- New Mexico opted into Medicaid expansion and began covering adults up to 138% of FPL in 2014.
- New Mexico Medicaid enrollment has grown to nearly a million people, including 300,000 Medicaid expansion enrollees.
- Populations eligible for Medicaid in New Mexico (including extended postpartum care as of 2022)
- Three insurers provide Medicaid managed care in New Mexico
ACA’s Medicaid eligibility expansion in New Mexico
of Federal Poverty Level
Medicaid enrollment growth during the COVID pandemic
The COVID pandemic pushed enrollment quite a bit higher: By November 2021, enrollment in New Mexico Medicaid was 88% higher than it had been in late 2013. And by the end of 2021, New Mexico Medicaid enrollment had grown to 954,491, including nearly 300,000 people enrolled in Medicaid expansion under the ACA.
Enrollment growth during the pandemic was driven primarily by the Families First Coronavirus Response Act, which provides states with additional federal Medicaid funding, but on the condition that coverage not be terminated for any enrollees during the public health emergency period. So the normal periodic eligibility redeterminations have been paused since March 2020.
Nationwide, millions of people could lose their Medicaid coverage once the public health emergency period ends. New Mexico officials estimate that about 85,000 New Mexico Medicaid enrollees will be ineligible for Medicaid at that point, and are working to ensure that these individuals do not become uninsured. Roughly half are expected to be eligible for employer-sponsored health insurance, while the other half will be eligible for subsidized coverage in the New Mexico marketplace/exchange.
Accepting Medicaid expansion
Before 2014, Medicaid was generally only available for the aged, blind, disabled, pregnant women, children, and some low-income parents. But the expanded guidelines provide coverage for adults 19-64 with household incomes up to 133% of poverty (138% counting the five percent income disregard).
On January 9, 2013, then-Governor Susana Martinez announced that New Mexico would participate in Medicaid expansion, describing expansion as “what is best for New Mexicans.” At the time, Martinez was only the second Republican governor to accept Medicaid expansion.
New Mexico’s Medicaid program was renamed Centennial Care starting January 1, 2014. Most of the previously enrolled members of New Mexico Medicaid were eligible to remain covered under Centennial Care, but the newly expanded guidelines meant that many more people were also eligible to join the program in 2014.
Centennial Care was designed to be a modernized overhaul of many aspects of the legacy New Mexico Medicaid system. The new program aims to teach enrollees to become better healthcare consumers and take a more active role in their own health. It’s also focused on integrated care and better case management for the sickest members. In addition, it’s transitioning away from a fee-for-service model towards a payment system that rewards providers based on outcomes.
New Mexico has accepted federal Medicaid expansion
- 954,491 – Number of New Mexicans covered by Medicaid/CHIP as of December 2021
- 496,813 – Increase in the number of New Mexicans covered by Medicaid/CHIP from late 2013 to December 2021
- 49% – Reduction in the uninsured rate from 2010 to 2019
- 88% – Increase in total Medicaid/CHIP enrollment in New Mexico since Medicaid expansion took effect
Who is eligible for Medicaid in New Mexico?
Centennial Care Medicaid in New Mexico is available to adults under age 65 with incomes up to 138% of poverty. Coverage is available to children and pregnant people with higher incomes. And Medicaid is also available to the aged, blind, and disabled, although there are both income and asset limits for those populations.
- Adults with household incomes up to 138% of poverty.
- Children with household income up to 245% of poverty are eligible for coverage through CHIP. For children age 0 – 6, the limit is 305% of poverty.
- Pregnant women with household incomes up to 255% of poverty. And as of April 2022, postpartum coverage extends for a year after the baby is born, instead of ending after 60 days.
How does Medicaid provide financial assistance to Medicare beneficiaries in New Mexico?
Many Medicare beneficiaries receive Medicaid assistance that can help them with the cost of Medicare premiums, lower prescription drug costs, and pay for expenses not covered by Medicare – such as long-term care.
Our guide to financial assistance for Medicare enrollees in New Mexico includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.
How do I enroll in Medicaid in New Mexico?
Medicaid enrollment is year-round; there is no open enrollment window. You have several options for submitting an application.
- Apply online through the Centennial Care website.
- Apply online at HealthCare.gov or apply by phone at 1-800-318-2596. Applications through HealthCare.gov are reviewed for eligibility and then transferred to the state Centennial Care program for final determination of eligibility. (Use this option only if you’re under 65 and don’t have Medicare.)
- Call 1-800-283-4465 (customer service) or 1-855-309-3766 (24/7 information line).
- Download a paper application, complete it, and mail it to Central ASPEN Scanning Area, PO Box 830, Bernalillo, NM, 87004.
- Visit a NM Human Services Department field office for in-person assistance with your application.
Centennial Care insurers: Blue Cross Blue Shield of New Mexico, Presbyterian, and Western Sky
Under a Medicaid managed care model like Centennial Care, the state contracts with private insurers rather than directly providing Medicaid coverage to residents. The state pays the insurers, and the insurers provide Medicaid benefits to enrollees. As of 2022, there are three insurers in the Centennial Care Medicaid managed care program: Blue Cross Blue Shield of New Mexico, Presbyterian, and Western Sky Community Care.
Four insurers had Centennial Care contracts through the end of 2018: Blue Cross Blue Shield of New Mexico, Molina, Presbyterian, and UnitedHealthcare. But Molina and UnitedHealthcare were not selected to continue to provide Medicaid managed care services in New Mexico starting in 2019. Presbyterian and Blue Cross Blue Shield had their contracts renewed, and Western Sky Community Care also won a contract with Centennial Care. Those three insurers are continuing to provide Medicaid managed care in 2020.
Molina filed a lawsuit against the state, alleging that Western Sky’s bid win may have been tainted by an official with a conflict of interest, but a judge threw out the lawsuit. Molina initially said that if they couldn’t remain in the Centennial Care program, they may leave the state entirely (including the exchange market), because Medicaid managed care is the “most significant portion” of Molina’s business in New Mexico. But that did not come to pass, and Molina still offers coverage in the New Mexico exchange.
New Mexico Medicaid enrollment
From the fall of 2013 through July 2016, total enrollment in New Mexico Medicaid increased by 303,355 people, or 66%, and reached 761,033. As was the case in most states, enrollment grew sharply in 2014 and 2015, but had mostly leveled off by 2016. By the end of 2017, New Mexico Medicaid enrollment had dropped slightly, and total enrollment growth stood at 63%
But as of November 2021, total New Mexico Medicaid and CHIP enrollment had grown by another 100,000 people, and stood at 861,297. This was an 88% increase over 2013 (pre-ACA expansion) levels. This large jump in enrollment since 2016 is mostly due to the COVID-19 pandemic and the Families First Coronavirus Response Act, which provides additional federal Medicaid funding as long as states do not disenroll anyone from Medicaid during the COVID public health emergency.
According to U.S. Census data, the uninsured rate in New Mexico fell from 19.6% in 2010 to 10% in 2019 — a drop of almost 50%, versus the national average drop of about 40%.
New Mexico opted for state subsidies instead of Medicaid buy-in
In 2017, Nevada lawmakers passed legislation that would have allowed for Medicaid buy-in, but Governor Brian Sandoval vetoed it. If he had approved it, New Mexico would have been the first state with a Medicaid buy-in program.
U.S. Representative, Ben Ray Lujan, who represents New Mexico’s 3rd Congressional District, supports the idea of Medicaid buy-in. And Governor Michelle Lujan Grisham, who was a U.S. Representative until winning her 2018 gubernatorial race, introduced legislation at the federal level in 2017 that would have allowed people to buy into Medicaid. The Health Care Choices and Affordability Act did not advance at the federal level, but creating a Medicaid buy-in program may end up being more feasible at the state level.
In early 2018, lawmakers in New Mexico passed two legislative memorials (SM3 and HM9) calling for a cost analysis of a potential Medicaid buy-in program in New Mexico. Lawmakers wanted to get a good idea of the costs of allowing New Mexico residents who aren’t eligible for Medicaid to purchase Medicaid instead of obtaining private coverage or remaining uninsured. They also wanted feedback from stakeholders in terms of the implications and pros and cons of a Medicaid buy-in program in New Mexico.
New Mexico reconsidered the buy-in program in 2019, but it didn’t pass. Instead, the state pivoted to focus on the idea of using state funds to provide additional subsidies for people who buy their own health insurance. In 2021, the state enacted legislation to reinstate the health insurance tax in NM (at the state level rather than the federal level) and use the money to create a Health Care Affordability Fund
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.