MEDICAID PERSONAL CARE SVC. REIMBURSEMENT

SB0140

SENATE BILL 140

57th legislature - STATE OF NEW MEXICO - second session, 2026

INTRODUCED BY

Michael Padilla

AN ACT

RELATING TO LABOR; REQUIRING THE HEALTH CARE AUTHORITY TO SET A
MINIMUM MEDICAID FEE SCHEDULE FOR REIMBURSING PERSONAL CARE
SERVICES; REQUIRING AT LEAST SEVENTY PERCENT OF MEDICAID
REIMBURSEMENT FOR PERSONAL CARE SERVICES TO BE USED FOR
COVERING DIRECT CARE WORKFORCE EXPENDITURES; MAKING AN
APPROPRIATION.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

SECTION 1.
A new section of the Public Assistance Act is
enacted to read:

"[
NEW MATERIAL
] MEDICAID REIMBURSEMENT FOR PERSONAL CARE
SERVICES.--

A. For the purposes of this section:

(1) "consumer-delegated personal care
services" means an arrangement in which a medicaid recipient
chooses a personal care services provider agency to be
responsible for delivering all personal care services to that
medicaid recipient;

(2) "consumer-directed personal care services"
means an arrangement in which a medicaid recipient has control
over all decisions relating to the delivery of personal care
services to the medicaid recipient and a personal care services
provider agency acts as a fiscal intermediary;

(3) "direct care worker" means a non-administrative employee of a personal care services provider
agency who spends the majority of the employee's work hours
providing personal care services;

(4) "direct care workforce expenditures" means
the sum of all wages, employee-related expenses and training
and supervision costs reasonably attributable to the furnishing
of personal care services;

(5) "employee-related expenses" means payments
made by a personal care services provider agency on behalf of
or for the benefit of direct care workers, including:

(a) payroll taxes;

(b) workers' compensation insurance
premiums;

(c) health insurance;

(d) dental insurance;

(e) life and disability insurance;

(f) retirement plan contributions;

(g) mileage reimbursements; and

(h) personal protective equipment;

(6) "medicaid" means the medical assistance
program established pursuant to Title 19 of the federal act and
regulations issued pursuant to that act;

(7) "personal care services" means services
provided to an individual to assist with activities of daily
living;

(8) "personal care services provider agency"
means an entity that:

(a) has entered into a medicaid provider
participation agreement with the medical assistance division of
the authority and: 1) is contracted with a managed care
organization to provide personal care services to medicaid
recipients; or 2) provides personal care services to medicaid
recipients through fee-for-service arrangements;

(b) is reimbursed for personal care
services provided to individuals covered by medicaid; and

(c) employs direct care workers to
provide personal care services to individuals covered by
medicaid;

(9) "training and supervision costs" means the
expenses directly related to developing and overseeing the
performance and skills of direct care workers. "Training and
supervision costs" include the costs for:

(a) education and training programs;

(b) direct observation of a direct care
worker;

(c) field supervision of direct care
workers; and

(d) care coordination activities; and

(10) "wages" means all payments made to direct
care workers for their services, including:

(a) salary;

(b) hourly pay;

(c) overtime pay;

(d) shift differentials;

(e) bonuses; and

(f) paid leave.

B. The authority shall implement the following
minimum reimbursement rates for personal care services:

(1) twenty-three dollars fifty cents ($23.50)
per hour, excluding gross receipts taxes, for consumer-delegated personal care services; and

(2) nineteen dollars seventy-eight cents
($19.78) per hour, excluding gross receipts taxes, for
consumer-directed personal care services.

C. A personal care services provider agency that
receives medicaid reimbursement for providing personal care
services shall use at least seventy percent of the medicaid
reimbursement to cover direct care workforce expenditures.

D. Before calculating the minimum amount of
medicaid reimbursement that a personal care services provider
agency is required to use to cover direct care workforce
expenditures, the costs of gross receipts taxes on personal
care services shall be deducted from the total amount of
medicaid reimbursement that the personal care services provider
agency receives.

E. Each personal care services provider agency
shall maintain accounting records to document that at least
seventy percent of medicaid reimbursement is being used to
cover direct care workforce expenditures. Upon request of the
authority, each personal care services provider agency shall
make the accounting records available to the authority within a
reasonable amount of time."

SECTION 2.
APPROPRIATION.--Fifty-one million four hundred
thousand dollars ($51,400,000) is appropriated from the general
fund to the health care authority for expenditure in fiscal
year 2027 to update the medicaid personal care services fee
schedule and increase medicaid reimbursement for personal care
services pursuant to Section 1 of this act. Any unexpended
balance remaining at the end of fiscal year 2027 shall revert
to the general fund.

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