New Mexico and the ACA’s Medicaid expansion

Medicaid enrollment up 63 percent since 2013; Lawmakers want to understand costs & implications of a Medicaid buy-in program

new-mexico Medicaid guide

New Mexico opted to expand Medicaid under the Affordable Care Act (ACA), providing coverage for all legal residents with household incomes up to 138 percent of poverty. Total enrollment in the program grew by 66 percent from the end of 2013 to July 2016. By the end of 2017, total enrollment was 63 percent higher than it had been in late 2013, indicating that enrollment growth had leveled off by 2016.

And according to US Census data, the uninsured rate in New Mexico fell from 18.6 percent in 2013 to 9.2 percent in 2016 — a drop of more than 50 percent, versus the national average drop of a little more than 40 percent.

New Mexico lawmakers request data on the cost of 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 want 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 want feedback from stakeholders in terms of the implications and pros and cons of a Medicaid buy-in program in New Mexico.

In 2017, Nevada lawmakers passed legislation that would have allowed for Medicaid buy-in, but Governor Brian Sandoval vetoed it. So far, no states have allowed residents who aren’t eligible for Medicaid to purchase coverage under the program, but U.S. Representative, Ben Ray Lujan, who represents New Mexico’s 3rd Congressional District, believes New Mexico should lead the way.

And U.S. Representative Michelle Lujan Grisham, who is leading the state’s 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.

There is still a long way to go, as the New Mexico legislature has only begun the process of compiling data. And if lawmakers were to open up New Mexico Medicaid for residents to purchase, a federal waiver would also be required. But New Mexico is a state to watch in terms of new innovations in the health care reform sphere, and that innovation might come in the form of a Medicaid buy-in (it might also come in the form of an auto-enrollment system for uninsured residents, as the state is studying various approaches to health care reform).

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 everyone with household incomes up to 133 percent of poverty (138 percent counting the five percent income disregard).

On January 9, 2013, 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. By the fall of 2014, a total of nine Republican governors had agreed to expand Medicaid. And by early 2018, the majority of the Medicaid expansion states had Republican governors.

New Mexico’s Medicaid program was renamed Centennial Care starting January 1, 2014. It includes four managed care organizations (MCOs): physical health, behavioral/mental health, long term care, and community benefits. 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 old 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. And it’s transitioning away from a fee-for-service model towards a payment system that rewards providers based on outcomes.

Centennial Care insurers: Molina and UnitedHealthcare didn’t win bids for 2019

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. Four insurers have 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 will have their contracts renewed, and Western Sky Community Care also won a contract with Centennial Care.

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 has said that if they aren’t part of the Centennial Care program in 2019, they may leve the state entirely (including the exchange market), because Medicaid managed care is the “most significant portion” of Molina’s business in New Mexico.

Who is eligible?

Centennial Care Medicaid in New Mexico is now available to residents with incomes up to 138 percent of poverty. Higher guidelines apply for some populations. The following people are eligible in addition to the aged, blind, and disabled, and this chart includes monthly income limits as well as income as a percentage of poverty level:

  • Adults with household incomes up to 138 percent of poverty.
  • Children with household income up to 240 percent of poverty are eligible for coverage through CHIP.  For children age 0 – 6, the limit is 300 percent of poverty.
  • Pregnancy-related services only, for pregnant women with household incomes up to 250 percent of poverty.

How do I enroll?

You can apply online through the Centennial Care website.  Or you can contact them by phone at 1-800-283-4465 (customer service) or 1-855-309-3766 (24/7 information line).

You can also download a paper application, complete it, and mail it to Central ASPEN Scanning Area, PO Box 830, Bernalillo, NM, 87004.

Or you can visit a NM Human Services Department field office for in-person assistance with your application.

You can also 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.

Medicaid enrollment is year-round; there is no open enrollment window.

Enrollment up 63 percent in four years

From the fall of 2013 through July 2016, total enrollment in New Mexico Medicaid increased by 303,355 people, or 66 percent, and stood at 761,033. But by the end of 2017, it had dropped slightly, to 743,780, and total enrollment growth stood at 63 percent. As was the case in most states, enrollment grew sharply in 2014 and 2015, but had mostly leveled off by 2016.

Not all of the new enrollees were newly-eligible under the expanded guidelines; some qualified prior to 2014 but were not aware of the availability of Medicaid. In every state – regardless of whether Medicaid was expanded or not – there have been “woodwork” applications, called such because previously eligible enrollees came “out of the woodwork,” enrolling thanks to the publicity surrounding the ACA and the exchanges.

At the end of 2015, the Kaiser Family Foundation estimated that there were still more than 109,000 uninsured New Mexico residents who were eligible for Medicaid. At the time, that was 47 percent of the state’s total uninsured population, far higher than the average of 27 percent across the whole country.


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.

New Mexico Medicaid

How to apply

Online at the Centennial Care website or healthcare.gov; or by phone at 1-800-318-2596; with a paper application or in-person at a NM Human Services Department field office.

Who is eligible

The aged, blind, and disabled.  Also, adults with income up to 138% of poverty.  Pregnant women are eligible for pregnancy-related coverage with household income up to 250% of poverty.  Children are eligible for CHIP with income up to 240% of poverty (ages 7 - 18) or 300% of poverty (ages 0 - 6).

More New Mexico coverage

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News, history, and enrollment info for your state marketplace

Medicare

Insurance for those over 64 (off-site)