MW/mt