AZTEC — San Juan County commissioners on Thursday reluctantly passed an ordinance that states the county will contribute to a statewide pool for uncompensated health care coverage, which could leave it with a roughly $4.4 million deficit in its indigent health care fund.
To lessen that deficit, officials say the county has two choices — raise taxes, or cut services.
Under the Safety Net Care Pool, which was created by a law passed in the recent legislative session, the county must dedicate about $3.2 million a year from its indigent fund to a statewide fund that pools money from New Mexico's counties and distributes it to hospitals. The law requires counties provide one-twelfth of 1 percent of their gross receipts taxes to the fund.
Hospitals with fewer than 25 beds will receive 60 percent of those funds. But larger hospitals — like San Juan Regional Medical Center — will receive none of the funds.
Repeated efforts on Thursday seeking comment from officials in the New Mexico Human Services Department, which is the agency tasked with distributing pooled funds, were unsuccessful.
Before the meeting, commissioners and staff met in a work session to discuss options to maintain the county indigent fund, a program that reimburses hospitals, clinics and other health care providers by partially covering county resident's uninsured medical bills.
"The scenarios that we're going to go through are critical," County Executive Officer Kim Carpenter told those in the room, "and they're not good."
Without reducing the number of approved health care providers, or reducing their reimbursements, the indigent fund would face a deficit of more than $4.39 million in fiscal year 2015, according to county projections.
The other three options include eliminating certain providers from the fund and cutting their reimbursement from 70 percent to the Medicaid rate of 33 percent. One option proposes eliminating all health care providers except San Juan Regional Medical Center and its inmate care program.
But with those options, the indigent fund still faces deficits. And those deficits are predicted to rise in the following years.
Linda Thompson, deputy county executive officer, told commissioners that county administrators need to know what kind of indigent program the county should continue offering. By law the county is required to provide the program but any revised form, Carpenter said, likely will have limited services.
"We're backed into a corner," he said.
In the commission meeting that followed, County Attorney Jim Durrett outlined the ordinance the commissioners later adopted, which states the county will pay into the statewide fund in March, June, September and December its required sums.
Commissioner GloJean Todacheene eventually motioned to pass the ordinance.
"I need a second," Commission Chairman Jack Fortner said. "Give me a reluctant second."
Commissioner Keith Johns said, "I don't like it — I want to be real clear on that — but that's a second."
Before the commission could vote, two county residents in the audience protested. Ron Lyman, who from his seat said he opposed the statewide fund before he was asked to step forward, walked to the podium and said into a microphone, "It's my understanding that everybody's in disagreement in paying this, so why don't we vote that way and stand our ground?"
When the commission finally voted, many of its members did it slowly and one at a time, looking at their hands, staring down at their desk or seeming to review the agenda.
Commissioner Margaret McDaniel voted "no."
"OK. It passes," Fortner said. "We all wanted to vote "No."