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Medicaid Buy-In Bill, Explained

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State lawmakers are considering a bill that would let residents who aren’t eligible for Medicaid coverage to buy into the program.


Nearly one million low-income New Mexicans were covered in 2017 when the state chipped in $1 billion of $5 billion for things like health care services.


Colin Baillio says the buy-in program could enroll up to sixteen thousand more New Mexicans. He’s the policy director for Health Action New Mexico. He spoke with Public Health New Mexico’s May Ortega.


Baillio: We’re really focused on people who don’t have any other options right now. People who aren’t able to get Medicare, Medicaid or financial assistance on the health insurance exchange would be able to purchase Medicaid coverage on their own. And the coverage would be adjusted based on their income so that it would be able to fit their family budget.

KUNM: The average monthly cost for individual insurance through the Affordable Care Act is $520, will this be less expensive? How much will it cost?


Baillio: The Medicaid buy-in plan on its own is expected to cost about $377 a month. Now for some families that will still be too much and so, that’s why the premiums will be adjusted based on income.

KUNM: Would this Medicaid buy-in program change how many providers are serving Medicaid patients? Would we see more services available?  

Baillio: One thing this is gonna do is make sure that when folks come in and they’re signed up for coverage, providers are going to get paid for their services. If somebody is uninsured and they come in, there’s often no way to make sure that doctors are going to be reimbursed. And included in this year’s session is going to be a discussion around how much we do pay providers for our Medicaid program and our vision is that this year we’ll be able to get that conversation started and get the buy-in up and running as a part of those efforts.

But then as we consider expanding the program out to more folks, we continue that discussion and really make it so Medicaid providers are getting paid adequately for their services across the entire program. And we see the Medicaid buy-in as a way to really jump-start that conversation.

KUNM: You mentioned that there are hopes to expand the program even further. Who are some people who wouldn’t qualify if this buy-in program were to launch?


Baillio: Some of the folks who wouldn’t qualify for the program are those who are receiving financial assistance on the marketplace. Folks who are able to get quality and affordable coverage for their families through their employer would also not be eligible for the coverage.


When we think about how we might be able to expand these programs, we’re considering pursuing federal waivers or other programs where we could bring in some federal dollars to help folks purchase Medicaid buy-in.


If they do get their coverage on the exchange and have that option to buy a public plan instead of going for one of the private options that’s on the marketplace – and as we think about employers who may want to have a lower-cost coverage option for their employees – we really want to have a discussion about that and study the full implications of it and see if we might be able to expand it to them in the future too.


But all these things take time and thorough study, and so we’ve included that in our bill as well.

KUNM: The Affordable Care Act has a way for states to create a Medicaid buy-in program already, why aren’t we doing that?


Baillio: So there’s something called the Section 1332 State Innovation Waiver which lets states take control of those federal dollars and spend them in ways that may work better for the state. And that’s an option we actually did a lot of exploring on and seeing if it would be something that would work well. There were still some lingering questions about what it might do to the marketplace and questions about whether it would be enough money on the table to make sure that we would be able to expand the program to everyone who might qualify for that.


This year we’re really laying the groundwork to help those folks who are uninsured get signed up for coverage.

Support for KUNM’s Public Health New Mexico project comes from the W.K. Kellogg Foundation, the McCune Charitable Foundation, and from KUNM listeners like you.

May joined KUNM's Public Health New Mexico team in early 2018. That same year, she established the New Mexico chapter of the National Association of Hispanic Journalists and received a fellowship from the Association of Health Care Journalists. She join Colorado Public Radio in late 2019.
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