SANTA FE, N.M. — New Mexico is pressing forward with plans to limit increases in state spending on Medicaid health care for low-income and disabled residents by adding monthly premiums and copayments from patients, as Senate Republicans in Washington contemplate fundamental changes to Medicaid.

State officials briefed lawmakers Wednesday on an array of proposed changes to the state’s Medicaid health care program designed to keep costs down while improving the delivery of health care for New Mexico’s poorest residents. Consumer advocates are warning that adding premiums and copays for people living on the cusp of poverty will wind up reducing and delaying the use of health care services.

Those concerns are overshadowed by a Republican proposal in the U.S. Senate to repeal the Medicaid expansion that has extended low- or no-cost insurance to about 250,000 individuals in New Mexico.


HIGH STAKES

Residents of New Mexico have flocked to enroll in Medicaid since eligibility was expanded in 2014 to cover individuals with annual incomes slightly above the federal poverty line — up to about $16,600.

That has helped cut the number of uninsured residents in half since 2013. It also has left New Mexico struggling to keep up with its share of Medicaid spending — the second-largest expense to the state general fund after public education.

State lawmakers have sought to increase federal matching funds to Medicaid by adding a provider fee from hospitals. New Mexico Gov. Susana Martinez vetoed the maneuver in April, as her administration pursues direct savings on medical care.


MEDICAID PREMIUMS

State officials want some Medicaid recipients to begin paying monthly premiums toward their health care insurance, while exempting the poorest participants.

Initial monthly premiums would be limited to between $10 and $50 per individual household. In subsequent years, they could rise to $50 for individuals or $100 per household. Native Americans would be exempt.

Abuko Estrada of the New Mexico Center on Law and Poverty says premiums would place new, counterproductive economic pressure on families struggling to pay for rent, groceries and utilities — and possibly discourage participation in Medicaid.

Currently, most individuals enrolled in Medicaid do not shoulder any costs, while small premiums are collected from patients with disabilities and families who qualify for the Children’s Health Insurance Program.


COPAYMENTS

New Mexico currently collects Medicaid copayments from a few thousand disabled patients as well as low-income families with children.

Under the new proposal, copayments would extend to the so-called Medicaid expansion population — adults with incomes above the federal poverty level, or $12,000 for an individual.

Copayments also would be applied to the use of emergency services for routine medical care and prescription drugs that costs more than similar brand-name and generic drugs.

Proponents say the payments are modest: $2 for prescriptions, $5 for routine doctor visits and $50 for hospital stays and surgeries.

Consumer advocates believe even small copayments are likely to discourage patients from seeking care, with costly long-term consequences when medical problems are ignored. Lawmakers including Democratic Sen. Gerald Ortiz y Pino say the plan would save little and add administrative costs.


RETROACTIVE COVERAGE

The Human Service Department wants to eliminate most retroactive Medicaid coverage that can pay for three-months of medical expenses if a patient was eligible for Medicaid immediately before enrollment.

Patient advocates say the current provision is a crucial protection against unforeseen medical charges that can bury individuals or family in medical debt.

They also say current provisions guard against bureaucratic delays in enrollment, when medical bills may stack up.