2013 New Mexico and Texas Departments of Health data shows one quarter of Dona Ana County residents needing hospitalization are going to Texas to get those services. But a lower Medicaid reimbursement rate in New Mexico means many Texas doctors aren’t accepting them anymore.
David Tafoya is 5 years old. His father Joshua said since his son was 18 months old he has suffered from a severe case of epilepsy.
“The stop breathing part or lack of oxygen to the brain from the seizure is usually the part you have to watch out for and in David’s case and because it is so prolonged.” Tafoya said “It can lead to long term brain damage and scarring.”
Status epilepticus is an intense neurologic and medical condition with a high mortality rate, it is characterized by prolonged seizures. There is no child neurologist accepting Medicaid in Las Cruces, New Mexico, where the Tafoyas live. So when David has had problems or needed check-ups, he’s seen a neurologist in El Paso.
“There has been instances where he has had a seizure that lasted an hour long, even after we have administered all the treatments. We’ve have to be transferred to El Paso Children's to get treatment.” Tafoya said “Basically to get the seizure to even stop.”
After two years of fits, trauma and a run of different medications, their neurologist managed to stabilize David’s epilepsy – giving hope for a normal life and his parents Carrie and Joshua some of peace of mind. But the trauma has left David suffering from PTSD; his mother Carrie said it has been hard to get him to the doctor.
“He use to have huge screaming fits, hide under that table, refuse to come out, he was terrified.” Carrie Tafoya said “Over the last year he has really come around to being around his current neurologist. He knows him, he remembers him, he is comfortable with him.” Carrie Tafoya said.
With a comfortable doctor patient relationship built over time, David went almost two years without a seizure. But the Tafoyas are concerned they may have to start all over again with a new neurologist as David’s current one announced he will no longer see him.
The New Mexico Health Department has reduced reimbursement rates to Medicaid providers citing a $400 million gap between the program’s costs and available state revenue. With these lower reimbursements rates some providers have stopped seeing New Mexico Medicaid patients.
Carrie Tafoya says they are going to have to travel all the way to Albuquerque for their son’s treatment and even just check-ups.
“It is already difficult because kids don’t like riding in the cars door a long time. So now we have to go to Albuquerque, which means 3 and half hours, which is 4 hours round trip (it) is going to be hard for them to stay in the car. That is a lot of screaming." Carrie Tafoya said.
That means paying for gas, hotel and parking expenses the Tafoyas can get the state to reimburse them- but that is concerning to State Senator and legislative finance committee chair John Arthur Smith. He says whatever funds the state is going to save on Medicaid cuts are likely to be eaten up by travel expenses.
“They are penny wise and pound foolish, on that. They are not saving money and then if you really have the clients best interests at heart. Quite frankly I challenge that.” Arthur Smith said he has flagged the issue with the state department of health for review. He says access to care should be simplified and kept nearby for patients like the Tafoyas.
Currently, the Medicaid expansion under the Affordable Care Act is fully funded but starting in 2017, states will begin contributing to the cost.
By 2020, states will fund ten percent of the expansion with the federal government paying the other 90%. Smith says the fact that New Mexico can’t cover the remaining 10% underscores the need for funding sources more reliable and diverse than oil and gas revenues.
The Tafoyas say worse than having to travel all the way to Albuquerque for care, is being left in limbo without a neurologist while their son’s patient referral is being processed.
“We are going to go that whole amount of time without having anybody to call. He is on some fairly intense medication that does have side effects, that include possibility of depression and in extreme cases- suicidal ideation.” Tafoya said
“It is serious medication. So hopefully nothing will happen and it all will be fine, but if something did happen we basically have no one to call. In the past we’ve been able to call someone.”
Making things even more difficult for the Tafoyas, according to UNM Health sciences data, there is only one primary care physician for every 1,099 New Mexicans.
And the number of medical specialists, like neurologists is well below the national benchmark.