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SANTA FE, N.M. (AP) — Low-income Medicaid patients in New Mexico may soon have to pay more for certain brand-name drugs or if they visit the emergency room to receive routine medical care, under a reform plan submitted Wednesday to federal regulators.

The state Human Services Department applied for federal authorization of new copayments and monthly premiums in an effort to conserve state spending on Medicaid health care for the poor and disabled.

Human Service Secretary Brent Earnest said New Mexico’s waiver application also would expand services for substance abuse disorders and phase out retroactive health care coverage by 2020 for newly enrolled patients.

Use of the emergency room for non-emergencies would cost Medicaid patients $25 per visit. A $10 copayment would apply to brand name drugs when cheaper equivalents are approved and available.

At the same time, New Mexico officials want to remove existing copayments under the Children’s Health Insurance Program and a program for working people with disabilities.

Taken together, the Medicaid changes would save the state general fund an estimated $90 million over a five-year period. Approval is up to the U.S. Centers for Medicare and Medicaid Services.

New Mexico residents flocked to enroll in Medicaid after the state expanded coverage in 2014 to include single patients living just above the federal poverty line. But enrollment has declined this year by tens of thousands of people as the Human Services Department cleared a backlog of expired enrollments.

“We haven’t seen people coming back to the programs as we might have expected,” Earnest said, referring to enrollment declines in Medicaid and the Supplemental Nutritional Assistance Program. He also linked declining enrollment to increased local economic activity.