FARMINGTON — San Juan County health care providers are making grim predictions as they face deep cuts in a county fund that partially pays many of their uninsured patients' medical bills.
They predict jails will crowd, crime will rise, public drunkenness will increase, emergency rooms will fill and some patients, many of whom are homeless, will die.
"What we're looking at is about a total of 168 people who are not going to get services — and that's only our services," Four Winds Recovery Center Director Jolene Schneider said.
The only way to prevent "deep" and "catastrophic" cuts to health care providers compensated under the county's indigent health care fund is if county commissioners implement "Scenario A," County Executive Officer Kim Carpenter said. That option would raise taxes, narrow eligibility for indigent fund coverage and reduce health care provider reimbursement rates, according to county documents.
The recent creation of the Safety Net Care Pool, county officials say, is forcing the county to make these cuts to its indigent fund. For months, county officials have been struggling to find $3 million to contribute to the pool. It was created by legislation passed in the last session that requires all counties to pay one-twelfth of 1 percent of their gross receipts taxes to the pool.
Carpenter said "Scenario A" could come before the commission soon, and the option is "highly possible."
As of February, 41,075 county residents were enrolled in Medicaid, according to state documents. But, according to the 2010 U.S. Census, a little more than 130,000 people live in the county, meaning there likely are many more uninsured residents who would qualify — and that's a problem, said San Juan Regional Medical Center CEO Rick Wallace.
"This is all acted upon totally prematurely," he said.
He said the sole community provider program, the predecessor to the safety net pool, had been helping the hospital pay for uncompensated medical bills. Now, without those payments — and without more Medicaid insured patients — the hospital is looking to the county's shrinking indigent fund to help cover its uncompensated health care claims, he said.
New Mexico Human Services Department officials say the hospital will get $7 million in Medicaid reimbursements for patients who spend the night. But Wallace said that money only funds inpatient Medicaid claims and contradicts the Affordable Care Act, which is designed to eliminate unnecessary overnight stays.
The Human Services Department replaced the old program with the expectation that more eligible uninsured people would sign up for Medicaid than currently have, he said.
"I think it's going to take two to three years," he said.
The county's "Scenario A" proposes a reimbursement drop from 70 percent to the Medicaid rate of about 33 percent, according to the document. The hospital would get about $3.4 million under the old rate, but under the proposed reduction that would drop to about $2.2 million, according to county documents.
San Juan County's DWI Alternative Sentencing Division got about $1 million under the old reimbursement rate but would get a little more than $483,000 under the proposed rate, according to county documents.
Presbyterian Medical Services and Four Winds Recovery Center would lose about half their indigent fund reimbursements, according to the documents.
Also, an additional 329 households would lose eligibility for indigent fund uncompensated care coverage, according to county documents.
Wallace said the hospital will continue accepting everyone, but it will need to find more revenue as it loses money that used to come from the indigent fund. In June, the hospital closed its Bloomfield clinic because it anticipated a $9.5 million funding loss.
County Alternative Sentencing Division Administrator Jennifer Miller said her agency's services would be significantly impacted. The division operates a minimum-security jail and counsels those convinced of DWIs.
As many as 10,000 lives would be affected, including families, employers and friends of those who drive while drunk, she said.
The community, she said, would see a bad change.
"We would not be able to continue to do the services as we've been providing them," she said.
Mike Renaud, Presbyterian Medical Services northwest regional director, said PMS's health center provided primary care to 1,800 new uninsured patients starting at the first of the year up to Tuesday. PMS also operates Totah Behavioral Health Authority, but much of the traditional care that had been paid for through the indigent fund cannot be billed to Medicaid, he said.
Totah serves many who are homeless or addicted to alcohol or drugs, "and when people don't get services," he said, "they relapse."
"It's too early for me to tell," he said. "The loss of that funding to Totah is certainly potentially very dangerous. The loss of funding to the health center is certainly not good."
Kristine Carlson, Totah's director, told the county commission in a meeting earlier this month she expects about 10 percent of her clients would die.
Efforts to reach Carlson by phone throughout the week were unsuccessful.
The closest detox centers aside from Four Winds are in Gallup and Durango, Colo.
Since July, Schneider said, the center has treated more than 3,700 admissions — and Medicaid doesn't pay those claims. The center already operates at a deficit, and its reserves have been dwindling over the past four years, she said.
"Things have to be cut," she said.
According to its projections, the center would lose almost $222,000 — seven full-time employees from the current 36, at least two beds, 887 days of care and 168 clients.
She said she hopes state officials will find a solution.