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Telemedicine Resources

 What is Telemedicine, and how can I access it?

 

Definition

Especially during the COVID-19 pandemic, it is important to stay home and refrain from visiting the hospital unless your medical issue requires urgent hands-on care.  However, you don’t have to forego your routine services or put off important visits during this time.  Even as services begin to reopen, 

Telemedicine is a way to access quality health care services over the phone or through video chat, including diagnosis, consultation, prescriptions, and referral to a physician. Telemedicine services are often covered by insurance and provide a safe, secure way to get care from a distance. 

Telemedicine is also an important resource if you think you are experiencing COVID-19 symptoms to lessen the risk of exposing yourself and others to the disease.

 

Why you should consider it

In addition to the reasons above, telemedicine allows you to receive specialist consultation from the comfort of your home and on your own time; you can record a video for your doctor if you’re experiencing symptoms outside of normal office hours, or you can chat with a doctor live if they’re available. Telemedicine is also more affordable than a traditional consultation and can be a great resource for those without insurance.

New Mexico also covers one of the widest ranges of telemedicine services in the country; so even if you’ve been unable to receive a consultation in another state, New Mexico may cover it!

 

What are my options?

Because of legislation passed in 2019, New Mexico law requires most insurance carriers to cover basic telemedicine at no extra cost. Below is a quick guide to telehealth under major insurance carriers in New Mexico. Find your insurance carrier below to see their current telemedicine policies, but call your carrier for the most accurate information. Even if you have insurance, self-pay may be more cost-effective, so be sure to explore all your options!

 

Insurance Carrier

Current Telemedicine Policy

Medicaid

Medicaid covers all telemedicine services under both fee-for-service and managed care plans. There are no restrictions on which providers can bill for telemedicine, so nobody is “out of network.” There is also no restriction on locations, so you can be located anywhere at time of service. 

See details here.

Medicare

Under Medicare Part B, telemedicine services are generally covered at the same level as in-person visits for approved providers. 

See details here.

True Health

True Health offers telehealth services through MDLive. For non-emergencies, call the True Health New Mexico Care Connect Line toll-free at 1-844-308-2552.

See details here.

NM Health Connections

Telemedicine is covered under regular member benefits. Providers bill with a modifier to indicate that services were dispersed through telemedicine, but costs are the same. 

Presbyterian

HIPPA compliance has been relaxed during Covid-19; now you can use skype or other software to visit with your doctor. Pricing is based on individual provider contracts using base rates established by CMS and NM HSD. Normal office visit copays will apply if services aren’t for treatment of confirmed COVID.

PHP is permitting all credentialed and contracted providers to conduct telemedicine video sessions for all routine services regardless of your telemedicine attestation.

See details here.

Blue Cross Blue Shield

Blue Cross Blue Shield offers telehealth services to members through MDLive. At least until June 18th, 2020, Blue Cross Blue Shield is waiving cost-sharing for telehealth services for insured members at all in-network providers.

See details here.

Molina

Molina offers Teladoc to its members at the same rate as in-person visits. Click here to set up an account and schedule an appointment.

See details here. 

NM Medical Insurance Pool

Teladoc and telehealth services are covered in-network for insured members. There are also limited teledentistry benefits for customers under 19.

 

 

 

 

Federally-Qualified Health Centers

FQHCs are offering expanded telehealth services, and are treated the same as in-person visits for billing purposes.

 

Self-Pay

There are many telemedicine services that allow self-pay, and they are often more affordable for uninsured individuals than in-person visits. Make sure you are accessing reputable providers. Teladoc contracts with many service providers and provides quality telemedicine services. Another good starting point is GoodRX, which has a database of reputable telehealth providers and allows you to compare prices and reviews from different providers

Health Action

What do I do if I lose my health insurance?

What do I do if I lose my health insurance?

Coronavirus is a public health emergency that has upended the economy, causing tens of thousands of New Mexicans to lose their jobs and the health insurance provided by their employer. No one should go without health coverage during this pandemic. Fortunately, there are quality coverage options available to all people in New Mexico. Most people who lose their insurance qualify for Medicaid or Marketplace coverage. If you don’t qualify for those options, you automatically qualify for comprehensive coverage on the New Mexico Medical Insurance Pool. It is important to sign up as soon as possible to avoid disruptions in coverage and meet the deadline for getting covered. Here is Health Action NM’s guide to staying covered and avoiding scams during this difficult time.

What do I qualify for?

Everyone qualifies for coverage during the pandemic. The first thing you should do is use Healthcare.gov’s online screening tool to see what type of coverage you might qualify for. Based on that screening, we recommend contacting the New Mexico Human Services Department, BeWellnm, or the NM Medical Insurance Pool to get help filling out your application. But if you want to sign up on your own, this blog post has some helpful tips.

 

Medicaid

Medicaid is a comprehensive health coverage program that is available to low-income U.S. citizens. If you receive coverage through Medicaid, all costs related to COVID-19 will be covered free of charge. If you were billed for testing or treatment related to COVID-19, you can file a complaint here. Medicaid eligibility is based on your household’s current monthly income, not how much you made in the past or expect to make this year. You qualify for Medicaid if you make less than the monthly income listed on the table below called “TABLE 1: Medicaid Eligibility.” When selecting your family size, include yourself, your spouse, and everyone you claim as a dependent, even if they don’t need coverage. If you have questions about whether or not to include someone when determining your family size, check here.  

TABLE 1: Medicaid Eligibility

To see if you qualify for Medicaid, select how many people are in your family at the far left of the table, then see if your monthly income is below the amount listed. If it is, you likely qualify for Medicaid. Even if you don’t qualify for Medicaid, your children might.

      Family Size

                Adults         

      Pregnant Women

                   Monthly Household Income

1

$1,467

$2,712

2

$1,983

$3,664

3

$2,498

$4,616

4

$3,013

$5,568

5

$3,528

$6,520

6

$4,043

$7,472

 

 

 

If you think you qualify for Medicaid, here is how you can sign up. We recommend starting off by calling the Human Services Department at 1-855-637-6574 to confirm that you meet the basic program requirements.

Sign up over the phone: If you want help with your application call or prefer to complete your application over the phone, call 1-855-637-6574. 

Sign up online:Online Application

Fill out the application on paper:Paper Application

Need help? Call customer service at 1-800-283-4465 or visit this webpage.

During the application process, you will be asked to provide information about your household income. The table below shows the type of income information that you will need to share to get covered.

                      How to determine monthly income for Medicaid

Type of Income

Does it count towards my income for Medicaid?

Earnings from a prior job

No

Current earnings from a spouse

Yes

Unemployment insurance

Yes, but not the additional $600/week for COVID-19 aid. To calculate the amount you should enter on your Medicaid application, subtract $2,400 per person who is receiving the benefit. 

Severance benefits

Yes (in the month they are received)

Expected earnings from a future job

No

SNAP benefits/food stamps

No

Tax rebates, including the special $1,200 per person rebate provided because of COVID-19

No

Source: Brookings Institute

Marketplace Coverage through BeWellNM

 Marketplace Coverage is available to individuals and families that do not qualify for Medicaid and are not offered insurance by an employer. COVID-19 testing and treatment is covered free of charge, thanks to an order signed by the New Mexico Superintendent of Insurance under Governor Lujan Grisham’s COVID-19 emergency order. Many Marketplace applicants qualify for premium reductions based on income and household size. These reductions are called Premium Tax Credits, and are based on your expected incomefor the year you are applying for coverage. For instance, if you were enrolling for coverage for 2021, you would calculate what you think your income will be for 2021, and the Marketplace will use that amount and your household size to calculate the discounts you qualify for. For questions about how to estimate your income and who to include in your household, click here.

 

If you lose your job-based health insurance, have a significant reduction in your income, or experience other qualifying events, you may be eligible for a special enrollment period to sign up for coverage. If you experience one of these events, you have a 60-day window to apply for coverage.

 

Remember, if your income goes up during the year, you should adjust it on Healthcare.gov so that you don’t have to pay it back at the end of the year. You can also adjust your income down if you expect to earn less, which will reduce your premiums. If you gain a new form of coverage, such as Medicaid or job-based coverage, make sure to terminate your coverage through BeWellNM to avoid unexpected fees.

 

TABLE 2: Eligibility for Marketplace Coverage through BeWellNM 

 

If you think you qualify for Marketplace Coverage through BeWellNM, here is how you can sign up. We recommend starting off by calling BeWellNM (New Mexico’s Health Insurance Exchange) at 1-833-862-3935 to confirm that you meet the basic program requirements. 

Sign up over the phone: If you want help with your application call or prefer to complete your application over the phone, call 1-833-862-3935.

Sign up online:Online Application

Fill out the application on paper:Paper Application

Helpful resources:

Get more helpful information:bewellnm.com

Use the NM Plan Comparison Tool:New Mexico Plan Comparison Tool 2020

Preview your options:Window Shop for a Plan

During the application process, you will be asked to provide information about your household income. The table below shows the type of income information that you will need to share to get covered.

 

 

The New Mexico Medical Insurance Pool

All people who reside in New Mexico qualify for the New Mexico Medical Insurance Pool (or “the pool”). COVID-19 testing and treatment is covered free of charge. You can sign up for the pool any time of the year. You can get premium discounts based on your income. 

TABLE 3: Eligibility for the Medical Insurance Pool

 NMMIP Eligibility.png

Normally, the pool uses your tax return from the previous year as well as any Social Security payments you receive to determine eligibility. However, if you lose your job or have other major changes in your economic situation, you can give them an estimate of your current income and the pool will work with you to reduce your premiums.

If you think you qualify for the New Mexico Medical Insurance Pool, here is how you can sign up. We recommend starting off by calling the pool at 1-505-424-7105 or 1-844-728-7896 to confirm that you meet the basic program requirements. 

If you want help with your application call or prefer to complete your application over the phone, call 1-505-424-7105 or 1-844-728-7896.

Fill out a digital or paper application:Digital or Print Application

 

Keep your employer coverage

COBRA allows you to continue the health coverage you had through your employer after you lose a job, as long as the termination did not involve gross misconduct. This option is available to workers whose employer covers 20 or more employees. COBRA is usually quite expensive and other coverage options, like Medicaid, Marketplace Coverage through BeWellNM, and the NM Medical Insurance Pool, are typically more affordable. Click here to see if you qualify for COBRA. For application assistance, call 1-866-444-3272. If you need more information, you can visit the following websites:

">NM COBRA FAQ

New Mexico COBRA Insurance - Health Care Continuation

U.S. Department of Labor: Continuation of Health Coverage (COBRA)

 How can I get help with my application?

If you want to talk to an enrollment counselor who is not affiliated with any health insurance company, visit https://bewellnm.com/Find-Counselor. They can usually help you sign up for any type of insurance, including Medicaid, Marketplace Coverage through BeWellNM, the NM Medical Insurance Pool, or Medicare.

If you want to talk to a broker about signing up for private insurance or insurance through the NM Medical Insurance Pool, visit https://bewellnm.com/Find-Broker to find a broker in your area.

Medicaid

Human Service Department’s Customer Assistance Center: 1-800-283-4465

Marketplace Coverage through BeWellNM

BeWellNM’s Call Center: 1-833-862-3935

NM Medical Insurance Pool

Office Number: 1-505-424-7105

Call Center: 1-844-728-7896

 

How do I avoid scams?

Unfortunately, some are using this pandemic as an opportunity to sell junk health insurance by misleading people about their options. Here are some websites you can trust to give you accurate information about comprehensive health coverage:

Hsd.state.nm.us or yes.state.nm.us

bewellnm.com

Healthcare.gov

NMMIP.org

 

Health Action

HANM Recommendations for Federal Action on COVID-19

COVID-19 has exposed major holes in our health care system and social safety net. Bold action is needed to ensure that New Mexicans have the resources they need. The Families First Coronavirus Response Act (FFCRA) was a critical first step in this effort.

However, additional steps will be necessary. The State of New Mexico, local clinics, and the New Mexicans who are weathering this crisis need more resources to ensure an adequate response. To that end, Health Action New Mexico has developed a series of health-related recommendations to help individuals and families access care and feel more financially secure, bolster the state’s capacity to respond, and assist clinics who help vulnerable populations. While this is by no means a comprehensive list of the steps necessary to address this crisis, we hope it provides useful insight on critical health coverage and access issues facing New Mexico and the United States.

Create a Universal Coronavirus Crisis Health Insurance Program.
While FFRCA guarantees free testing for uninsured Americans, treatment costs may deter individuals from seeking necessary services. According to the Robert Wood Johnson Foundation, while “costs clearly pose a barrier for the uninsured, the likelihood of significant cost-sharing, combined with a wariness about out-of-network billing, may deter even those with insurance from seeking care.” That is why it is imperative for the federal government to establish a COVID-19 Coronavirus Health Insurance Program built upon the framework of Medicare.

Because our health insurance system is so fractured, it is difficult to have a coordinated response to a global pandemic. Medicare’s provider network, billing system, and consumer protections are well-suited to take on this challenge. In addition, health insurers did not anticipate the resources necessary to cover COVID-19 and will likely require a bailout if they are overwhelmed by those costs. Creating a federally financed and administered program to offset those costs and logistical challenges is prudent. As the authors of a recent article on this approach describe, there are four major upsides to this type of program:

  1. “In one step, Congress could stop financial barriers from interfering with coronavirus care — a threat that will otherwise grow as more people lose employment and their health insurance. There is little value in providing free diagnosis if patients who test positive are reluctant to go to the hospital as their condition deteriorates. Every delay in treatment is an opportunity for the virus to spread deeper into communities.
  2. “A second advantage is better data. A new program using a single billing system could aggregate information quickly about where and how much illness is occurring. Places like Taiwan and South Korea are each using a single data set to identify and track changes in demographic and clinical factors associated with infection and hospitalization. A single billing system can also improve the ability to track the total number of tests performed, which is helpful for gauging disease prevalence. This information can then be used to drive local recommendations for social distancing and clinical care.
  3. “A third advantage is a more sustainable national response. Insurance companies did not include the potential massive expense of care for novel coronavirus in their actuarial calculations and are at risk for massive losses in the coming year that could not have been predicted. Rather than wait for the insurance industry to need bailouts or much higher premiums in ensuing years, the federal government can assume the expense directly. Doing so will also relieve the unexpected burden of coronavirus on self-insured employers, reducing the pressure for layoffs.
  4. “A fourth and final advantage is a mechanism for everyone to benefit from medications and vaccines for the novel coronavirus. A new program can negotiate for a global purchase of critical medical advances for the entire population at a fair price for the companies that have invested to develop them.”

It is vital that this program be universal, so that no one goes without necessary testing and treatment. This effort should be carried out in conjunction with other measures to help as many people as possible sign up for comprehensive health insurance. We recommend the swift adoption of a Universal Coronavirus Crisis Health Insurance Program.

Further enhance the Medicaid Federal Matching Assistance Percentage (FMAP).
State budgets are going to be under immense pressure, as officials decide how to meet the increased demand for effective public services while the economy is in freefall. The FFRCA provides some relief by increasing the Medicaid FMAP by 6.2%. States should not be forced to cut Medicaid at a time when our health care system is under so much strain. We recommend that, at a minimum, the Medicaid FMAP be increased by an additional 5.8%, for a total 12% increase when combined with the provisions of FFRCA. The provision should also include a mechanism to automatically increase the FMAP if economic conditions worsen.

Restore the 100% FMAP for Medicaid expansion.
In addition to providing relief for state budgets, our hope is that restoring the 100% FMAP for Medicaid expansion will encourage other states, including our neighbors in Texas, to reconsider expanding their program during this difficult time. Because the communities along the border of New Mexico and Texas are so interconnected, poor access to medical services on the other side of the state line puts New Mexico at heightened risk. We recommend that Congress restore the 100% FMAP for Medicaid expansion for the duration of the crisis and maintain the matching rate until state budgets have fully recovered.

Provide additional health care resources to Native Americans, Indian Health Service (IHS), and tribal public health programs.
First and foremost, Native American tribes and nations should be consulted to determine their priorities and needs. IHS is chronically underfunded and will likely require additional capacity to administer tests and take precautions necessary to keep health care workers safe. Tribes also need additional resources for public health programs. To reduce barriers to health coverage, premiums should be waived for Native Americans who qualify for Marketplace coverage. We recommend adopting measures to address the health needs prioritized by tribal leaders.

Provide an infusion of resources to private non-profit clinics, Federally Qualified Health Centers (FQHCs), and FQHC look alikes.
As clinics that disproportionately serve the uninsured prepare for a major surge in services, clinic finances are of great concern. These clinics in particular operate on very thin margins and rely on donations, private foundation grants, and patient co-pays to keep their doors open. Many of these funding sources may be strained in the coming months, even as the clinics have an influx of patients. Federal grants should be made available to private non-profit clinics, with additional resources made available to those who serve a higher proportion of uninsured patients. FQHC funding should also be increased. We recommend that Congress provide an infusion of resources to private non-profit community clinics, FQHCs, and FQHC look alikes.

Ensure rural providers have the resources they need.
Because the Coronavirus has reached urban centers first, there are concerns that states will be financially pressured to divert resources towards hospitals in those areas. We recommend the establishment of a Rural Provider Emergency Fund that providers can tap into if hospital or clinic financing takes a downturn during the pandemic.

Create a Special Enrollment Period (SEP) on the federal Health Insurance Marketplace and waive Marketplace premiums for certain populations.
States like New Mexico that currently rely on the federal Health Insurance Marketplace platform (Healthcare.gov) cannot establish SEPs. Instead the federal government sets SEPs. Despite requests from a variety of leaders and stakeholders, the Trump administration has not yet established a COVID-19 SEP. We recommend a general SEP lasting through April and a rolling SEP for qualifying uninsured individuals who contract COVID-19. One way to provide targeted economic relief for families and encourage uninsured New Mexicans to sign up for coverage is to eliminate premiums for Marketplace coverage in the coming months. We recommend that Congress adjust Marketplace advance premium tax credits so that they cover premiums for individuals under 400% FPL in their entirety for the next three months.

Give states the authority to work directly with the World Health Organization (WHO) and other countries to secure COVID-19 testing kits.
The federal government’s response to developing and distributing COVID-19 testing kits has been a failure. The Trump administration chose not to secure tests from WHO when they were first available. Given that there is still a massive shortage of testing kits, states need to be able to get effective kits however they can. We recommend that Congress pass measures allowing states to work directly with WHO and other countries to secure COVID-19 testing kits.

Bolster production of personal protective equipment for all who need it and combat price gouging for basic medical and sanitary supplies.
Medical professionals and medically vulnerable populations need personal protective equipment. Shortages of respirators have been alarming and there are reports of individuals purchasing the respirators en masse. The federal government should take steps to boost production of equipment and make sure that they are immediately available to those who need it. In addition, basic medical and sanitary supplies should be readily available to consumers, but reports of price gouging have been on the rise in recent weeks. We recommend subsidizing the production of personal protective equipment, creating processes for ensuring those who need it most have access, and combat price gouging for basic medical and sanitary supplies, including medications.

Immediately reverse the public charge rule.
While US Customs and Immigration Services announced a temporary suspension of public charge rules, Health Action New Mexico has heard from several partner organizations that families continue to fear that public charge rules will be used against them in the future. We need to make sure that no one fears using public services that they qualify for during this global pandemic. We recommend amending federal statutes to reverse recent changes to public charge rules.

Forgive medical debt for those diagnosed with COVID-19.
When people are diagnosed with COVID-19, the last thing they should worry about is medical bills, especially as the overall economy is on a downward trajectory. According to a study published in the National Center for Biotechnology Information, “problems paying medical costs are associated with higher credit card debt, more calls from bill collectors, increased bankruptcy rates, and diminished access to care.” We recommend forgiving medical debt for all people diagnosed with COVID-19.

— — —

We need bold, decisive action as soon as possible to ensure that all people can access the services they need . If you agree with our recommendations, please share this with your Members of Congress. Find your Representative and Senator here.

Health Action

Methane and ozone pollution are a public health issue

Methane and ozone pollution are a public health issue

New Mexico has a methane waste and pollution problem that is a critical public health issue both by polluting our air and worsening the climate crisis which promises serious health and catastrophic weather events if not put in check. Our health and our future depend on state agencies taking a comprehensive approach to reducing methane and air pollution across the state. 

Methane is a potent greenhouse gas, more than 80 times more powerful than carbon dioxide in the near term. In fact, about 25 percent of the global warming we are experiencing today is attributable to methane pollution.  Here in New Mexico, oil and gas operations release more than 1 million metric tons of methane every year. That has the same short-term impacts as 22 coal-fired power plants or 28 million automobiles.

In 2014, NASA discovered a methane cloud the size of Delaware hovering over the Four Corners region , the highest concentration of atmospheric methane in the United States. In addition to methane, the oil and gas industry releases hundreds of thousands of tons of smog-producing volatile organic compounds (VOCs) in New Mexico that can trigger asthma attacks and worsen other respiratory diseases such as emphysema. New Mexico already has a higher rate of asthma than the national average. 

Rural communities, tribal communities, children, unborn babies and the elderly are especially at risk. Eddy, Lea, San Juan, Rio Arriba and Chavez counties – the five New Mexico counties home to 97 percent of the state’s oil and gas wells – are all at risk of violating federal ozone standards of 70 parts per million.  The release hazardous air pollutants such as benzene and toluene that are proven to cause cancer, putting those living closest to oil and gas operations at the greatest risk. More than 130,000 New Mexicans live within a half-mile of oil and gas development. When oil and gas companies waste natural gas by burning it, releasing it into the air or by not fixing leaky equipment, New Mexico taxpayers lose out on tax and royalty revenue. 

New Mexico is proposing common sense rules to mitigate methane and ozone pollution ensuring  that is  critical industry is primed to grow with strong standards to protect public health.  HANM endorses methane and ozone mitigation. 

 

 
 
 
Health Action

On Giving Tuesday, give the gift of health

 

 

 
 

Friends,

The Health Action NM team is grateful for the support you have given us over the years. Your generous contributions make our work possible. We hope this year, you will continue to support our organization.

As you know, Health Action NM works tirelessly to pursue a positive vision of health care in our state. That vision is that every single person in New Mexico has affordable, accessible, accountable health care. Over the past year, we have not only taken on efforts to protect our coverage gains, but also laid the groundwork for a positive agenda.

Now we’re ready to take action. Health Action NM has an ambitious agenda for the upcoming legislative session, including:

But we can’t do it without your support. Your donation can have a positive impact on the lives of thousands of people in New Mexico.

Sincerely,
Barbara Webber
Executive Director of Health Action NM

 

 
Health Action

What's at stake in health care

The Affordable Care Act (ACA) ushered in a new era of health care in America. Insurance companies can no longer deny coverage due to pre-existing conditions; lifetime and annual caps on coverage are banned; all plans must cover free preventive services; financial assistance is available low-income and middle class families; and Medicaid is expanded to people in need. New Mexico saw the largest drop in the percent of people who are uninsured, falling from 28% in 2013 to 13% in 2016. We should celebrate this incredible accomplishment and build upon our progress to ensure every person in our state and country are covered by quality health coverage.


Attacks on health care

A barrage of federal policy changes threatens to dismantle the gains we made. After several failed attempts to repeal and replace the ACA, GOP Members of Congress are now publicly discussing another attempt to dismantle the law next year. Previous versions would have capped and slashed Medicaid by over $1 trillion, dismantled the ACA’s pre-existing condition protections, raised premiums on people who need care the most, and eliminated the essential health benefits.

Congress repealed the individual responsibility provision of the ACA, which the Congressional Budget Office estimates will lead to 13 million people becoming uninsured over the next 10 years, including 90,000 New Mexicans.

The Trump administration has also taken extraordinary efforts to undo the law administratively. Over the past year and a half, the Trump administration:

  1. Unilaterally ended payments that reduce out-of-pocket costs for low-and-moderate income consumers
  2. Allowed states to impose burdensome requirements on Medicaid beneficiaries in order to slash enrollment
  3. Expanded junk insurance that can discriminate against people with pre-existing conditions
  4. Shortened the period to enroll in health coverage by half
  5. Slashed critical outreach and enrollment funding

And most recently, the administration refused to defend pre-existing condition protections in court, arguing that critical protections should be struck down in case called Texas v United States. Experts say it “would have ramifications in almost every aspect of the health insurance market and the health care delivery system,” leading to widespread chaos. 27% of New Mexicans have a pre-existing condition and would be at risk of being locked out of health coverage if the court sides with the Trump administration.


States can take the lead

In the absence of leadership at the federal level, states must take action to protect the critical gains made under the ACA. This presents an opportunity to build upon what works and fix what isn’t working. Health Action NM supports a wide array of policy options that would do just that.

  1. Adopt a Medicaid buy-in option to create a more affordable health care option for New Mexico
  2. Build the ACA’s consumer protections into state law to protect against a negative ruling in Texas v United States
  3. Creating common sense rules to ensure discriminatory substandard insurance does not flood New Mexico
  4. Address the flaws of the “individual mandate” and move towards a model that actively assists people who are uninsured to sign up for $0 premium health coverage


What we need from national leaders

According to a 2018 survey, 92% of working-age adults think that all Americans should have the right to affordable health care. Ultimately, Americans need certainty that Congress and the federal administration will work to make the health law work and will commit to building upon the successes of the health law and identify areas of agreement. We urge leaders to come together to work for the common good and meet people’s expectation of a health system that is accessible and affordable for all people.

Voters should be informed of the positions their elected representatives hold on health care and ask people running for office about critical issues, such as:

  1. Do you support the full array of the Affordable Care Act’s consumer protections, including pre-existing condition protections and essential health benefits?
  2. What are your ideas for protecting and building upon the coverage gains made under the Affordable Care Act?
  3. How do we get make sure every single person can get the care they need, when they need it, at a cost they can afford?

 

Health Action New Mexico is a 501c3 non-profit and does not endorse candidates for public office.

Health Action

Health Action NM opposes short-term junk plans

The following letter was submitted to the US Department of Health and Human Services on April 23, 2018.

 

To Whom It May Concern,

 

Health Action NM is a non-profit consumer advocacy organization that has served New Mexico since 1995. The organization has conducted extensive community outreach over the past several years to educate New Mexicans about new health coverage options under the Affordable Care Act (ACA). Our staff has held over 500 community events across 13 counties since 2013, reaching 17,000 individuals and families and connecting over 5,000 with enrollment assistance and health system navigation services.

The education and assistance provided by Health Action New Mexico gave our staff a deep understanding of the rural, underserved, and hardworking communities across our state and the struggles that they face as they attempt to get the coverage and care they need to stay healthy. There is a need for high quality, affordable health coverage in every community of our great state.

Prior to the enactment of the Affordable Care Act (ACA), people with pre-existing conditions could be denied coverage or charged exorbitant premiums in the individual health insurance market, leaving many of the sickest patients without any meaningful way to protect against the high cost of health care. President Donald J. Trump made numerous commitments to protecting people with pre-existing conditions, protections which enjoy support from a large majority of Americans.

The proposed regulations submitted by the Department of Health and Human Services regarding short-term limited duration plans violate the principle that people living with illness should not be subject to discrimination due to their health status. Moreover, according to the National Association of Insurance Commissioners, these regulations would have the effect of separating healthy people into a market that puts them at greater risk of facing financial hardship if they do become sick or injured, while increasing premiums in the ACA-compliant individual health insurance market that covers people with higher medical needs. The overall impact will be to shift costs towards individuals who are sicker.

According to a recent report by the non-partisan Kaiser Family Foundation, “Mid-year results from 2017 suggest the individual market is stabilizing and insurers in this market are regaining profitability. Insurer financial results show no sign of a market collapse. Second quarter premium and claims data from 2017 support the notion that 2017 premium increases were necessary as a one-time market correction to adjust for a sicker-than-expected risk pool. Although individual market enrollees appear on average to be sicker than the market pre-ACA, data on hospitalizations in this market suggest that the risk pool is stable on average and not getting progressively sicker as of early 2017.” We are on the verge of a stable individual marketplace that works for Americans. Segmenting healthier people out of the market will undermine the insurance that people who desperately need care rely upon.

Health Action NM recognizes the need to bring down health insurance premiums for Americans. However, we do not believe the correct strategy for achieving this goal is to shift costs to people with greater health needs and re-invent a system of discrimination against people with pre-existing conditions. Instead, the federal government should continue to encourage states to apply for reinsurance through a 1332 waiver, increase funding for outreach and enrollment, and request that Congress pursue cost-effective policy changes that will have positive effects on the individual marketplace.

We urge the department to rescind the proposed regulation.

 

Sincerely,

Colin Baillio

Director of Policy and Communications

Health Action NM

Health Action

Webinar: What you need to know about your preventive and mental health benefits

Health Action NM and the Office of the Superintendent of Insurance are teaming up to give you the information you need to access your mental health and free preventive benefits. Your health insurance must cover these benefits. Please join us for a live webinar on March 22, 2018 at 9:30 AM.

Here is a link to the webinar: https://nmosi.webex.com/nmosi/onstage/g.php?MTID=efc403cd738a90b0a85f39e7235e27db7

For audio: +1-415-655-0002;806 299 174

 

PRESENTATION I: 

Get the most out of your health insurance: Your right to services for mental health, alcohol or drug use problems.

This brief presentation will review the history of mental health parity and use a plain language video to demonstrate how health plans are required to give equal importance to the health of both the body and the mind.

The presentation will highlight red flags that a consumer may encounter that signals unequal access to mental health services or services to address alcohol and drug problems. For example, if a health plan restricts access to services by requiring use of lower cost therapies before accessing other types of services, or not having enough providers in their network. The presentation will use case scenarios to illustrate how the problems with equal access may look to a consumer, and how these can be resolved.

The presentation will conclude with clear advice about how to file a complaint with health insurance companies and how to contact OSI for further support in resolving problems.

 

PRESENTATION II:

Get the most out of your health insurance: Your right to no-cost prevention services.

This brief presentation will use plain language to review the basics of “cost-sharing”, or co-pays and deductibles, and emphasize that preventive care services are available to consumers at no cost, or “cost-sharing free”. The presentation will describe what is typically included in a well-person exam and what are common preventive care services, as well as provide a complete list of preventive care services that consumers can expect to receive at no cost. 

The presentation will highlight red flags that a consumer may encounter when accessing preventive services and provide advice about how to be a smart consumer when it comes to using preventive services. Important tips for Bronze plan users will be included.  The presentation will use case scenarios to illustrate common problems in accessing preventive services, and how these can be resolved. 

The presentation will conclude with clear advice about how to file a complaint with health insurance companies and how to contact OSI for further support in resolving problems.

Health Action

Medicaid Buy-In: The Basics

Sponsors: Representative Deborah Armstrong, Senator Jerry Ortiz y Pino, and Representative Nathan Small

New Mexico should allow people use their own dollars and tax credits to purchase health coverage through the state Medicaid program.

  • Medicaid is a public health coverage program that provides New Mexico’s children, families, people with disabilities, and older adults with comprehensive health care benefits.
  • Medicaid is a trusted, proven program that has served New Mexico for more than 50 years.
  • More than 40% of New Mexicans are already covered by Medicaid.

New Mexicans want high quality health coverage.

  • Medicaid covers the ten essential health benefits plus dental and vision care.
  • 93% of office-based physicians accept new Medicaid patients in New Mexico, according to a 2015 study from the Center for Disease Control & Prevention.

New Mexicans want affordable health coverage.

  • Medicaid for adults costs $297 per person a month according to the Kaiser Family Foundation, compared to the average $520 premium per month for employer insurance.
  • Tax credits and employer contributions could make health coverage even more affordable for working families. 

New Mexico could be a national leader in expanding affordable health care.

  • With a bold vision and smart planning, New Mexico could be the first state to take the innovative approach of a Medicaid buy-in.
  • Congressman Ben Ray Luján has introduced federal legislation using the Medicaid buy-in model.

SM 3 & HM 9 request the Legislative Health and Human Services Committee to study how a Medicaid buy-in could work in New Mexico. The bills passed with bipartisan support during the legislative session. The Legislative Health and Human Services Committee will study the concept throughout the summer! Check our website regularly for updates. 

Let’s work together to make sure every person in New Mexico can get the care they need to be healthy.

Health Action

Our Priorites for the 2018 Legislative Session

Given that this will be a short session and the governor’s final year in office, the 2018 New Mexico legislative session probably won’t be all about passing sweeping legislation. Instead, it will lay the groundwork for the 2019 session and beyond. Health Action NM plans to advocate for ideas that will improve health and increase access to care.

Medicaid buy-in study

Sponsors: Representative Deborah Armstrong, Senator Jerry Ortiz y Pino, and Representative Nathan Small

The Big Idea: Medicaid provides comprehensive health benefits at a lower cost than private insurance. We should allow everyone to participate in Medicaid by letting people and small businesses use their own dollars and tax credits to buy Medicaid coverage.

The Bill: SM 3 & HM 9 request the Legislative Health and Human Services Committee to explore how a “Medicaid buy-in” could expand health coverage and make health care more affordable for the people of New Mexico.

The Bottom Line: Everyone should be able to get the health care they need without breaking the bank. Let’s bring our values to life by giving the people of New Mexico a new option so that they can make the choice that works best for their family.

Health coverage stability task force

Sponsors: Representative Liz Thomson, Representative Debbie Armstrong, and Senator Bill Tallman

The Big Idea: Policy changes at the federal level may destabilize New Mexico’s health care system and disrupt access to care. The repeal of the individual mandate, re-introduction of “junk insurance,” and end of federal cost sharing subsidies could put people’s health and wallets in jeopardy. The task force will explore an exciting new idea: automatic enrollment for people who are uninsured and eligible for no-cost or low-cost health care.

The Bill: SM 7 directs the Office of the Superintendent of Insurance to set up a task force to study disruptions to New Mexico’s individual health insurance market and report recommendations to the Legislative Health and Human Services Committee.

The Bottom Line: New Mexico needs to take a proactive approach to protect people’s health care.

State agency drug purchasing council

Sponsors: Senator Jeff Steinborn and Representative Joanne Ferrary

The Big Idea: Prescription medication costs are skyrocketing, straining pocketbooks and the state budget. A recent Legislative Finance Committee analysis found that prescription medication spending in New Mexico jumped from $442 million in 2014 to $738 million in 2017, due in large part to price increases. A number of state agencies purchase medications but there is no communication with one another about purchasing decisions. By coming together, state agencies can negotiate better deals for taxpayers and begin to address the unfair pricing practices of pharmaceutical companies.

The Bill: SB 8 and HB 59 bring together state agencies that purchase prescription medications to find cost savings through smarter, better-coordinated purchasing decisions.

The Bottom Line: Prescription medication costs are rising at an unsustainable rate and New Mexico do everything in its power to get the best possible deal.

Health care cost commission

Sponsor: Representative Debbie Armstrong

The Big Idea: Health care costs are always on the rise, outpacing wage increases and making it difficult for New Mexicans to afford health coverage. And yet, the state does not have any formal body to look at what’s driving health spending or make recommendations on how to make health care more affordable. Many states have set up cost commissions to take the problem of health care costs head on, leading to savings and innovation.

The Bill: HM 29 would task the Office of the Superintendent of Insurance to establish a working group to identify priorities for a health cost commission and draft legislation for the 2019 session.

The Bottom Line: New Mexicans want access to high quality affordable health care and it’s time for the state to take affordability head on.

Fully Funding Medicaid

The Big Idea: Medicaid is a public health coverage program that gives kids, people with disabilities, older adults, and working New Mexicans access to high quality health care. Medicaid saw a wave of cuts over the past few years. With 42% of people in New Mexico relying on Medicaid for their health care needs, it is essential that we fully invest in their health so that our families and neighbors can live healthy lives.

The Bill: SB 192 assesses a fee on certain health care providers in order to draw down federal matching dollars and improve Medicaid doctor and facility payments. Several other potential proposals may be included in the state budget.

The Bottom Line: New Mexico should stand by our commitment to invest in our people’s health.

Health Action

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