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).
- healthinsurance.org contributor
- September 28, 2016
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.
And the uninsured rate has fallen from 20.2 percent in 2013 to 12.8 percent in 2015, according to Gallup data.
Although New Mexico accepted federal funds to expand Medicaid, the legislature didn’t fully-fund that state’s traditional Medicaid program (which covers people who were eligible based on the pre-ACA guideliens) during the 2016 session, which is resulting in a significant shortfall in federal matching funds.
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.
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 represents 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.
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 66 percent in three 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.
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 are “coming out of the woodwork” and 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.