New Mexico: Some Good Waiver News for a Change

Those of us who follow Medicaid waiver activity around the country can feel that we’re being constantly assaulted by bad news. So here’s some good news to brighten your day:  instead of proposing burdensome requirements that limit access to Medicaid enrollment and services, New Mexico is planning to improve its section 1115 waiver – known as Centennial Care – by removing harmful provisions and making the program work better.

New Mexico’s 1115 waiver was originally approved in 2013 and was recently renewed for an additional five-year period.  Both the original application and the renewal were developed and approved under then-Governor Susana Martinez, a Republican.  But a new governor, Democrat Michelle Lujan Grisham, took office in January.  It didn’t take long for her administration to announce that they planned to get rid of certain parts of the waiver that she considered to be counter to Medicaid’s purpose of providing health care and related services to low-income New Mexicans.  This was music to the ears of those of us who had pushed for improvements to the waiver as it was being developed and had pressed the new governor and her team to modify it.

Governor Lujan Grisham’s administration has requested CMS approval for the following changes to the waiver, each of which will promote access to services:

  1. Eliminate premiums for adults in the ACA expansion category who have incomes above 100% of the federal poverty level, along with associated lock-out periods for nonpayment.  An extensive body of research establishes that premiums are a barrier to enrollment, which in turn is a barrier to receiving needed care.  Loss of coverage also harms providers by increasing uncompensated care.
  2. Eliminate copays for “non-emergency” use of the ER and non-preferred drugs.  Again, extensive research shows that copays are a barrier to receiving care and impose administrative and financial burdens on providers.
  3. Reinstate three months of retroactive eligibility.  The approved waiver reduces retroactive eligibility from three months to one in 2019 and would eliminate it entirely in 2020.  New Mexico proposes to reinstate the full three months of retroactive coverage.  This step will protect both patients and providers from financial hardship.
  4. Increase access to home- and community-based services through additional waiver “slots”.  One of the positive aspects of Centennial Care is that it promotes access to HCBS for seniors and people with disabilities by making the full menu of services that previously were offered through 1915(c) waivers – with capped enrollment – available to any Medicaid enrollee who is found to need them.  This means that only those individuals whose income is above the Medicaid eligibility level need a waiver slot to get these services.  The state is proposing to add 1,500 slots to the currently-authorized 4,289, to serve more people in the community rather than forcing them into institutional care.
  5. Expand home visiting services.  Home visiting provides important supportive services to expectant and new parents and their young children.  The waiver renewal authorized a pilot program in up to four counties; the state now seeks to remove that limit and allow expansion of home visiting to reach more areas of our large state and to serve more families.  In addition, the current waiver authorizes only two home visiting models (the Nurse Family Partnership and Parents as Teachers); New Mexico is asking for authority to add other evidence-based models that may emerge over the course of the waiver period.

Although these modifications won’t make Centennial Care the perfect Medicaid model, they will greatly improve it by expanding access to important services and removing barriers to coverage and care.  They show the importance of having the right leadership in place – leadership that understands the value of Medicaid and the importance of access to the crucial services it covers.  And they once again demonstrate the value of advocacy in surfacing the issues and building support for positive change.  Even after a waiver is approved, it’s never too late to push to make it better!


Ellen Pinnes is with The Disability Coalition of New Mexico.