Medicaid, SCHIP, and Federal Authority²

HIFA Demonstration - In 2002, New Mexico received a HIFA waiver to expand coverage to low-income uninsured working adults. In July 2005, the state implemented the New Mexico State Coverage Insurance (SCI). This is a public-private partnership resulting in the creation of a new employer-sponsored insurance program. The state contracts with managed care organizations to provide the product.

The program is available to low-income, uninsured, working adults with family income below 200 percent of FPL. An individual may enroll through their employer, as a self-employed individual, or as an individual without employer-sponsored insurance. The premium is paid through contributions from the employer and employee in combination with state and federal funds. Individuals and the self-employed must pay the employer as well as the employee portion of the premium. The benefit package is a comprehensive health care benefit with a claims benefit maximum. The SCI plan features cost-sharing designed to ensure that low-income participants would have access to care. Enrollment in the program began July 2005 and, as of August 2006, the program covered over 5,000 lives.

To learn more about the New Mexico State Coverage Insurance program, read SCI's Profile in Coverage.

To learn more about the NMSCI HIFA Waiver, read SCI's HIFA Waiver Comparison Chart.

Section 1115 Waiver - In 1998, New Mexico received approval for a SCHIP demonstration for implementation of co-payment requirements and a 6-month period of SCHIP ineligibility in instances where an applicant's health insurance was voluntarily dropped. New Mexico SCHIP covers children up to age 19 in families with income between 185 percent and 235 percent FPL.

Reinsurance

New Mexico Health Insurance Alliance (HIA) was created in 1994 by the state legislature to provide increased access to health insurance for small businesses, self-employed individuals, and other qualified individuals. HIA is an alliance of independent health insurers that operates without medical or industry underwriting, sets yearly rates, and simplifies participation for employers. Carriers in the state are assessed an annual administrative fee withheld from gross premiums. Costs not paid via premium assessments are collected from the carriers proportionately by market share.

Legislation passed in 2005 (HB 294) reduced premiums for small businesses by changing the HIA premium structure. The bill also expanded the HIA's responsibility for outreach, public awareness, and assistance to employers in obtaining and maintaining health insurance.

HIA is part of the Insure New Mexico ! model. It offers three types of broker-assisted comprehensive plans: PPO, Indemnity, and HMO through 11 participating commercial carriers. Employee and dependent share of premiums depend on employer contribution. NMHIA policies are available to those who currently offer insurance coverage. It is available for employees and dependents of small businesses (2-50 employees), self-employed persons with at least one dependent, and individuals.

High-Risk Pool  

The New Mexico Medical Insurance Pool (NMMIP) became operational in 1988 and is financed by premiums and assessments to insurers. High-risk individuals previously rejected by commercial carriers, those having received a rate increase or rate quote exceeding certain limits based on health status, those who have specific pre-existing conditions, or who have received notice of a rider, waiver, or restrictive provision are eligible to participate. The premium cap is set at 140 percent of the standard risk rate. New Mexico operates a 75 percent premium subsidy for recipients who earn between 0 percent and 200 percent FPL and a 50 percent premium reduction for recipients between 200 percent FPL and 399 percent FPL. The subsidy program is called the Low Income Premium Program (LIPP). NMMIP will be offering a "group" product designed for high-risk members of the Small Employer Insurance Program (see below) administered by the same carrier. At the end of June 2006, over 2,300 persons were enrolled in the New Mexico Medical Insurance Pool.

NMMIP will be offering a "group" product designed for high-risk members of the Small Employer Insurance Program (see below) administered by the same carrier. This product is another Insure New Mexico! solution for employers and has a similar benefit package to SCI but with different premiums and cost sharing.

Group Purchasing Arrangements  

In 2005, the New Mexico legislature created the Small Employer Insurance Program (SEIP). SEIP is one of the Insure New Mexico! initiatives that are addressing the problem of the high number of uninsured working adults in New Mexico. SEIP is specifically tailored towards helping small employers and non-profits, with 50 or fewer employees, to voluntarily buy into a state-administered pool if the firm has not offered insurance for twelve months. The pool will be self-funded by premium contributions paid by employers and employees and backed by a stop-loss insurance policy. To maintain the integrity of the risk pool, high-risk SEIP members will become members of the high-risk pool, NMMIP. The SEIP program and NMMIP will use the same administrator so the individuals within the group will not know if they are drawing coverage from SEIP or from NMMIP. The benefit package will be similar to the New Mexico State Coverage Insurance program and NMMIP.

Dependent Coverage

An individual or group health policy may not terminate coverage of an unmarried dependent before the dependent's 25th birthday. This applies regardless of whether the dependent is enrolled in an educational institution. (59A-22-30.1)

Other

Insure New Mexico!
New Mexico has created a portal to facilitate insurance coverage called Insure New Mexico! This initiative features health insurance products custom-designed for each small employer, based on employee demographics and the needs of a specific employer group. The custom product will incorporate coverage for each employee through publicly administered products including New Mexico State Coverage Insurance (NMSCI), New Mexico Medical Insurance Pool (NMMIP), and the Small Employers Insurance Pool (SEIP).

Notes and Sources

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