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How is New Mexico handling Medicaid renewals after the pandemic?
The COVID pandemic pushed Medicaid enrollment in New Mexico quite a bit higher: By October 2022, enrollment was 93% higher than it had been in late 2013, and stood at nearly 900,000 people. When partial benefit enrollees are included, New Mexico Medicaid enrollment was even higher, at about 969,000 people as of mid-2022. Nearly 300,000 people were covered under Medicaid expansion in New Mexico at that point.
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 disenrollments due to periodic eligibility redeterminations have been paused since March 2020. But although the public health emergency is expected to continue until mid-May 2023, the ban on Medicaid disenrollments is no longer linked to the public health emergency, and instead ends on March 31, 2023, under the terms of the Consolidated Appropriations Act that was enacted in late 2022.
So states can resume Medicaid disenrollments as early as April 1, 2023. New Mexico began mailing renewal notices in mid-March 2023, but the first round of disenrollments won’t happen until May 1. The New Mexico Human Services Department has a page on its website about the return to normal eligibility redeterminations starting in the spring of 2023.
People with Medicaid are being encouraged to update their contact information and then wait to receive a turquoise envelope in the mail (or renewal information via text or email, for those who have signed up for electronic communications). Renewals cannot be conducted early, and this process will be spread out over 12 months. So some people will not get their renewal packet until late 2023 or early 2024. (Coverage will continue until an enrollee’s renewal date, even if they no longer meet the eligibility guidelines.)
New Mexico is taking two fairly unique steps to ensure that people can maintain their coverage during the return to normal eligibility renewals and disenrollments:
- For people who transition from Medicaid to a plan obtained through the exchange (beWellnm), the state will pay their net (after-subsidy) premium for the first month of their new coverage, as long as they are eligible for premium subsidies and their projected income for 2023 isn’t more than 400% of the poverty level (for a single person, that’s $54,320, and for a family of four, it’s $110,000). This ensures that a person’s coverage is effectuated and that they will thus have the ACA’s 90-day premium grace period going forward. Rhode Island has implemented a somewhat similar policy.
- When a person enrolls in a plan through beWellnm after losing Medicaid, they can choose either a prospective effective date (the first of the month after they apply) or a retroactive effective date, with coverage effective back to the first day of the month in which they applied for their new coverage. In most other states, private plans obtained in the exchange cannot have retroactive effective dates (unless the qualifying event is the birth or adoption of a child), but New Mexico’s approach could ultimately be picked up by other state-run exchanges.
New Mexico is also offering an indefinite special enrollment period for people who lose Medicaid during the “unwinding” of the pandemic-era continuous coverage rule. (HealthCare.gov is offering a similar special enrollment period, although it ends on July 31, 2024 in the states that use HealthCare.gov.)
An estimated 100,000 Medicaid enrollees in New Mexico will lose their Medicaid and need to transition to other coverage. Many will be able to enroll in an employer’s plan, but for those who don’t have access to employer-sponsored coverage, the state’s approach to transitioning people to beWellnm plans is certainly innovative and something that other states might emulate.
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.
The following populations are eligible for Medicaid in New Mexico (the limits below include a built-in 5% income disregard that’s used for MAGI-based Medicaid eligibility):
- 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. (New Mexico has the nation’s highest percentage of births covered by Medicaid)
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.
How many New Mexico residents have Medicaid coverage?
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 October 2022, total New Mexico Medicaid and CHIP enrollment had grown by another 120,000 people, and stood at 881,681. This was a 93% 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 between March 2020 and March 2023 (this was initially slated to continue through the end of the COVID public health emergency, but the end date was changed to March 31, 2023 by the Consolidated Appropriations Act that was enacted in late 2022).
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 has accepted federal Medicaid expansion
- 881,681 – Number of New Mexicans covered by Medicaid/CHIP as of October 2022 (source; enrollment including partial coverage is higher)
- 424,003 – Increase in the number of New Mexicans covered by Medicaid/CHIP from late 2013 to October 2022 (source)
- 49% – Reduction in the uninsured rate from 2010 to 2019
- 93% – Increase in total Medicaid/CHIP enrollment in New Mexico since Medicaid expansion took effect
New Mexico opted to expand Medicaid under the Affordable Care Act (ACA), providing coverage for all legal residents with household incomes up to 138% of poverty. Total enrollment in the program grew by 66% from the end of 2013 to July 2016, and then leveled off for a few years.
The COVID pandemic pushed enrollment quite a bit higher: By October 2022, enrollment in New Mexico Medicaid was 93% higher than it had been in late 2013, and stood at nearly 900,000 people. When partial benefit enrollees are included, New Mexico Medicaid enrollment was even higher, at about 969,000 people as of mid-2022. Nearly 300,000 people were covered under Medicaid expansion in New Mexico at that point.
New Mexico’s Medicaid expansion history
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 opted for state subsidies instead of Medicaid buy-in, but that’s being reconsidered in 2023
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.
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. That program is being used to make private health insurance more affordable and more robust for people with mid-range incomes who purchased coverage through beWellnm.
But the state is reconsidering the Medicaid buy-in idea in 2023. HB400, which passed in the House Health and Human Services Committee in late February, would create a Medicaid buy-in for people under age 65 who aren’t already eligible for Medicaid under existing rules. As described in the legislation, this buy-in option would be available by 2026.
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.
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.
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 2023, 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.
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.