HOUSE BILL 186

57th legislature - STATE OF NEW MEXICO - first session, 2025

INTRODUCED BY

Reena Szczepanski

AN ACT

RELATING TO HEALTH CARE; ENACTING A NEW SECTION OF THE PUBLIC ASSISTANCE ACT TO ALLOW THE SECRETARY OF HEALTH CARE AUTHORITY TO AMEND THE NEW MEXICO STATE MEDICAID PLAN TO CREATE A STATE-ADMINISTERED HEALTH COVERAGE PLAN; REQUIRING COLLABORATION BETWEEN THE HEALTH CARE AUTHORITY AND THE OFFICE OF SUPERINTENDENT OF INSURANCE TO ENROLL INDIVIDUALS IN THE PLAN; MAKING AN APPROPRIATION.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     SECTION 1. A new section of the Public Assistance Act is enacted to read:

     "[NEW MATERIAL] DEVELOPMENT OF MEDICAID FORWARD PLAN.--

          A. Subject to the appropriation and availability of federal and state funds, the secretary shall:

                (1) amend the New Mexico medicaid state plan pursuant to the federal act to provide medical assistance by January 1, 2028 to residents who:

                     (a) are under age sixty-five;

                     (b) are not otherwise eligible for and enrolled in mandatory coverage or optional full medicaid coverage under the New Mexico medicaid state plan; and

                     (c) have a household income that exceeds one hundred thirty-three percent of the federal poverty level; and

                (2) in consultation with the medicaid advisory committee and representatives of Indian nations, tribes and pueblos that are located wholly or partially in New Mexico, and consistent with the federal act, promulgate rules that:

                     (a) establish an affordability scale for premiums and cost-sharing based on household income for individuals eligible to enroll in the medicaid forward plan and offer discounted premiums and cost-sharing; provided that such financial assistance is, at a minimum, offered to individuals with household incomes below four hundred percent of the federal poverty level; and

                     (b) set the total amount of premiums to be assessed to medicaid forward plan enrollees, after an actuarial analysis, to ensure maximum access to coverage. Premiums imposed may be set at a level sufficient to offset the costs of health benefits under the medicaid forward plan and related administrative costs.

          B. Consistent with the federal act and subject to the appropriation and availability of federal and state funds, the secretary may, in consultation with the medicaid advisory committee and representatives of Indian nations, tribes and pueblos that are located wholly or partially in New Mexico, promulgate rules that phase in coverage to all individuals described in Subsection A of this section.

          C. The secretary shall consult with representatives of Indian nations, tribes and pueblos that are located wholly or partially in New Mexico to ensure that implementation and expansion of the medicaid forward plan promotes effective communication and collaboration, including information on participation in the medicaid forward plan.

          D. The secretary shall promulgate rules consistent with and necessary to carry out the provisions of this section.

          E. The secretary and the superintendent of insurance may seek any federal waivers necessary to administer the medicaid forward plan, provide the medicaid forward plan to additional persons and maximize federal dollars to ensure affordability for enrollees."

     SECTION 2. A new section of the Public Assistance Act is enacted to read:

     "[NEW MATERIAL] ENROLLMENT.--

          A. The secretary and superintendent of insurance shall coordinate efforts and cooperate with the New Mexico health insurance exchange to establish:

                (1) systems under which individuals may apply for enrollment in, receive a determination of eligibility for participation in and renew participation in medicaid, the medicaid forward plan or a qualified health plan offered through the New Mexico health insurance exchange; and

                (2) consumer outreach programs to assist individuals with enrolling in medicaid, the medicaid forward plan and qualified health plans offered through the New Mexico health insurance exchange.

          B. The secretary, the superintendent of insurance and the New Mexico health insurance exchange may coordinate efforts and cooperate to make the medicaid forward plan available for direct purchase through the New Mexico health insurance exchange platform.

          C. The secretary, the superintendent of insurance and the New Mexico health insurance exchange shall promulgate rules consistent with and necessary to carry out the provisions of this section."

     SECTION 3. APPROPRIATION.--Two million dollars ($2,000,000) is appropriated from the general fund to the health care authority for expenditure in fiscal years 2026 and 2027 to hire staff and contract for consulting or technical assistance for the development of the medicaid forward plan described in Section 1 of this act. Any unexpended or unencumbered balance remaining at the end of fiscal year 2027 shall revert to the general fund.

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