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HOUSE BILL 186
57
TH 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
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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
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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
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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
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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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