State agencies (still) need a culture shift, and fast!

2018-10-10T09:40:47+00:00 Blog Posts, Health Blog|

By Bill Jordan, MA
October 10, 2018

Our communities are healthier when everyone has access to health care. Healthy communities are good for business, the economy, and the state. January 2014 marked a new beginning for a healthier New Mexico. That’s when health care became available to all citizens and permanent residents in our state.

The Affordable Care Act (ACA), or ObamaCare, was fully implemented by 2014 and Medicaid was expanded to cover low-income adults. Coverage was now theoretically available to all New Mexicans. The kind of coverage depended on their income level.

Prior to the ACA, the Human Services Department (HSD) played the role of gatekeeper for the programs they administered, such as Medicaid. Instead of working hard to enroll everyone who was eligible, they seemed to view their job as making sure that as few people got enrolled as possible – even though they were eligible.

Back in 2013, I wrote a blog about how there needed to be a culture shift from gatekeeper to facilitator at HSD in order for the ACA and Medicaid expansion to be successful. Not only did that shift never happen, things at HSD got worse.

HSD actually institutionalized polices that made it more difficult for people to apply for Medicaid at the very time that the federal government was saying everyone should be helped to sign up for coverage. That federal policy was called “no wrong door” and it meant that no matter where you tried to get health care coverage, through HSD or through the federal Insurance Exchange, you could get coverage. Everyone in every agency was supposed to facilitate enrollment. Running contrary to the intent of ObamaCare, HSD still thought it was their job to be gatekeepers, not facilitators.

Things got so bad in 2015 that advocates took HSD to court, the state lost and a “Special Master” was appointed by the judge to oversee the operations of Medicaid and SNAP (food stamps) enrollment. As recently as April of this year, the judge again found HSD guilty of “violating people’s rights by imposing inconsistent and excessive requirements on applicants seeking benefits, delaying eligibility decisions.”

Our state can and must do better, but lifting barriers and welcoming all of those who are eligible for public programs will require a major culture shift in state government.

Come January 2019, when a new governor takes office, Medicaid in New Mexico will be under new leadership. One of the first orders of business should be to simplify enrollment, implement a policy of “no wrong door,” and begin to bring about a long overdue culture shift in the agency. The state’s HSD workers who currently enroll New Mexicans in Medicaid would then no longer determine whether applicants are eligible, but rather they would determine under which insurance plan they’re eligible. The interface between Medicaid and the Insurance Marketplace would be seamless. 

To further improve enrollment, HSD could cross-match Medicaid and SNAP applications to see if recipients of one program are eligible and could benefit from enrollment in the other. Also, the state tax department could determine what kind of health coverage families qualify for based on their income level, and then send them an application form with their tax refund check. If we are to help our families succeed and improve child well-being in our state, we need to maximize health care coverage and work supports like SNAP and child care assistance.

If that transition from gatekeeper to facilitator is successful, New Mexicans will be healthier and financially more secure. Families and children will have more opportunities to thrive and succeed, and our whole state will benefit. Let’s hope the new Governor’s commitment to implementation of the Affordable Care Act is deep enough to reach into the Human Services Department to help ensure that it works for all of New Mexico … and quickly!

Bill Jordan is the Senior Policy Advisor & Government Relations Officer at New Mexico Voices for Children