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 The New Mexico Health Policy Commission monitors, analyzes and makes recommendations on access to healthcare. Healthcare is provided to New Mexicans by a mix of private and public organizations and healthcare providers. Healthcare services are provided to medically indigent persons through: Human Services Department, Department of Health, community health centers, federal facilities (e.g., Indian Health Service), tribal agencies, schools, etc. The private sector provides significant amounts of uncompensated healthcare services. Services are provided to children with chronic illness and disability through the Children’s Medical Services program.
Develop community-level behavioral health services across the state. Provide diagnosis and treatment of sexually transmitted diseases in a range of different settings, in collaboration with communities and primary care clinics. Increase mental health providers in school-based health centers. Improve access to behavioral health services and enhance collaboration between the programs and agencies that provide them. Continue to facilitate enrollment for Medicaid SALUD!
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 New Mexico’s healthcare system has several components. They include emergency medical services; primary care; medical specialties; dentistry; and long-term care. Primary care services include the basic diagnostic and treatment services found in general practice, family practice, pediatrics, obstetrics/gynecology, general internal medicine and general dentistry. As for the prevention of illness or injury, some efforts, such as immunization, take place in medical clinics; others take place outside of the healthcare system. For example, some environmental health problems are prevented by refuse collection and the assurance of safe drinking water; injury prevention includes such things as building codes and enforcement of laws against driving while intoxicated (DWI). In this report we focus on access to healthcare services, rather than the broad spectrum of preventive activities. Access to primary care is important both for treating and for preventing illness.  Healthcare services in New Mexico are provided or financed by many different organizations, including private medical practices, health maintenance organizations, health insurance companies, Medicare, tribal health programs, the U.S. Public Health Service, the Veterans’ Administration, Medicaid and other state programs. The New Mexico Health Policy Commission (HPC) plays a long-term role that includes planning, monitoring and technical support. The question, “what services exist?” (availability) is different from the question, “what services are people able to use?” (access). There are many barriers that can block people’s access to specific healthcare services. Common barriers include poverty; lack of health insurance; lack of knowledge about services; inadequate transportation; and language barriers. Other, more subtle, barriers may be important as well. For example, a person may stay away if he fears that his visit will not be confidential, thinks he would be unwelcome, or is made to feel shame for seeking a particular service.(1) Clearly poverty creates barriers. However, several programs provide access for low-income people. Medicaid covers children and pregnant women with income below 185% of the federal poverty level (FPL, defined as the minimum income needed for an adequate diet). The gaps in coverage that remain are filled to some extent by several programs. Medicare provides coverage to older adults and persons with kidney failure. The State Children’s Health Insurance Plan, with federal matching funds, will extend coverage to children up to 235% of FPL. Adults other than pregnant women are eligible for Medicaid only if their income is less than 37% of FPL. As a result, some employed adults do not qualify for Medicaid even though their incomes are too low to afford private health insurance. The “safety net” for them includes county indigent funds, as well as federal, state and local subsidies to local community clinics. County indigent funds vary in their eligibility criteria; for example, residency requirements and whether coverage is extended to legal immigrants or undocumented persons. The range of covered services also varies widely. The publicly funded, community-based primary care centers provide services under a sliding fee schedule, based on a patient’s income. In addition, hospitals, clinics and doctors’ offices provide significant amounts of uncompensated care, for which no cost estimates are available. As discussed above, the existence of a program or service does not necessarily mean that everyone who is eligible can actually use it. The Health Policy Tracking Service (HPTS) uses two different methods to estimate how many people lack access to primary care services: 1., The population in excess of what our primary care resources could cover; and, 2., The number of people who are uninsured AND have not received care from the community health center system in the past year. Using these methods, HPTS calculates that 20% to 36% of New Mexicans lack access to primary care.(2) Another approach is used by the New Mexico Health Policy Commission: telephone surveys that ask New Mexicans about health coverage, their need for particular healthcare services, and whether they have been able to get the services that they needed. Rapid change has been occurring in the healthcare system, in New Mexico and nationwide. Thus, even our most recent published data, based on a 1999 HPC survey(3), may not be up-to-date on all access issues. However, that survey found that 14% of adults had no coverage at all during 1998. Another 7% had coverage for only part of the year. In the survey, “coverage” includes any health insurance, programs such as Medicaid, and organizations such as the Indian Health Service and Veterans’ Administration. As for children, 10% were without healthcare coverage throughout 1998, and another 7% had coverage for only part of the year.(3) According to the same 1999 survey, even among New Mexicans who had healthcare coverage, access problems were not rare. At that time, among New Mexicans with healthcare coverage, nearly 14% of persons who needed dental care were unable to get it. 25% of those who said that they had needed mental health services stated that they had been unable to get them. Nearly 12% of those who needed primary care services had been unable to get them. It is important to note also that in New Mexico, working does not always mean having access to healthcare: among persons who said that they could not afford coverage, over 55% were working full-time. In fact, 12% of adults who were working full-time did not have coverage at all in 1998.(3) Nationally, treatment for mental disorders seems especially problematic; even without focusing on the medically indigent, national studies have found that such treatment, when needed, is usually delayed for years, and in many cases is never received. In fact, these studies have shown that people with mental disorders have more problems than others in accessing any medical care.(4,5) In New Mexico, there appear to be significant gaps in access to dentistry. Community health center clinics funded under the Rural Primary Health Care Act are the safety net for people not covered under other systems, yet only 35% of these clinics provided oral health care. As with other aspects of the healthcare system, the picture continues to change. For example, in October 1999, Medicaid fees were increased to 85% of the average fees in the 1997 American Dental Association, in order to encourage dentists to participate in the Medicaid program. In this discussion, we have focused mainly on the economic barriers related to income and healthcare coverage. The other, less obvious types of barriers will also continue to be important; they need to be addressed even within existing healthcare systems. These include people’s knowledge about services, transportation, language barriers, and the complexity of the systems that people have to deal with in order to get needed care. All of these will undoubtedly continue to be challenges for New Mexico as well as the nation.     New Mexico Health Policy Commission (Data on access):
New Mexico Human Services Department:
Behavioral Health Services Division, New Mexico Department of Health
Crisis Response (24 hour per day hotline/referral)
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