Healthcare • Medicaid • Fiscal Responsibility • Access
Secure Medicaid
A responsible plan to protect healthcare access, control Medicaid costs, and prepare New Mexico for potential federal funding cuts — without sacrificing quality of care for patients.
Medicaid is a lifeline for hundreds of thousands of New Mexicans, but rising healthcare costs and potential federal funding cuts demand proactive action. This plan focuses on smarter care delivery, prevention, accountability, and innovation to control costs while protecting access to quality healthcare — especially for seniors, children, and rural communities.
The state allocates nearly $1 billion for Medicaid. With the potential cuts proposed by the Federal Government, we must prepare for the possibility of these subsidies being reduced or eliminated.
I have examined various expenditures within the state budget and identified opportunities to significantly cut costs through one-time investments in different types of machinery. Additionally, thanks to advancements in technology, 60-70% of surgeries can now be conducted at Ambulatory Surgical Centers instead of costly hospitals.
I also propose enhancing Federally Qualified Health Centers (FQHCs) by making one-time investments in equipment, enabling patients to receive their tests in-house rather than at external facilities, which can drive up costs.
Medicaid Cost Reduction Strategies
- Chronic Disease Management: Invest in community health programs for early intervention in conditions like diabetes, hypertension, and asthma to lower long-term treatment costs.
- Incentives for Wellness: Provide incentives, such as reduced co-pays, for Medicaid recipients who complete annual check-ups, vaccinations, and screenings.
- School-Based Clinics: Expand access to healthcare for children through clinics in schools, reducing costly ER visits.
Improve Managed Care Efficiency (Centennial Care Enhancements)
- Capitated Payment Models: Shift to per-member-per-month payments for cost predictability.
- Care Coordination: Enhance teamwork among primary care doctors, specialists, and social workers to avoid unnecessary tests and hospitalizations.
- Accountability Measures: Require Medicaid managed care organizations (MCOs) to meet quality and cost benchmarks.
Expand Telehealth Services
- Rural Access: Increase telehealth reimbursements in rural areas to cut travel costs and treatment delays.
- Mental Health & Substance Use Treatment: Expand virtual counseling to reduce inpatient psychiatric costs.
- Remote Monitoring: Use telemedicine for monitoring chronic diseases to allow early intervention and reduce hospital admissions.
Reduce Emergency RM (ER) Overuse
- 24/7 Nurse Hotlines: Expand nurse advice lines to help patients find appropriate care settings.
- Primary Care Expansion: Offer extended clinic hours and same-day appointments to prevent non-urgent ER visits.
- High-Utilizer Case Management: Identify frequent ER users and assign case managers to guide them to primary care.
Lower Prescription Drug Costs
- Bulk Purchasing: Join or expand multi-state purchasing pools for prescription drugs.
- Generic & Biosimilar Incentives: Negotiate better deals to increase the use of generic medications.
- Drug Rebates & Transparency: Strengthen rebate programs and improve transparency in pharmacy benefit manager contracts.
Integrate Behavioral Health & Social Services
- Housing Assistance for High-Cost Patients: Provide stable housing to reduce hospital visits for homeless Medicaid recipients.
- Food & Nutrition Support: Expand food programs to prevent malnutrition-related hospitalizations.
- Behavioral Health Parity: Fully integrate mental health and substance use disorder treatments into primary care.
Reduce Fraud, Waste, & Abuse
- Advanced Data Analytics: Use AI and statistical algorithms to detect improper billing patterns.
- Tighten Eligibility Verification: Improve enrollment oversight to ensure only eligible individuals receive benefits.
- Audit Providers: Conduct routine audits to prevent unnecessary procedures and billing errors
Transition to Alternative Payment Models
- Accountable Care Organizations (ACOs): Create networks that share savings when costs are lowered without sacrificing quality.
- Bundled Payments: Pay for entire treatment episodes instead of per service to avoid unnecessary treatments.
- Value-Based Payments: Tie payments to health outcomes instead of service volume.
Expand Home and Community-Based Services (HCBS)
- Reduce Nursing Home Dependence: Increase funding for home care aides to help elderly and disabled individuals stay at home.
- Family Caregiver Support: Offer respite care or stipends for family caregivers to lower professional care costs.
- In-Home Monitoring: Provide remote health monitoring for elderly Medicaid patients to prevent hospitalizations.
Maximize Federal and Private Partnerships
- Medicaid Waivers: Apply for 1115 waivers to test cost-saving measures like work requirements or health savings accounts.
- Public-Private Health Initiatives: Collaborate with private health foundations and hospitals to fund preventive care programs.
- Leverage Federal Grants: Seek additional funding for rural healthcare and telehealth expansion.
Key Themes in Successful Medicaid Reduction Models
- Managed Care & ACOs: Shift from fee-for-service to value-based care (e.g., Oregon, Massachusetts, Tennessee).
- Care Coordination: Implement regional teams to support high-risk patients (e.g., Minnesota, Vermont).
- Preventive & Primary Care Investment: Enhance community health teams and incentivize wellness visits (e.g., North Carolina, Indiana).
- Prescription Drug Cost Control: Utilize bulk purchasing and negotiate drug prices (e.g., Massachusetts, North Carolina).
- Fraud & Waste Reduction: Strengthen eligibility criteria and apply data analytics to detect fraud (e.g., Tennessee, Colorado).
- Home & Community-Based Services (HCBS): Decrease reliance on costly institutional care (e.g., Rhode Island, Tennessee).
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