Losing Medicaid Coverage and Access to Specialized Services?

BHSD CEO Wayne Lindstrom Responds to Concerns…

Greetings-

An issue was presented to BHSD recently that suggested that those with SMI who present for treatment and who have traditionally had Medicare and Medicaid are now losing their Medicaid coverage and are losing access to specialized BH services. The implications are that specialized BH services (IOP, ACT, PSR, CCSS, etc.) are not covered under Medicare and therefore would not be available to some of the most vulnerable individuals.

Federal rule prohibits the Expansion Population from being eligible for Medicare. If they are eligible for Part A, B, etc. of Medicare, they are not eligible for the Expansion. If they meet a nursing facility level of care, they could be eligible for a long-term care category and become a dual. But if they don’t meet nursing facility level of care then the only other full coverage category available would be Parent/Caretaker which means they must be a parent and have very low household income. It has been suggested that some of the individuals who are being dropped from Medicaid were not part of the expansion population but are prior eligibles for Medicaid through their SSDI. It would be helpful to identify any specific instances where this may have occurred.

Thank you- Wayne

Wayne W. Lindstrom, Ph.D.
Director, Behavioral Health Services Division
CEO, Behavioral Health Collaborative

New Mexico Human Services Department
37 Plaza la Prensa
Santa Fe NM 87507
Mailing Address: PO Box 2348, Santa Fe, NM 87504
Office: 505-476-9295