One of the hot topics before the Legislature in the next session will be SCP. We're not talking about a recreational drug or a brand of motor oil.
The New Mexico Sole Community Provider program is how we cover healthcare for uninsured, underinsured and poor patients. Since 1994 SCP has helped 29 of the state's hospitals by matching federal funding with county funding at about $4 federal for every $1 provided by counties. As budgets have withered, especially for smaller, rural hospitals, the program has been a life saver.
After the federal Center for Medicare and Medicaid Services questioned the formula used by the state Human Services Department to disburse SCP funding, HSD revised its formula. Suddenly, the federal match plummeted from $246 million to $69 million.
How many organizations of any kind can sustain a 70 percent cut in one revenue stream? It prompted some pretty drastic budget cuts all over the state. Gila Regional Medical Center in Silver City, for example, cut the hours of 70 employees in half.
Now as Medicaid morphs into Centennial Care, HSD proposes to eliminate the SCP program and replace it with a new program. The department wants to intercept the one-eighth-cent gross receipts tax that counties levy for indigent care and pool funding. HSD would then distribute money depending on the size of each hospital. Smaller hospitals would receive more. Larger hospitals would see an increase in the base rate for Medicaid-covered services.
Counties see this as the state's hand in their pockets. Again. They would still have to fund indigent care, and some counties have used the funds to pay for drug and alcohol treatment, prisoner healthcare, indigent burial and other services not covered under the proposed new program. The New Mexico Association of Counties and many individual counties have passed resolutions against the proposal.
Maria Meadowcroft, spokeswoman for Holy Cross Hospital in Taos, explained: "It is unclear whether Holy Cross Hospital (and the other 28 Sole Community Provider hospitals) will receive any money. If they do receive funding, no one knows how much to expect or when to expect the payments."
Scott Annala, Lincoln County indigent healthcare administrator, told the Ruidoso News that without funding, "there goes the indigent program for 31 counties."
There's some logic in the state's proposal: It would direct all the indigent care funding into one (much smaller) pot. The state would divvy up money according to need; the smallest hospitals would get the most. Counties' indigent care costs should be lower because Obamacare will move more uninsured patients into Medicaid. And there would be more transparency.
Who do you trust, the state or the county?
Unless your county government is totally inept, sympathies usually tilt toward local government because the public likes the idea of local decision making that fits local needs. And voters, after all, approved these indigent care taxes.
Legislators of both parties have said they're reluctant to harm their community hospitals or their counties.
As Republican Sen. Carroll Leavell told the Carlsbad Current-Argus: "I have real concerns about this. I don't remember anything that goes to Santa Fe coming back to counties with more. The bill has not been introduced yet, but if it is, I am not going to support it."
Local governments are touchy about funding because they took a hit with recent tax changes. In 2004 lawmakers repealed the gross receipts tax on food but promised local governments a "hold harmless" provision, meaning, the state would compensate for their lost revenues, but the big tax package approved last year called for a gradual phaseout of the hold harmless provision.
At meetings around the state, local governments have pleaded with lawmakers, as they did recently in Gallup, to "fix SCP and fix hold harmless." Until then, city and county governments are like onions, losing layer after layer.