New Mexico will require hospitals to notify the state of mergers and acquisitions and grant the
state government oversight over such transactions, reports the Santa Fe New Mexican. Under
the Health Care Consolidation Oversight Act, the Office of the Superintendent of Insurance’s
review of proposed transactions can include the potential reduction or elimination in access to
essential services, along with the availability, accessibility, and quality of health care services to
affected communities, including patient costs and potential for the transaction to affect health
outcomes for residents. The legislation follows a failed $11 billion health care merger in the
state and aims to address concerns over the trend of hospital acquisitions by out-of-state and
private equity firms.

New Mexico is capping cost-sharing for certain services in state-regulated plans, including
diabetes supplies, breast cancer screening exams, and sexually transmitted infection (STI)
treatment, reports Source NM. State-regulated plans will be required to provide basic diabetes
care and supplies alongside a $25 cap on a 30-day supply of insulin. In addition, cost-sharing is
eliminated for diagnostic breast exams and prevention and treatment for STIs. Cancer
biomarker testing must now also be covered by insurance, though cost-sharing is allowed.

New Mexico’s superintendent of insurance issued an order requiring state-regulated commercial
health insurers to expand access to behavioral health services, reports Rio Rancho Observer.
Insurers are now required to cover out-of-network behavioral health services at in-network rates,
including services from primary care physicians, specialist visits, and inpatient hospital stays.

New Mexico has passed a law to reduce consumer prescription drug costs, according to the Los Alamos Daily Post. Senate Bill 51 stipulates that insurers must apply any discounts enrollees
receive to their cost-sharing obligation for prescription drugs, ensuring that pharmacies pass on discounts to consumers.

New Mexico has initiated a study to explore a Medicaid buy-in program, according to Source New Mexico. Intended to expand access to affordable health care, House Bill 400 directs the Human Services Department to evaluate a plan to lift Medicaid’s income cap and allow residents above the current cap to purchase affordable coverage by paying premiums and income-based co-pays.

Most of those who qualify for health coverage on New Mexico’s healthcare exchange, beWellnm, will be receiving large healthcare savings, reports Los Alamos Daily Post. These savings in premiums, deductibles, co-pays and other out-of-pocket costs are due to the federal Inflation Reduction Act of 2022, as well as New Mexico’s Health Insurance Marketplace Affordability Program. This state program reduces premiums and out-of-pocket costs not just for New Mexicans who qualify for coverage on the marketplace, but also for small businesses and their employees. It also provides resources for planning, design and implementation of healthcare coverage initiatives for uninsured New Mexicans.

Uninsured patients in New Mexico are often charged up to ten times more for medical treatments than insured patients, reports KRQE. These statistics, taken from a study prepared for the New Mexico Center on Law and Poverty, have dire implications for uninsured New Mexicans, namely, that they will likely incur medical debt. The study looked at the prices of 17 different medical services across 43 New Mexico hospitals and revealed that prices varied widely between those with and without health insurance. For instance, for a certain coronary artery stent, the average list price was around $85,000 but the average insurance payments totaled only around $44,000, meaning that the uninsured patient was stuck with a bill almost double what an insured patient would receive. New Mexico passed the Patients Debt Collection Act in 2021, which bans hospitals from suing low-income patients or sending them to collections, but advocates claim that more protections may be required, given the disparities in hospital charges.

A survey of New Mexico residents has found that roughly one in two respondents didn’t seek medical care in the past two years due to cost, according to NM Political Report. Notably, Latino/Hispanic and Black respondents were the most worried about paying for care. Most respondents blamed the federal government for the high cost of healthcare, and seventy-two percent said they support a government-administered health plan, sometimes referred to as a public option.

The New Mexico legislature will hold a hearing on uninsured patients' hospital charges following the passage of HM 36, according to NM Together for Healthcare. The legislation also asks the Human Services Department to report to the legislature on how hospitals are using public funds designated for the care of low-income, uninsured patients. 

New Mexico’s governor signed a bill creating the Health Care Affordability Fund and eliminating cost sharing for behavioral services covered by health insurance plans, announced the Office of the Governor. The Health Care Affordability Fund will be used to invest in initiatives to make health insurance and healthcare services more affordable for working families, such as lowering premiums and out-of-pocket costs for individuals who purchase health insurance from the state marketplace and uninsured residents who do not qualify for federal assistance. The Urban Institute estimates that investing in these initiatives could provide up to 23,000 uninsured New Mexicans with affordable healthcare coverage.

New Mexico’s governor signed the Patients’ Debt Collection Protection Act into law, reported KRWG. This law will protect patients from medical debt by requiring hospitals and other healthcare facilities to screen uninsured patients for public insurance and other financial assistance programs. In addition, the law also protects patients whose household income is at or below 200% of the federal poverty level from being sent to debt collectors or sued by healthcare facilities for unpaid medical bills.

Lorraine Rogge was billed $12,387 for a vaginosis, vaginitis and sexually transmitted infections testing panel after experiencing pelvic pain and cramping, according to Kaiser Health News’ Bill of the Month. Her insurer negotiated a rate of $7,172, of which the insurer paid $4,162 and Lorraine was responsible for $3,010. Although Lorraine’s repeated appeals to her insurance company were denied, after a call and email from Kaiser Health News, Carlsbad Medical Center agreed to waive the remainder of her account balance. The big takeaway is to always ask how much tests are going to cost and what exactly you are being tested for, especially when obtaining care from a new doctor.

New Mexico has launched a new partnership between the state Attorney General, Auditor, Ombudsman, and Department of Health and Adult Protective Services to increase accountability and the standard of care for individuals in nursing homes and long-term care facilities, according to a press release from the Office of the Governor. The partnering organizations will review data and investigate complaints about fraud and abuse, as well as charge civil penalties and prosecute as needed. These efforts are intended to strengthen financial transparency and protection of the elderly.

The Governor of New Mexico signed four significant public health bills designed to reduce the high cost of prescription drugs and develop more affordable healthcare insurance options, the office reported in a press release. Of note is House Bill 292, which caps co-pays and out-of-pocket expenses for insulin at $25 per prescription for a 30-day supply – making them the lowest in the country. Also, House Bill 100 empowers beWellnm, the New Mexico health insurance exchange, to operate as a fully state-based exchange meeting the needs of families seeking health insurance coverage in New Mexico and promoting access to more affordable, higher-quality insurance plans.

A recent Commonwealth Fund case study reported on New Mexico’s community health workers (CHWs) who link vulnerable residents to organizations that address the need for stable housing, legal assistance and job training. The practice of embedding CHWs into medical settings in New Mexico began in earnest more than a decade ago with a pilot between University of New Mexico Hospital  and a Medicaid managed care organization. The CHWs provided both navigation and social supports — connecting members to medical homes, making home visits and encouraging adherence to treatment recommendations. A study found these efforts reduced emergency department visits and hospital admissions as well as use of prescription drugs (including narcotics) and produced a fourfold return for the health plan that sponsored it.

Legislation increasing access to, and the affordability of, health insurance for New Mexico families passed both the state House and Senate, reports the Los Alamos Daily Post. The bill codifies Affordable Care Act requirements for state-based health insurance exchanges and authorizes BeWellNM to continue moving toward becoming a fully state-based exchange.  

The New Mexico Human Services Department (NMHSD) funded a report called The Uninsured in New Mexico released by the Urban Institute that finds 187,000 New Mexicans (10.5 percent) under age 65 are uninsured. Over half of the uninsured are already eligible for coverage options available, such as Medicaid or an Exchange plan. The administration is coordinating with the health insurance exchange, beWellNM, and developing targeted outreach and enrollment efforts to reach those New Mexicans and get them covered. For those that remain uninsured or underinsured, the administration is developing options that will help more hardworking New Mexicans get health insurance that works for their family’s budget.

Residents say the only hospital in Carlsbad, N.M. is notorious for suing its patients, adding in lots of mystery charges and refusing to give itemized bills, reports CNN. When patients can’t pay, the hospital will sometimes sue them to collect the money. An investigation of court records shows that in the past 10 years, Carlsbad Medical center has sued more than 3,000 people to collect debts. In a statement, the hospital CEO said they sue fewer than one percent of the patients who receive care at the hospital. Still, most other hospitals in the area haven’t sued any patients for debt collection over the past 10 years.

During the 2019 legislative session, New Mexico enacted SB337, which takes effect in January 2020 and will protect New Mexico residents (who have state-regulated health plans) from surprise balance billing, reports Healthinsurance.org. Under the state’s new law, patients cannot be charged more than their regular in-network cost-sharing obligations (copays, deductible, coinsurance, up to the maximum out-of-pocket level for their plan) if they receive emergency care at an out-of-network facility or receive non-emergency care from an out-of-network provider at an in-network facility, as long as the patient either had “no ability or opportunity” to receive the care from an in-network provider instead. This includes situations in which there is no in-network provider available.

The Governor of New Mexico announced that the state will seek federal approval to reverse cost-sharing and enrollment provisions instituted by the previous Governor that were designed to conserve state spending on Medicaid, reports AP News. Specifically, the state will reverse course on its plans to charge some Medicaid patients a monthly insurance premium of $10 and co-payments of $8 on certain brand-name drugs and visits to the emergency room for routine medical care. According to the Governor, these provisions threaten to limit access to emergency services and disrupt health coverage for hundreds of thousands of state residents who are poor and disabled.

Several New Mexico organizations and individuals have come together to form the NM Together for Healthcare initiative, to make quality healthcare affordable for everyone by focusing on a Medicaid buy-in plan that will expand access to care. The buy-in plan is a concept that is being examined across the country in other states as well. The idea would allow for people to buy into low-cost coverage through a Medicaid plan.

In an attempt to provide transparency to the people of New Mexico, the New Mexico Healthcare Compare website will provide the average cost to Medicaid of nine healthcare procedures at multiple facilities across the state. Legislation passed in 2015 required the state’s Department of Health to explore approaches to post cost and quality on frequently used health care services. The New Mexico Healthcare Compare website was developed based on recommendations made from the National Association of Health Data Organizations. According to Albuquerque Business First, the website will continue to add both procedures as well as payment information to include other insurance types such as individual or employer insurance policies as well as Medicare. Additionally the website includes quality metrics such as 30-day readmission rates and information on patient ratings.

Recommendations from research conducted by the National Association of Health Data Organizations, outlined a framework for the development of publicly available information on cost and quality measure of frequently-used health care services in New Mexico. Findings let to the launch of a website in January 2018. 

A strategy to use Community Health Workers in the health care system to identify unmet social needs is the topic of a Health Affairs blog post from the University of New Mexico Health Sciences Center (UNMHSC). Primary care providers understand that addressing social determinants of health is important but are often unequipped to identity these needs. The UNMHSC teamed withed Community Health workers to handle this aspect of care. In light of their success, this model has been replicated in other clinical settings across New Mexico and has been deployed in 12 other states.

In a forum looking to address the issue of increasing drug prices in New Mexico several options were outlined according to the Albuquerque Journal. The forum was sponsored by the New Mexico Coalition for Healthcare Value and is looking to education, information and networking events in order to work towards solutions to increasing drug prices.

Proposed legislation in New Mexico seeks to reduce state spending on Medicaid by pushing hundreds off the New Mexico Medical Insurance Pool, also called the “high-risk pool,” and onto the state’s health insurance exchange, according to Las Cruces Sun-News. The high-risk pool currently offers health coverage for the sickest of the sick, more than 2,700 people who suffer from heart disease, cancer, Hepatitis C, neurological disorders and HIV/AIDS. The population using the high-risk pool has shrunk from a high of about 10,000 individuals to about a quarter of that number since New Mexico’s health exchange began operating. The bill would also eliminate Medicaid funding for the pool, transferring the entire cost of paying for the pool to certain insurers and the commercial markets—costs that would be passed on to consumers.

A federal law requiring the U.S. Health and Human Services Department (HHS) to consider integrating and expanding the use of video conferencing for rural populations to access medical care was originally developed in New Mexico, according to the Silver City Sun-News.

Hepatitis C is the most expensive condition treated in Medicaid, due to blockbuster drug prices, according to the Albuquerque Journal. New Mexico’s total spending for prescription drugs has risen by 54 percent in two years, with Hepatitis C drugs accounting for nearly two-thirds of the 2016 pharmaceutical drug expenses. Last year the New Mexico Department of Human Services developed a hepatitis C action plan with the goal of treating all Medicaid patients with hepatitis C within a decade while being financially responsible.

The New Mexico Medicaid program is seeking federal authority to charge copayments to enrollees, except for pregnant women and children, according to Las Cruces Sun-News. New Mexico has one of the highest Medicaid enrollment rates in the country. The secretary of the state's Human Services Department suggested these fees could help maintain Medicaid spending by steering patients away from wasteful spending.

The New Mexico Department of Health submitted its Health System Innovation Final Design for the SIM Model Design Cooperative Agreement. The state aims to use patient-centered medical homes to improve alignment of clinical, behavioral and oral healthcare, in addition to social services to improve population health.

Recommendations from research conducted by the National Association of Health Data Organizations, outlined a framework for the implementation and development of an All-Payer Claims Database in New Mexico. The report provides information on key issues around legislation, governance, oversight and collaboration.

New Mexico will become the latest state to institute an all-payer claims database(APCD), a move intended to increase healthcare price transparency for consumers, according to FierceHealthPayer. Staff at the State Human Services Department expect to award a contract early next month  for a consultant to help the agency plan an all-payer claims database.

Jacob Kuriyan, founder of Physmark Inc., which creates software designed to reduce healthcare costs, analyzed New Mexico’s Medicaid database and identified changes that could save taxpayers more than $200 million, reports the Albuquerque Journal. These ideas include reducing the amount Medicaid pays for those without chronic disease by 10 percent - which would save the program around $67 million—and altering Medicaid fee-for-service program provider payments to be more in line with Medicare payments. Additionally Kuriyan suggests that the state should expand cost-containment strategies used in some areas of the state to narrow the state’s wide regional price variations.

Albuquerque Business First: The New Mexico Department of Health has been paying close attention to the rise of telehealth and convened a summit on the topic in mid June. At the summit, the CEO of Net Medical Xpress stated that telehealth could be successful with proper partnerships with public organizations and the private sector. The experts attending the summit concluded that telehealth access provides significant benefits to patient care and can lower the patient costs.

Since passage of the Affordable Care Act more than 13,000 people in New Mexico have received tax credits to assist in purchasing health insurance, while the uninsurance rate decreased from 20 percent in 2013 to 15 percent in 2014, according to KRWG.org. In addition, more than $68,000 has been returned to consumers after insurers failed to meet the federally mandated 80/20 medical loss ratio requirement. The U.S. Department of Health & Human Services also highlights New Mexico's investment of $7 million into rate review and $144 million into community health centers.

Albuquerque Journal: The New Mexico state legislature passed a law that limits non-compete clauses between hospitals and providers. The law went into effect July 1, 2015, and allows providers to remain in communities where they have created significant relationships with patients by allowing them to move more freely from one practice to another. The New Mexico Medical Society believes that this law will help to improve patient continuity of care.

New Mexico’s NurseAdvice is a free 24/7 call line staffed by nurses that patients can call when they are experiencing a medical issue. The call line provides patients with multiple advantages including increasing access for those living in rural areas and advising patients on whether or not they should go to the emergency room. NurseAdvice is also one of the least expensive technologies that can be used to reach a patient in their home. KRQE—a CBS-affiliated television station in Albuquerque—reports that during an April emergency preparedness summit in Atlanta, the CDC recommended NurseAdvice as a national model for other states moving forward.

Albuquerque’s CBS affiliate KRQE reported on the difficulty that many in New Mexico are having in paying and understanding their medical bills. Think New Mexico, a state advocacy group, believes that lack of transparency causes patients in New Mexico to pay hundreds of dollars extra each year in medical costs. Advocacy group Costs of Care argues that it is “inexcusable that [consumers] cannot get at least basic information about price and quality in healthcare.” There are currently competing legislative bills addressing healthcare cost transparency—one proposed by Think New Mexico and the other by the New Mexico Hospital Association—being discussed. Healthcare systems have stated that they must first figure out how to make the billing process cleaner.