The Supreme Court's decision on the Affordable Care Act is front and center nationally, but debates about health care have taken on extra intensity in New Mexico. That much was clear on Monday, June 25, in the Roundhouse during a presentation on Centennial Care, the sweeping Medicaid redesign proposed by Gov. Susana Martinez' administration.
The chambers were packed for the Health and Human Services Committee hearing, with tribal leaders out in force. Sen. Dede Feldman (D-Bernalillo), chair of the committee, called the level of public interest "unprecedented."
It isn't just the wide scope of the changes that has people on high alert about Centennial Care. New Mexico submitted its proposal to the feds two days before rules about public input went into effect, allowing the state to slip past new regulations. But concerns were raised that tribal input hadn’t been adequate. New Mexico yanked its proposal to allow time for more people to have a say.
Sidonie Squier, cabinet secretary of the Human Services Department, was running defense. She said the state had done everything required to get feedback from tribes with the exception of one "bureaucratic technicality." Indian Health Services hadn't been given proper 30-day notice about the drafted plan before it was submitted to the feds, she said, but that oversight was being remedied. Squier said concern over Native American health was part of the motivation for streamlining Medicaid delivery, and any uproar over a lack of tribal consultation was "much ado about not much."
Tribal representatives disagreed.
Navajo Nation Vice President Rex Lee Jim said his government had limited opportunity to weigh in during the development of Centennial Care. Consulting with Indian Health Services is not the same thing as consulting with tribal authorities, he added.
The governor of Jemez Pueblo, Joshua Madalena, said he was offended to hear Secretary Squier insist that her office had adequately included Native Americans in the Medicaid redesign when many tribes, including his, weren't contacted.
"Each tribe is unique in its own way—culture, traditions, way of life and especially language," said Madalena. "Each tribe will sit up here and tell you a different story, their own beliefs and ways of how to provide health care services in their communities."
Shelly Chimoni, executive director of the All Indian Pueblo Council, testified that the state's own documentation shows that only six of 22 tribes were consulted. Of that six, one listed someone as a governor who never held the position. Chimoni said that in the past, tribes have worked hand-in-hand with the state as part of the Medicaid group, which laid out clear protocol for ensuring an inclusive communication process.
"There should really not be a question of what consultation is," said Chimoni. She suggested that the state establish a better plan for documenting talks with tribal leaders.
One in four New Mexicans get their health care through Medicaid, which serves low-income and disabled populations, including a high number of Native Americans. Administration of the program is shared by federal and state governments, and the budgets of both are hobbled by Medicaid costs that have ballooned into the billions of dollars. "The cost growth is unsustainable," Squier said. "More state flexibility is the answer that we need."