NM insurance program back to ‘full scale’ operation

June 19, 2009 03:23 AM

By Dianne Stallings
The Ruidoso News

RUIDOSO, N.M. — New Mexico’s state health insurance program is back up and running, said Scott Annala, Lincoln County Indigent Health Care Coordinator.

Reporting to county commissioners Tuesday, Annala said the State Coverage Insurance is “going full scale.”

“At one time, they had a waiting list of 10,000,” he said. But that list was handled since efforts were renewed in February and now the program is trying to sign up as many enrollee as possible at least until September, Annala said.

At that point, more revenue must be found.

Although the program is aimed at low-income people who are not on Medicaid coverage, a single-person household can earn up to $21,000 and a household of four up to $44,100.

The premiums range from $90 to $110 per month and can be paid by an employer or an individual, he said.

“I would anticipate (because of the SCI availability) claims through the county Indigent Health Care Fund will be lower,” Annala said. “Anyone who comes through my office can get an application and I’m glad to be a portal.”

The three insurance entities participating in SCI are Lovelace Community Health Plan, Presbyterian Health Plan and Molina Healthcare.

Applications may be obtained through Annala at 258-1232 or by calling 1-888-997-2583.

In related health care issues, commissioners approved claims processed during June, the last month of the fiscal year, under the county IHCF and the Sole Community Provider Program tied to the county hospital in Ruidoso.

County Manager Tom Stewart said 68 of 76 claims filed under the sole provider program were recommended for approval for a total of $105,422, bringing the year-end figure to $850,224. For the full year, 761 claims were processed with a 13 percent disapproval rate.

Under the IHCF, 63 claims were submitted this month and 61 were recommended for approval for a total of $50,502.85. That brought the total for the year to $421,637.22.

“Last year, the average Indigent Health Care Fund monthly payment was $44,272,” Stewart said.

“This year, our average pace was $35,136.44 per month, down from last year. Ending the year, we spent $421,637 of the budget for claims this year, which was $571,663. The balance will be rolled over for neat year’s claims.”

Commissioners heard from James Gibson, administrator of the Lincoln County Medical Center, the county hospital in Ruidoso, that excess revenue over expenses was listed at $1,359,00.

The hospital saw an increase in net assets of $1,118,000 in the audit for the period ending December 31, 2008. About $800,000 came from operations and $300,000 from donations.

The LCMC is managed by Presbyterian HealthCare Services under contract with the county.

Presbyterian leases the hospital for $800,000 per year, manages the ambulance service and two of the county’s rural health care clinics.

“It was not an extremely good year last year,” Gibson told commissioners.

“We experienced a real drop in volume for in-patients and out-patients.”

When that trend became clear, he dropped spending and expenses, Gibson said. He pointed to a summary of the percentage of net accounts receivable from all payers. It showed that in 2007, 22 percent fell under Medicare and that dropped to 16 percent in 2008, and self-pay accounted for 12 percent in 2007 and fell to 5 percent in 2008.

On the other side, Medicaid went up from 19 percent to 20 percent; commercial on contracts from 27 percent to 35 percent; and commercial, noncontract and other, from 20 percent to 24 percent.

While the main hospital experienced volume problems, the rural health clinics saw one of their best years with the smallest operating loss posted by the clinic in Carrizozo, he said.

The audit was performed by the Ernst and Young auditing firm and resulted in an “unqualified” opinion, which is a good declaration by an auditor.

In other action, commissioners approved an annual self-imposed mill levy tax rate of 6.221 mills for properties within the Alpine Sanitation District. One mill equates to $1 for each $1,000 of taxable property value.