Report from Santa Fe; Pam Hyde

The is made possible in part by a grant from the members of the National Education Association of New Mexico, an organization of professionals who believe that investing in public education is an investment in our state's economic future. I'm Lorraine Mills, welcome to report from Santa Fe. Our guest today is Pam Hyde, the cabinet secretary for the state of New Mexico's Department of Human Services. Welcome to the show. Thank you. Glad to be here. Well, it's wonderful to have you. We've got a lot of catching up to do. I went to your website, which is www.state.nm.us slash HSD.

And it's really an up-to-date, very well, very, very accessible to the public website and I urge people to go there. And when we went there, I noticed at the top, it said serving one in three New Mexicans. Can you explain a little about the mission of the Human Services Department and how you come up with the one in three figures? Sure. The Human Services Department's mission is to impact poverty. We try to impact poverty and helping people who are in poverty and also, frankly, helping to impact the impact of poverty on the state. So we want to reduce that. Poverty is not good for a state. It's not good for the economy. So when we help people who are impacted by poverty, we help the state as well. The one in three New Mexicans comes from the fact that we serve a lot of people. We serve 400,000 people, give or take, in Medicaid alone. And then we do food stamps. We do child support. We do TANF for what used to be

called welfare. It's now the temporary assistance for needy families and other programs and the low income energy assistance program that we've got so much attention, LIHEAP. So by the time we do all that, we've served 600,000 or more in New Mexicans. And that's almost a third of us. Wow. You have been in the news lately because the Fed, the Federal Government has decided through their Deficit Reduction Act to modify or change the certification process for Medicaid and insisting that the recipients have the documentation of citizenship and proof of identity. How is that going to impact us? And I know that this is caused for concern for a lot of Medicaid recipients. How will it affect New Mexicans? It's a big cause for concern, not so much because of the requirement themselves, but because of the documentation that the feds are requiring that we use to prove identity and to prove citizenship. So for example, if you have a passport,

that proves both identity and citizenship. But if you don't have a passport, then you have to have two different pieces of documentation, one that requires, one that shows who you are and the other that shows you're a citizen of the United States. And the problem with this is that we think it's actually going to hurt people who are citizens and who have been receiving Medicaid and who are very dependent on that program for a long time. For example, elderly people, people with developmental disabilities who are on waiver programs, tribal members, folks like that, who might not necessarily have the kinds of paper that the federal government is requiring that we use. These documents generally have to be originals. And in some cases, people don't have birth certificates or they don't have some of the required pieces of information. In some cases, some of our older individuals in nursing homes and some of the developmentally disabled individuals, they're cognitively impaired. They can't even tell us where they were born, much less, get those kind of documents. So we're very concerned that it's going to

have a negative impact. And we've been working with other states and with the federal government to try to see how we can best implement this. I understand that you're having several agencies work together. Explain how you're doing that. It's health, the health department aging and tax and rev department. The tax and rev department in our state actually provides identification for people, whether they're drivers or not. They provide drivers license, but they also provide identification. There are certain things you have to show in order to show who you are and they will issue an identification. The aging long-term services department is responsible for some of our waiver programs, so they're trying to work with some of the elders and others to try to help figure out how to do this documentation. Our department of health, of course, keeps the vital records, so they keep birth certificates. And for people who are born in New Mexico back to 1905, I believe, they have records of that. But if you're born in another state, or if you were born before 1905, or if you were born as a tribal member and maybe didn't back in the days when you didn't

have to turn those records into the state, we may or may not have that kind of documentation. But the other departments are being very helpful. We're going to try to do an electronic interface with the Department of Health to get records that are available. But we still think there's going to be a lot of people who are going to struggle with this requirement. We really want people to go ahead and come in, though. We don't want them to be scared off. We want to try to help them find the documentation that they need. And haven't you extended the deadline? I think the feds wanted immediate. And our state is doing six months to try to find this paperwork. Well, actually, what we've done is for people who would have been responsible to re-certify in certain categories in July, we're actually extending it in other six months. So people who used to would have had to have reapplied in six months, we're going to allow them to reapply in 12 months. That's the longest we're allowed to go by the federal government and that will give them and us a little bit more time to help put that documentation together. How many new Mexicans you think will be affected by the new regulations?

Well, at some point, all 400,000 have to re-certify and then, of course, anyone new coming onto the program has to bring this documentation with them. The federal government is allowing us a little time, usually it's up to 45 days to process the application. So during that period of time, we can keep the process going while people are looking for the documentation. And their rationale for this is deficit reduction. Is this really going to reduce the deficit? Well, I think it may reduce the deficit just by, frankly, kicking people off the program, which we think is really unfortunate. That is not the point. I think there were some people in Congress who felt strongly that non-citizens were getting a lot of Medicaid services. We, frankly, just don't have evidence that that's the case. On the other hand, by making everyone have to do this documentation, it's putting a burden and a strain on everyone. Well, I'm particularly concerned for the developmentally disabled and for the people with Alzheimer's and old and who just can't remember.

They have to have those people fall through the cracks. That's a frightening idea. It is. And we actually are working, that's why we're working very hard with the AG Long Term Services Department. We're also working, frankly, with nursing home facilities and with hospitals and others who might be able to produce or help find information about people's birth and about their citizenship. There actually is a process that we can do, have an affidavit sign by two different people who are not related to the individual about, who knows something about the individual's birth and citizenship. But that's a last resort. We have to, by the federal rules, use this original documentation first. Family Bible? You know, that's a little iffy. That's a third or fourth tier. And it's really not going to be a real documentation for citizenship. The other area that they're new regulations part of the deficit reduction act is TANF. So I've heard a lot of discussion about how some of the,

we're already such a poor state and some of the work requirements are going to be really, really restrictive for mothers of small children. Please tell us what the changes are and how that will affect New Mexico. Well, to tell you the truth, these changes and the regulations and these changes just came to us the last week. So we're just sorting out what they are. What they've done those increase the work requirements and they're defining now, work participation in a way that used to be each state could define that. And now they're defining it state or nationwide. And that's going to require every state to make changes because every state's implemented this program in their own way in a way that makes sense for us. So they're defining like what counts for, for example, in some cases going to substance abuse services could count. Or going to other kinds of service needs like education or other things could count toward the requirements. Those things are frankly being restricted. It's not called the deficit reduction act for nothing. The federal government is really trying to tighten down on these programs so they can save federal money.

And unfortunately the result of that is making it more difficult for people to get services. The elephant in the room in this sort of discussion though is the hospitals and the emergency room care. Don't you think that's really where the state is losing every state is losing so much money and where the feds are losing so much money? Is there any attempt either at the state level or the federal level to address this problem that anyone who needs emergency care is in a life threatening situation, whether they can pay it or whether they're citizens, the hospitals must give them this care. Well, there's actually a couple of things that have gone on. Actually the federal government last year passed some law that directly funds, it doesn't go through the state, but directly funds some of the emergency care for, frankly, for non-citizens. It's a recognition that the law doesn't allow hospitals to turn people away so they die. But as a consequence, then people are actually serving people who may not meet the various documentation requirements or may not be met at Medicaid eligible otherwise. There's also some work going on in our state looking at deficits or the uncompensated care that are mostly borne by hospitals, in some cases by providers as well.

And trying to look at what does it mean in the way we have our Medicaid programs set up, for example, we don't cover adults without children, we don't cover them. Most people don't realize that, but in other states they often do up to a certain level of poverty in our state. If you don't have a child and you're not disabled and you're not elderly, we just don't cover you at all. So that's directly translating into costs at hospitals and costs at emergency rooms. So we're looking at what we can do about that and looking at what that might mean for uncompensated care. We've also, as you know, in the last session, introduced and got passed two or three things that were really happy now in the fact this month, implementing, and that is some changes to the Medicaid program the way we count income that allows us to serve more children and more pregnant women. The children are started up this month, the pregnant women will start up a little later in a couple months.

We also got passed and introduced the premium assistance program, which will let us, for people who are not Medicaid eligible, help them pay insurance premiums to cover their children. We really want those healthy kids out there. We want them to be able to get the care they need. Yes. Is this the interior in New Mexico? Yes, it is. Good. Tell me more about the whole interior in New Mexico program as it applies to children. And people need to know that this is so high above the basic poverty level that I think people would be surprised that most kids in the state would qualify and get this care, get the immunizations, get the wealth, child checks, get the eye and hearing tests. So for kids 0-5 now, almost any of child 0-5 will be able to get insurance, either because their parents have enough money or their employer's sponsor insurance or because we have subsidies to help. So we really encourage anyone with young children to come in and let us help them find ways to be insured. We also just started a new small employer insurance program. This one is a little difficult and we've taken us a while to get it off the ground, but it's starting this month.

It's actually going to help employers and we're particularly focusing on nonprofits, small employers, nonprofits who haven't been able to offer insurance up to this point. We now have a way to put several of these programs together and make a package for them. It's actually going to make it more affordable for them to offer insurance for their employees. So we really want them to do that. We want employers to be a part of the process and we want these individuals, especially low income individuals to get the insurance they need. You know, health care in America and in Mexico might be the biggest hardest problem we have and what I've seen is that every year we're making progress. You know, the whole thing can't be solved right away, but every year, more and more people are eligible for coverage. And I just want to be sure that our viewers know, you know, keep checking, you know, look at your website and health department website and just see because more and more help is there now to get everybody covered. That's absolutely true and interestingly enough, a couple of states have gotten a lot of attention lately, like Massachusetts and others.

The fact is we actually implemented a couple of years ago, something called the State Coverage Insurance Program, SCI as some people know it. We have about 5,000 people on that program right now. That program is very similar to a concept that Massachusetts just passed. So we already have it in effect. Now, Massachusetts has other things that we don't have, but any state is a little different. We have a number of different opportunities now for employers and a number of different opportunities for individuals. And then as I said, we're looking at the adults because we've got, we're doing pretty well now at having opportunities for children. We need more opportunities for adults to get coverage. I think the reason Massachusetts got so much press was that they compared it to automobile insurance, you know, that you've got to be covered. You can't drive you without car insurance and you're not supposed to be living without this health insurance now. And so we're all watching and waiting to see how that turns out. Massachusetts is very instructive, but it's very different than New Mexico. Massachusetts only has about a 7% unemployment. I mean, uninsured rate.

And we're at 21%. So we've got a big, in there, they have much higher income on average. Well, just the whole poverty scale. We're very different and we have to do some more things at the low income level really to get some of the individuals that Massachusetts already has covered. So we've got ways to go, but again, we did things before Massachusetts did and we're proud of that and want to make sure we get the word out about that as well. I'd like to shift our focus a little bit because this Father's Day, I was very happy to see a list of the 20 best dads. We're used to deadbeat dads and, you know, beating people up and negative publicity. And here were some wonderful stories about some parents who had really, really given more than they had to. Whose idea was that? And you also have another, the governor has another program, the fresh chart program. So let's talk about child support.

The idea for the good dads came from actually from case workers. I was out visiting some of the offices and they said, you know, we put the list out of people who don't pay. Why don't we put the list out of people who do? And so it was a great idea we did. We went and looked and we have thousands of non-custodial parents who pay every month the way they're supposed to and the way they've promised the court that they will do and the promise their families. So we just wanted to highlight some of them and we found plenty to highlight and it went over very well. I think both the dads and the families and the non-custodial parents really appreciated that. So there were several news channels that did, you know, like close-ups on some of these families. And the feeling between the dad and the kids, it was really a lovely father's day story. It was and what we know from the research that's out there is when a father or when both parents, it's really not gender. Yes, it's when both parents are involved in a child's life, the child does better in school, better in life. So it's really critical to keep both parents involved and to have both parents take some responsibility for the child.

And what is the Fresh Start program? The Fresh Start program is an interesting idea that we talked about for some time, the legislature passed an opportunity for us to do something with this a year ago and the governor launched it about a year ago. And this is an opportunity for parents who have struggled, frankly, because the interest and are rears of what they owe has grown so large that they just throw up their hands and say, well, why bother? So we've got an opportunity now if a father or a mother is supposed to be paying and hasn't been able to. We had a period of time where the interest was very high. We actually got that lowered, too. The interest is lower now. We've in that process, we've been able to forgive, just literally get it off the books about $7 million in arrearages. But in return, we've gotten these non custodial parents in reengaged with their families and kids and have signed new agreements that are more affordable for them.

So we've collected over $500,000 for families as well. So it's a win-win all the way around. We get to sort of erase debt and the families get reengaged. And then, frankly, the child gets money coming into the home again so that they can live the way they should. It's been a great program. And also the psychological acknowledgement that the parent makes for that child by making the payments. But I can imagine that you would get a parent who might have another family and have a child from another relationship. And then sometimes owing $100,000 and they make $20,000. I'm sure it was absolutely prohibitive. And that's why it's called fresh start. Because they can come forth, acknowledge this, have their past arrears forgiven, and then work out a payment plan monthly ongoing. And so how much did you say you've forgiven?

Actually, it's close to $7 million now. We've been able to forgive in hundreds of cases. But at the same time, collected over $500,000 in new dollars that weren't being collected. So again, it's a win-win for both the non custodial and for the parent and child that live together. You know, so many of what we've been talking about is about children, the health care for children and the child support. Do you have any other parts of your agency that are focused primarily on children? Well, we have all kinds of stuff going on for children. I mean, in every program that we do, touches children, for example, our home energy assistance program. A lot of seniors take advantage of that program because they're low income, but so do a lot of families with children in the home. So literally prevents children from being cold in the winter and from being hot in the southern part of the state in the summer. So that program helps children. We have back to school programs that provide clothing allowances for children, and we actually just increased that recently. So kids get to go in and buy some new school clothes, and it's so important to kids to have, you know, clothes and the latest clothes and the latest shoes.

And it's not very much, it's only $100, but it's better than nothing. And otherwise they would be having hand-me-downs and things that just weren't, you know, what kids think of as the right clothes to wear these days. So that's an important program for children. And then on the other end of the spectrum, the elderly, what are you doing? I mean, my gosh, you know, with Medicaid. Are there any, and the LIHEAP heating program? Are there any of the programs that are specifically just for the elderly? Well, I think those are the main ones. I mean, we have a number of small programs. We actually help fund through the LIHEAP program, the weatherization program. That actually is administered by the mortgage finance authority. But that program actually helps seniors and others to weatherize their homes. And I tell you, if I used to run that program actually in another state, and it's so critical seniors, they've lived in their home for 30 years,

but they can't keep it up anymore. They can't keep the windowpains, you know, fix the way they're supposed to, and they can't keep the heating fixed the way it's supposed to. And it probably wasn't insulated. It wasn't insulated. The old house. So the weatherization program really helps our seniors out there. The focus being on poverty. You manage a huge department with a huge amount of money. But if you could wave a magic wand and change anything in the state to make things better for our poor, what would you do? Would it be education, economic development? If you could really make anything happen here that you visioned, what are some changes that you could suggest? Well, there's no question. Educational opportunities is a huge one. And I think the Governor Richardson and Lieutenant Governor Denish have been very focused on education, not just because it's the thing to do today, but because it has such an impact on our state's future.

And I know the Dianne Denish in particular has really been trying to help people understand that this investment in kids is about our economic future, not just about children, and that they go hand in hand. So education is clearly one, and I think we're on the right track. We're not there yet by any means, but we're on the right track. Just plain old income. I mean, we're at a point where if you've got $12,000 a year, that's not enough to live on. I don't care what you say. So we need more jobs that have living wage in our state. So that's critical and just the income. And back to the children and education. So pre-K is definitely the pre-kindergarten programs. Definitely are stepping that direction. Yeah. I mean, the evidence is clear that when kids have that kind of start, they do better in school, and they can then have a better opportunity. What are we looking for in the next session? Oh, my goodness.

I think there's going to be all kinds of things. You know, it's a 60-day session. So I think there'll be educational initiatives. There'll be health care initiatives. I think the governor's got some water initiatives that he's thinking about. So those decisions aren't all made. And I know there'll be a lot of discussion throughout the interim. We have a behavioral health collaborative. It's very unique in this state. And we are working with local communities to develop some legislative initiatives that have sort of emanating from the grassroots. I think that'll be different. And we'll be talking about that through the interim as well. And we're a little more about that because are we not the first state that has taken all the behavioral health elements from so many departments and put it all in and said, we are. Yeah. It's a very unique experiment, some would say. It's literally a purchasing group across multiple agencies. The state legislature created an entity. There's a legal entity now called the purchasing collaborative. And that collaborative creates one contract with one entity to manage multiple fund sources. Frankly, the collaborative does a whole bunch more.

We've created 15 local groups that represent communities all around the state working every actively with them about local voice and local needs. We're doing statewide planning for behavioral health. We're developing a comprehensive legislative agenda. We're doing a lot of program development and behavioral health. Now, a lot of this is going to take resources, but at least we're trying to put together that if there were any resources, here's where the priorities are. And so we've got a lot going on. A lot of workforce, licensure issues going on in behavioral health. So a lot of people in the country are watching us in this area. So the next session, do you have a particular pet project that you want to draw attention to from the lawmakers and from the citizens? Well, again, our health and human service secretaries work together on a lot of things that a couple things that I lead on are behavioral health. The uninsured, those are two big ones that I lead on, but I work with the other secretaries on a number of things. You know, we have six goals that the governor has set forth for us.

One has to do with ensuring New Mexico. One has to do with behavioral health. One has to do with improving health outcomes. That includes everything from diabetes to trying to get New Mexicans on the move and trying to deal with obesity and those kinds of hepatitis, those issues, infectious disease, flu, those issues. We have one about protecting vulnerable populations. We're really trying to eliminate and abuse and neglect and trying to deal with that in institutions as well as in homes. And then we're trying to do a lot with workforce. We recognize that we need more docs, we need more nurses, we need more behavioral health professionals, and we need to develop our workforce in the health and human services arena so they can do what we call evidence-based practices. So they're doing the best they can for people of our state. So there's big goals and we have lots of tasks we're working on under all of those goals. Well, and hunger, I forgot. Oh, yes.

Hunger and nutrition is one of the big ones too. We're doing a lot of work in the Food Stamp Arena and in the Women Infants and Children's Program and just nutrition issues through the schools and others. So we've got a lot on our plates. It's an ambitious agenda and I say more power to you. These are things that really need to be done. And I'm so grateful that you've taken the time to share what's going on in the Department of Human Services. Thank you. Our guest today is Pam Hyde, who's the Cabinet Secretary for the Department of Human Services. Thank you for joining us. Thank you. My pleasure. And I'm Lorraine Mills. I'd like to thank you our viewers for being with us today and report from Santa Fe. We'll see you next week. Report from Santa Fe is made possible in part by a grant from the members of the National Education Association of New Mexico, an organization of professionals who believe that investing in public education is an investment in our state's economic future. Thank you. Thank you.

Thank you.