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
- October 21, 2015
New Mexico opted to expand Medicaid under the ACA, providing coverage for all legal residents with household incomes up to 138 percent of poverty. Total enrollment in the program has grown by 57 percent since the end of 2013, but the Kaiser Family Foundation estimates that there are still more than 109,000 uninsured New Mexico residents who are eligible for Medicaid. That’s 47 percent of the state’s total uninsured population.
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 57 percent in two years
From the fall of 2013 through June 2014, total enrollment in New Mexico Medicaid increased by 119,431 people. This is less than the total new enrollments, but people cycle in and out of the Medicaid eligibility, so while many people gained coverage, others became ineligible during the same time.
During the first open enrollment period, 30,147 people enrolled in Medicaid through HealthCare.gov But the state has also worked to enroll people directly through the state Medicaid office, and total enrollment had grown to 165,000 by September 2014.
By July 2015, total enrollment in New Mexico’s Medicaid/CHIP had grown to 717,189 people – a 57 percent increase over enrollment in late 2013, and another 140,000 people since the summer of 2014.
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.