Medicaid Modernization Las Cruces Public Input Working Sessions July 27, 2011 Table Group Comments

Table 1 Question Coordinated Service Delivery System 1. What is the right portion of services to help people stay out of institutions? Right now, a small number of people with complex medical and social needs get a lot of services to help them stay out of nursing homes or other institutions. Others stay on waiting lists and get little to no services. How do you think we can make this system more balanced so that people get the services they need the most during these times when resources are limited? 2. (if time allows) Tell us one thing that you think is working really well in the Medicaid program today that you want to make sure we keep. Tell us one thing that you want us to consider to make the program stronger. y y y y y y y y y y y y y More education to people about resources, i.e. behavioral health (bh). More Personal Care Option (PCO) or services like that while on a wait list. Keep a carve out for Behavioral Health otherwise medical care most funding Assist keeping healthy people healthy Regional Option for behavioral health instead of single Statewide Entity (SE) Increase income limits, the guideline to obtaining waiver services More preventative services, A system that has measurable outcomes for success, i.e. hospital, residential stays that are expensive would make those attainable and reward providers What working Medicaid funding should be sustained. Carve out is working well School based health centers are working well. Continue to support and make stronger Telehealth is working, need expansion to rural and frontier New Mexico SCI is working, but need to address long wait list due to lack of funding.

Tables 2 & 10 Question Personal Responsibility 1. How do you think the State could increase the sense of personal responsibility that people take for their own health and for helping to financially support the services they need? 2. (if time allows) Tell us one thing that you think is working really well in the Medicaid program today that you want to make sure we keep. Tell us one thing that you want us to consider to make the program stronger.

y y y y y y y

y y y y y y y y

Better dental program Services/program needs to be tailored to state needs, i.e heart disease and diabetes. Individualized need more specialized needs. Incentivizing, taking care of ourselves. Behavioral health coming together, not carved out. (Didn t seem to be a consensus at this table on this issue) Reward and incentives need to be client specific. Most people on Medicaid are poor and can t afford co-pays, but had differing opinions. Quality of care givers under PCO. There needs to be better quality care givers. More than 40 hours of training and training should be specialized, especially with those people with Developmental Disabilities. Caregivers may not have the experience or training to support needs. Already curriculum that is out there we should look at DD Waiver is very complicated and needs to be more thought about incorporating into a universal waiver. Slow down on this issue. Incentives for vehicles. Hospitals using something like preventative care menu to look at specific signs of treatment that connects with that. ER, why they use it. Clinics and Urgent care are not open late. People do want to see their own providers if available. What works DD Waiver, co pays are working. Medicaid is doing what it is supposed to do, covering the cost of health care.

Table 10 y Need to educate communities in personal responsibility. y More programs in schools and communities y Accountable as program and community y Personal responsibility Loaded. Have different definitions. What does it mean? y Copay scale is great, but does it go all the way down to zero. How far up does it go? y Medication and DRE, how are we going to be personally responsible when some people are very poor. y How working in several cities Good rewards and incentives i.e. OptumHealth NM s health insurance has a healthy rewards program . Free blood work, BMI, full physical, etc. Some of those services could be written into the program to keep people healthy. People have to follow-up on what they ve told them. y What s working well o Need better transportation o Need data from the state. Need to be informed about what s happening in the state.

Table 3 & 11 Question Pay for Performance 1. How can the State encourage providers to take more responsibility for the health of their patients? What do you think providers can do and what do you think the individual has to do? 2. (if time allows) Tell us one thing that you think is working really well in the Medicaid program today that you want to make sure we keep. Tell us one thing that you want us to consider to make the program stronger. Instead of encourage should be require . Concerned about Fraud All programs should have a thorough inspection. Providers Important that they have to have some standards to measure how they are going to reduce the amount of patient abuse. Would not want to pay doctors to get rid of people. y Patients More education, more opportunity. Promatoras or others educate people instead of going to ERs y Incentives like car insurance if you don t have accidents you get money back. Under Health Care Reform would be good to have incentives for not over utilizing care. y Keep DD waiver the way it is. y Keep all 12 waivers as we have them. Global gives opportunity below 1902 baseline. Very risky to manage ourselves. y Keep transportation system, as is. Table 11 y Home visits generated by providers. If providers generate it will help keep people healthy. Check-ups would reduce visits to hospital y Education and prevention. More education more healthy. y Services in rural areas. Need more providers in rural areas. Would cut down on transportation y Medical increased knowledge y Money incentives to stay healthy y Make recipients aware of the costs. Send out information on how much their visits cost. y Getting what they need to stay healthy y Well child - $25 incentive keeps people healthy. y Access to care and take back some different waivers into one. Take bits and pieces into one. y y y

Tables 4 & 12 Question Administrative Simplicity 1. What can the State do to make it easier for you to get services or for providers to offer services? 2. (if time allows) Tell us one thing that you think is working really well in the Medicaid program today that you want to make sure we keep. Tell us one thing that you want us to consider to make the program stronger. Agreed with reducing MCOs to simplify admin. Burden. Consider competitive bidding Simplify re-enrollment process, especially with chronic conditions. Simplify the credentialing process for providers. Once enrolled in Medicaid should be automatically enrolled in all Managed Care plans. Very time consuming for providers y Roll primary care into traditional or managed care plans. y Consider ways to produce access between rural and urban areas. y State and local needs, need to invest in local behavioral health y Increase provider incentives to work in rural areas. y Tort reform brought up to increase doctors who want to practice in NM and reduce overutilization of services. y What works y Continue and grow successful outreach program for Medicaid eligibility y Incentives for integrated health systems. y Question Is input from meetings recorded, collated and published online. Table 12 y Have to have a one-stop shop for eligibility y What works y Keep DD waiver programs y y y y y

Table 5 Question Coordinated Service Delivery System

1. Through both COLTs and the Personal Care Option (PCO) program, the State offers services that help people stay in their homes and communities rather than have to go to a nursing home or other institution. What Medicaid and other community resources do you use or do you think should be available to help keep folks safely at home. 2. (if time allows) Tell us one thing that you think is working really well in the Medicaid program today that you want to make sure we keep. Tell us one thing that you want us to consider to make the program stronger. y y y y y y y y y y y y y y y y y y y y y y y y y Telehealth It works and need to strengthen to make it better. Works well for elderly Workforce Development How are we training people within our communities to make this a profession? Streamline same day billing for physical and behavioral health. DD Waive and CoLTS works well but needs less paper work and less repetitive. Transportation, transportation, transportation, especially for emergency and urgent care. Vision What is the vision for this program? Proper and adequate access to providers People have equal access People reimbursed equitably. Everyone in this system seeks the health of the client. Patient driven, not profit driven. Extended re-enrollment. Ideally once a year. Some express lane eligibility. If child qualifies for free food, automatically enrolled in New MexiKids. How do we delivery health care to undocumented? Cut somewhere else. Don t do it on the budget of health care. Identify inefficiencies in other state departments. Streamline and reduce paperwork. Ideal that everyone has a co-pay, but reality most families cannot pay. Family and Infant Health program strengthened and paid through CHIP. Remove transportation barriers. Carve out BH Increase reimbursement rates across the board. Keep costs low for patients. Reduce prior authorization for outpatient, includes managed care. Seamless transition to providers to provide bh services.

Table 6 Question Personal Responsibility 1. Will incentives or rewards change people s willingness to eat more healthy foods, exercise more, stop smoking and seek preventive care? If so, what kind of rewards might work? 2. (if time allows) Tell us one thing that you think is working really well in the Medicaid program today that you want to make sure we keep. Tell us one thing that you want us to consider to make the program stronger. y y y y y y y y y y y y y y y Yes, incentives are a good idea. As long as they go back into health care services. Every rural and urban population is different and need to be sensitive to those populations. Tailor made for those areas. After second wellness money comes back No shows, cost money. Needs to be some kind of consequence that is very sensitive and tailor made. Not eliminating full range services under the programs. Knowing a list of full range services, being clear and concise of what they are. This will help them be responsible. Overall from provider perspective, the process can be discouraging, but Question #2 PE/MOSAA is working Need outreach workers that go to communities Streamline education Health campaign Online options are not real options for many communities Needs to be an expansion of community workers. Needs to be better organized Solution Real coordination of agencies that are working in communities that are able to do the same thing and same kinds of coverage. Making sure that the coverage takes place. More regionalized power. Build an infrastructure in rural areas. Better advocate in rural communities. Empower. Better medication management. Get rid of the monopolies!

y y y y y

Table 7 Question Pay for Performance 1. What things could your doctor s office do differently to make it easier for you to get the care you think you need, for example, would staying open longer or getting a call from the doctor s office to remind you about an appointment or a test help you?

2. (if time allows) Tell us one thing that you think is working really well in the Medicaid program today that you want to make sure we keep. Tell us one thing that you want us to consider to make the program stronger. y y y y Looked at difficulties in health care providers offices Simplifying billing and making in timely manner. Medicaid providers are having difficulty staying in business because Medicaid reimbursement is low System change, such as student loan forgiveness program for Medicaid providers. Look at percentage of Medicaid clients they take throughout their career. Health care providers. Agencies need to help families complete application process. Increase case management Well kept secrets that are available to clients that should be known to get access to services. Equalization of services from womb to tomb. Work well o DD waiver, keep separate o PCO o Don t keep adding more to the schools. School nurses are not funded. Keep BH carved out

y y y y y

Table 8 and 13 Question Personal Responsibility 1. What can the State do to help make sure people do not go to the Emergency Room unless they have a real medical emergency? 2. (if time allows) Tell us one thing that you think is working really well in the Medicaid program today that you want to make sure we keep. Tell us one thing that you want us to consider to make the program stronger. y y y y People need to be educated Access to services in rural areas Nursing hotline Incentive and dis-incentives to clients. Make sure that is educated in ER and A campaign across the state, telling people they need to take responsibility for their health. Making healthy choices cool Keep the DD Waiver program. Cannot absorb any more cuts Needs to be an easier process for prescribing doctors to be able to order medication. MCOs need to be better at helping people get the right medications. MCOs More efficient and effective promote health

y y y

y BH working as a carve out. Table 13 y Need to see people more quickly before an ER visit. y When at ER need to see them quickly. y Rural areas, such as Hatch and Anthony don t have urgent care and their only option is ER y Takes 40 minutes to get care after hours. y People have to travel miles to be seen, because there aren t enough doctors y Urgent care is not available or closes early y No doctor care 24 hours/7days a week. y Need doctors to stay locally. y Need to use a hot/warm line staffed by nurses to determine if an ER visit is necessary. y Need to make more resources available for medical care. y Cost per medical care and medications are way too high. Need a cost oversight group. y What working y Need to keep Medicaid for children. y Keep dental y Medicaid for working patients y Medications y Psycho social rehab working y People with no insurance have a hard time paying for medications and don t go early. Low cost of care. y When will bh funding be carved out? y Is there another option than OptumHealth or SE y How come Medicaid only covers certain transportation companies and not a wider variety.

Table 9 Personal Responsibility 1. What do you think the State could/should do to help Medicaid members make and keep appointments for prevention and wellness services? 2. (if time allows) What are the top 2 things you would want the State to keep in mind as we introduce a greater sense of personal responsibility into the system? y y y y y Community based health at the schools Alternative hours/extended hours Penalty fee for no shows and cancellations Provider education on all levels of funding for education on benefits and importance of health and health education for disease management. Incentivize clinics for holding patients accountable.