State Sen. Jacob Candelaria Among Plaintiffs Suing Insurance Companies For Medical Cannabis Coverage In New Mexico

Medical marijuana and insurance coverage is an ongoing problem across the U.S. even though there are around 37 legal medical marijuana programs in the country. With cannabis illegal on the federal level via its classification as a Schedule 1 substance, viewed as having no accepted medical value and high abuse potential. As such, it is not covered by Medicare and often also not by other private health insurances.

Now, a small group of medical marijuana patients in New Mexico is placing all their efforts into changing this, at least in their state.

Six medical patients and licensed medical marijuana dispensaries Ultra Health have filed a class-action lawsuit, claiming that insurers should cover the cost of medical cannabis because it is a behavioral health service, reported the Albuquerque Journal.

The lawsuit was filed on Friday in state district court in Albuquerque against seven insurers: Blue Cross and Blue Shield of New Mexico, True Health New Mexico, Cigna Health and Life Insurance Co., Molina Healthcare of New Mexico, Presbyterian Health Plan, Presbyterian Insurance Co. and Western Sky Community Care – for failing to cover medical marijuana expenses.

Plaintiffs in the lawsuit are demanding “recovery for themselves, and for every other similarly situated behavioral or mental health patient unlawfully subjected to paying for the entire cost of medically necessary cannabis, in violation of state law.”

“The idea of health insurance plans paying for medical cannabis may seem like an impossible dream, but all the foundational elements have already fallen into place,” Ultra Health president and CEO Duke Rodriguez said in a statement on Monday. “Revolutionizing behavioral health care in New Mexico will take only a few small steps, rather than a giant leap.”

The lawsuit is mainly based on legislation passed in 2021, Rodriguez said. Senate Bill 317, signed by Governor Michelle Lujan Grisham in April 2021 deals with behavioral health cost-sharing. The law, which took effect in January, demands that insurers cover 100% of behavioral health services, including the prescribed treatment of a behavioral health condition.

Prior to resorting to the courts, Ultra Health tried another approach. In February, it sent a letter to New Mexico health insurers and the Office of the Superintendent of Insurance seeking assurances that cannabis coverage be viewed as a behavioral health service under state law. According to Ultra Health, insurers have not responded.

In addition, the lawsuit also opens doors for other medical cannabis patients to join.

“There will be more patients identified who have been harmed by insurers not lawfully abiding to the statutory duty of eliminating any cost-sharing related to behavioral health services,” Rodriguez said. “Insurers have not acted in good faith.”

Senator Among Plaintiffs 

Among the six plaintiffs is state Senator Jacob Candelaria. As per the lawsuit, Candelaria has been a medical marijuana patient since 2019, when his doctor recommended cannabis as a treatment for PTSD after antidepressants showed little improvement. The lawsuit also details that Candelaria spends between $500 and $1,000 a month for medical marijuana from his pocket. Candelaria is insured by Blue Cross and Blue Shield of New Mexico.

The senator told the Journal that medical cannabis helped him with PTSD and that he decided to join the lawsuit not for his personal benefit but for many “New Mexicans who are struggling to pay for their health care.”

April data from the New Mexico Department of Health indicated that out of the state's 134,307 registered medical cannabis patients, 73,000 of them are being treated for PTSD.

“Senate Bill 317 was transformational,” Candelaria said. “This suit, you know, it becomes necessary to actually make that transformation happen.”

Other medical marijuana patients signed as plaintiffs include Tomas Lorenzo Valencia, Bryce Bryant-Flynn, Matias Trujillo, Erica Rowland, and Ariel McDougal.

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