FARMINGTON — San Juan County's manager says the state agency overseeing a recently restructured program that helps New Mexico hospitals pay for uninsured care — which already requires a $3 million county payment — is asking for another $1.5 million.
"It's not an additional payment," said Brent Earnest, deputy secretary of the New Mexico Human Services Department, which is the agency managing the new program.
Earnest said the $1.5 million is part of a payment the county had already approved, and it is significantly less than the county had agreed to pay into the program that preceeded it. Kim Carpenter, the county's executive officer, said the county is not going to pay it.
Under Senate Bill 268, which passed in the recent legislative session, the department requires that all counties contribute one-twelfth of 1-percent of their gross receipts to the state-wide fund, known as the Safety Net Care Pool.
But this payment is bankrupting San Juan County's health care assistance program, formerly known as the "indigent health care program," Carpenter has said. This program also helps uninsured county residents pay medical bills and reimburses providers for care delivered to the uninsured.
The county cut the local health care program's reimbursement rates nearly in half last month to lessen the expected deficit, but officials still anticipate a $6.5 million shortfall in that fund without further action.
One option is to raise taxes. The other is to cut services. Commissioners have discussed imposing a one-eight of 1 percent gross receipts tax on all businesses in the county and three cites, which is a 2.5 cent tax on every $20 purchase that would take in an estimated $4.4 million in its first year. But commissioners have said this tax likely won't pass without their constituent's support, and it still wouldn't eliminate the deficit.
Paying an additional $1.5 million to the department would worsen an already bad situation, Carpenter said.
"How can they sit there and say it's not additional?" he said. "How much money is going to the state? Three million or four-and-a-half million?"
Either way, the county has received a bill for the $1.5 million.
The state's safety net fund replaces the Sole Community Provider Program, which also helped hospitals pay uncompensated care. Under that program the county had agreed to pay the department $11.3 million for 2013, according to a letter to the county from the department.
Carpenter said San Juan Regional Medical Center made that payment, not the county. The hospital had helped the county make the sole provider payment, but doesn't anymore under the safety net fund.
During this time, the sole provider program was being phased out as the safety net fund was being phased in, Earnest said, but hospitals still needed reimbursement for uncompensated care.
The department gave counties a choice — either make the original payment or, he said, pay what is required by the safety net pool, whichever is the lesser amount.
Counties make these payments quarterly, and San Juan County's received the bill for $1.5 million for January to June of this year, he said.
"It's not an additional payment. It's actually significantly less than they were going to pay us," he said.
When asked for a response, Carpenter laughed.
"That's interesting," he said. "That's very interesting."
He said $1.5 million added to $3 million is $4.5 million, and the county was only asked to pay $3 million in quarterly amounts. Based on that math, he said, $1.5 million is an additional payment, one for which county officials weren't told they should budget.
Deputy county attorney Doug Echols said the department has no authority to require counties to make this payment as it's not a provision in the new law. He said the safety net pool law became effective in July 1, but the department says the county "committed to make a payment to a completely different program that no longer exists (the sole community program), but we're going to have you make that payment to us instead."
He knows of no counties making the payment, he said.
Earnest said 11 counties, as of Thursday, already have made payments totaling $2.5 million.
Steve Kopelman, New Mexico Association of Counties executive director, said counties are choosing to make this payment to support their hospitals.
In San Juan, Doña Ana and Santa Fe counties are three of the state's larger hospitals that, under the safety net pool, will receive the least, if any, money for uncompensated care. San Juan County officials recently learned its hospital may get $880,000.
Doña Ana and Santa Fe haven't made the payment either. Carpenter said San Juan County doesn't have the money.
"The county's not going to pay it. 'Kay? And if you talk to most counties," he said, "they too are not going to pay it."