The State of Mexico Congress is considering legislation that would require the state’s social security institute for public servants, ISSEMyM, to reimburse members for out-of-pocket medication, supplies, and treatment costs not covered by the institute. The proposal, spearheaded by the Movimiento Ciudadano (MC) parliamentary group, aims to address financial burdens faced by beneficiaries when essential healthcare is unavailable through ISSEMyM.
The initiative, formally presented as a reform to the State of Mexico and Municipal Public Servants Social Security Law by Deputy Maricela Beltrán Sánchez (MC), would establish a pathway for beneficiaries to seek care from other institutions – prioritizing public options, with private care allowed in exceptional circumstances – and subsequently claim reimbursement for associated expenses, provided they submit supporting documentation. Existing regulations already permit reimbursement in cases of extreme urgency or when ISSEMyM services are demonstrably inaccessible, provisions that would be maintained under the proposed changes.
According to Deputy Beltrán Sánchez, the cost of medications for common conditions like diabetes, hypertension, cancer, and autoimmune diseases places a disproportionate economic strain on families in the State of Mexico. She highlighted that the financial impact is particularly acute for households with disabilities or limited incomes. Data cited in the proposal indicates that personal out-of-pocket spending on over-the-counter medications rose from 35.2 percent of total health expenditure in 2018 to 48.2 percent in 2020.
Under the proposed legislation, ISSEMyM would be obligated to reimburse the full cost of medications or treatments not provided directly, provided they are acquired promptly from either public or private pharmacies. Beneficiaries seeking reimbursement would need to submit a medical prescription from an authorized healthcare professional alongside proof of purchase.
The process outlined in the proposal includes a five-day period for ISSEMyM to establish a case file upon receiving a reimbursement request. The institute would then seek confirmation from the prescribing medical facility within another five days to verify whether the medication had been fully or partially dispensed. Failure to respond within the allotted timeframe would trigger a referral to the institute’s internal control body for administrative review.
Upon verification of the medication shortage, ISSEMyM would authorize reimbursement for the documented expenses. Payments would be issued via the beneficiary’s preferred method, subject to budgetary constraints. Beltrán Sánchez emphasized that the measure is not intended to supplant ISSEMyM’s primary responsibility to provide medications but rather to serve as a supplementary, exceptional remedy when the system fails. She stated the mechanism would too incentivize ISSEMyM to improve its efficiency, as each unfulfilled prescription would now carry administrative consequences.
The proposal was supported by Deputy Juan Manuel Zepeda Hernández (MC), coordinator of the MC parliamentary group, who has previously advocated for strengthening transparency and citizen participation within the legislative process. Zepeda Hernández recently proposed protocols for police conduct during demonstrations and has championed legal assistance programs with a focus on intercultural and agrarian issues, according to information from the State of Mexico Congress website.
The LXII Legislature of the State of Mexico is currently reviewing the initiative, with no date set for a vote. The proposal’s fate remains uncertain, pending further debate and consideration of budgetary implications.
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