Briefing on Insure New Mexico! Council for Medicaid Advisory Committee August 15, 2005

1. Briefing on Insure New Mexico! Council for Medicaid Advisory Committee August 15, 2005

2. Reminder . . . • 2003 – Health Care Coverage and Access Task Force • 2004 – Insure New Mexico! Council • Charges: • reduce number of uninsured • increase number of employers offering insurance • 34 Recommendations, 6 passed legislature • 2005 – Working on Remaining Recommendations and Limited New Ones • Report due to Governor in December 2005 • Minutes on www.insurenewmexico.state.nm.us.

3. Insure New Mexico!Legislation Signed by Governor 2005 Legislation • Expand the Functions and Reduce Rates of the Health Insurance Alliance - < 10,000 lives • Allowing Individual Health Care Coverage of Unmarried Dependents until their Twenty-Fifth Birthday - < 4,000 lives • Require Insurers to Offer Insurance Coverage for Certain Part-Time Employees - < 4,000 lives • Small Employer Insurance Program (GSD) - < 3,000 lives FY06 Budget • Implement the State Coverage Insurance (SCI) Program ($4 million general fund) - < 10,000 lives • Medicaid Outreach to Enroll Native American and Hispanic Children ($1 million general fund) – < 5,000 lives

4. Insure New Mexico! Council – Remaining Initiatives A. Increase Insurance Options • Require insurers tooffer domestic partner health insurance benefits to employers of any size who want to provide this coverage. [L 2006 – Mimi Stewart wants to carry] • State-subsidized reinsurance plan similar to HealthyNY model. [L & B] • Essential benefits with less mandated benefits and annual or lifetime caps. (Maes and Beffort bills) [L 2007– Beffort wants to carry] Subcommittee looking at Minimum Healthcare Protection Act, HMO Act & creation of standard benefit package (ala TX) with and without mandates NOTE: HSAs considered and not considered important to charge of increasing the number of uninsured, and no legislation needed for market to do them within current law.

5. Insure New Mexico! Council – Remaining Initiatives B. Tax Incentives for Small Employers[2006] • Tax credit for businesses that provide health insurance for part-time employees working at least 20 hours a week. This credit is estimated to benefit 7,000 part-time employees (a total of 10,000 individuals, with families). [L & B ~$15 million] • Graduated tax credit for small businesses (25 employees or less OR less than 10 employees) that offer health insurance for their employees. Small businesses currently offering health insurance would receive a five percent tax credit, while small businesses not currently offering health insurance would receive a 10 percent tax credit declining to five percent in the second year. This tax credit is designed to entice small businesses to begin and continue to offer health insurance for employees. This tax credit is estimated to benefit 5,000 employees (a total of 7,500 individuals, with families). [L & B ~$9-18 million; Varela and Grubesic carried] • Tax Credit for small businesses offering insurance for families with small children. [L & B] or for low-income employees.

6. Insure New Mexico! Council – Remaining Initiatives C. Medicaid [2006] • Increase Medicaid coverage adults up to 100 percent of the federal poverty level (FPL) by developing a limited benefit plan for such adults with appropriate cost-sharing, beginning with adults w/ children up to 50% FPL (currently ~ 33% FPL). (< 11,000 lives @ ~$22 million GF)[B & R] • Increase coverage for: • Prenatal care up to 235% FPL (now 185%) [B & R; K Martinez] (< 1,200 women ~$3.9 million GF). • Infants and toddlers up to 300% FPL (now 235%) [B & R; K Martinez] (< 7,800 children to age 19 @ ~$3.8 million GF). • Increase aggressive outreach to families with children (bring enrollment from 411,000 projected at end of FY 2006 up to 430,000 by end of FY 2007 @ ~ $14.6 million GF annualized). [B] • Expand SCI ($4 million GF for ~ 7,000 lives). [B]

7. Insure New Mexico! Council – Remaining Initiatives D. Use New Mexico Clout [2006] • Expand the use of federally-qualified health centers (FQHCs) and primary care clinics. [B ~ $2 million] • Increase use of telehealth and electronic billing. [L? & B] • Develop in-state healthcare capacity in New Mexico so fewer dollars are spent out-of-state and are instead redirected towards in-state providers. [R] • Give preference in doing business with the state or getting access to industrial revenue bonds to companies who offer health insurance for their employees. The Governor should call on New Mexico businesses to give preference to vendors, contractors and suppliers that offer health insurance for their employees. [EO or L & R– GSD, Economic Development and/or All State Agencies]

8. Insure New Mexico! Council – Remaining Initiatives E. Increase Knowledge of Health Insurance Options [2006] • Educate the public regarding prevention and wellness and the link to reducing the cost of health insurance premiums. [B] • Train brokers and increase HIA’s outreach capacity to small businesses. [B]

9. Insure New Mexico! Council – Remaining Initiatives Revenue to Pay for Recommendations • Close the tax loophole for smokeless tobacco products and target to uninsured. From 25 percent to 40 percent = ~ $2.3 million. [L – Gail Beam was interested.] • Increase liquor excise tax and target to uninsured. From five cents a drink to 15 cents a drink would generate an estimated $72 million.[L – Ortiz y Pino was interested.] • Use part of any uncompensated care savings to pay for the health insurance of low-income populations after the insurance options are implemented (e.g., ME model). [L, B & R – Heaton likely interested] • Assure that individuals and employers participate appropriately in the cost of insurance made available through these recommendations (e.g., appropriate co-pays, premiums based on income, mandates, etc.). • Maximize federal revenue through use of Medicaid for low-income and targeted populations. [B & R – Feldman, Trujillo, Picraux] • Repeal GRT exemption on “junk” food

10. Insure New Mexico! Council – NEW POSSIBILITIES • Market-Based Universal Coverage www.nmhealthchoices.org[L & B – 2007] • Mandates on employers and individuals • State role in collecting funds and providing vouchers • Voucher amount depends on income and health status • Vouchers used to purchase private sector insurance • Mandates or Encouragement to Provide Wellness Benefits • “WalMart Mandates” for Large Employers