PEDIATRIC PALLIATIVE CARE MEDICAID BENEFIT

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A MEMORIAL
REQUESTING THE HEALTH CARE AUTHORITY TO SUBMIT A STATE PLAN
AMENDMENT TO CREATE A PEDIATRIC PALLIATIVE CARE BENEFIT UNDER
MEDICAID THAT ALLOWS CONCURRENT CURATIVE CARE.
WHEREAS, children in New Mexico with serious, complex or
life-limiting medical conditions often experience repeated
hospitalizations, emergency room visits and prolonged
suffering that could be alleviated through pediatric
palliative care; and
WHEREAS, pediatric palliative care provides
comprehensive, family-centered services focused on pain and
symptom management, psychosocial and spiritual support and
care coordination, which can be delivered concurrently with
curative treatment; and
WHEREAS, because pediatric hospice care under current
medicaid rules is limited to children with a terminal
prognosis of six months or less and often carries a stigma
associated with end-of-life care, many families decline these
services even when their child would benefit from supportive
care; and
WHEREAS, the New Mexico medicaid managed care program
currently lacks a pediatric palliative care benefit,
preventing access to supportive services that are available
in other states through approved medicaid state plan
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amendments; and
WHEREAS, expanding access to pediatric hospice services
and ensuring that hospice programs have the clinical and
financial support needed to care for children will complement
the development of a pediatric palliative care benefit and
ensure a full continuum of care for families; and
WHEREAS, a 2024 proposal by the university of New Mexico
center for health policy, developed in collaboration with the
medical assistance division of the health care authority,
outlined a feasible model for a medicaid pediatric palliative
care benefit, including eligibility criteria,
interdisciplinary team standards, tiered per-member-per-month
payments and measurable quality outcomes; and
WHEREAS, establishing a medicaid pediatric palliative
care benefit has been shown in other states to improve
quality of life, reduce family stress, decrease avoidable
hospital utilization and generate net savings for medicaid
programs;
NOW, THEREFORE, BE IT RESOLVED BY THE SENATE OF THE
STATE OF NEW MEXICO that the health care authority be
requested to develop and submit to the federal centers for
medicare and medicaid services a state plan amendment
creating a pediatric palliative care benefit that:
A. provides coordinated, interdisciplinary and
family-centered care to children with serious, complex or
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life-limiting illnesses;
B. allows concurrent curative and palliative
treatments without requiring a hospice election;
C. includes pain and symptom management,
psychosocial and emotional support, care coordination and
twenty-four-hour nurse consultation services; and
D. requires the use of quality and performance
measures consistent with nationally recognized palliative
care standards; and
BE IT FURTHER RESOLVED that the health care authority be
requested to consult with the New Mexico association for home
and hospice care, pediatric care providers, hospice agencies
and family advocates in preparing the state plan amendment;
and
BE IT FURTHER RESOLVED that the health care authority be
requested to provide an update on progress toward submission
of the state plan amendment to the legislative health and
human services committee and the legislative finance
committee by October 1, 2026; and
BE IT FURTHER RESOLVED that the health care authority be
requested to explore strategies to expand access to pediatric
hospice care and to ensure adequate provider supports,
including reimbursement and training, to deliver high-quality
hospice services for children to strengthen the continuum of
care for seriously ill children and their families; and
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BE IT FURTHER RESOLVED that copies of this memorial be
transmitted to the governor, the secretary of health care
authority, the legislative health and human services committee
and the legislative finance committee.