Title V staff monitor the insurance landscape in the state and work to ensure that women and children are insured.  While we know insurance coverage does not completely ensure access to care, it is an important piece of assuring access. The uninsured population in NM continues to fall, to a current low of approximately 10%, and Medicaid rolls continue to increase.  All told, the uninsured population in NM has dropped by 50% since inception of the Affordable Care Act (ACA), largely due to the Medicaid Expansion.  It is unclear if the number of uninsured New Mexicans can be reduced much further as there will always be those who do not qualify for assistance, the undocumented, and those who choose not to purchase insurance. 

Analysis of PRAMS data shows that the ACA not only increased insurance rates overall but also specifically for women.  Preconception health insurance and postpartum health insurance coverage increased from 2012-2013 to 2015-2016, and the percentage of women who were uninsured before, during, and after pregnancy decreased from before implementation of the ACA to after implementation of the ACA. In addition, a higher percentage of women had continuous Medicaid coverage after implementation of the ACA than before implementation.

If Medicaid buy-in becomes a reality in NM that may also help increase insurance coverage, although it may also just create a shift from private to public insurance.  The NM Legislature did not pass the bill proposing a Medicaid buy-in program in New Mexico but they have said that they will convene a task force to continue studying the issue.  The Legislature did pass some bills that were an attempt to enshrine ACA protections into state law, including one that requires insurance companies to cover all contraceptive options in parallel with the ACA requirements.

Title V works hard to maintain relationships with Medicaid staff and the managed care organizations. Medicaid now covers slightly more than 50% of all New Mexicans and over 70% of births, and reports from HSD are that the Medicaid rolls have been increasing rapidly since the COVID pandemic began.  This will increase the cost to the state in a time when our state budget is suffering due to low oil and gas prices and the increased need for unemployment, health, and other benefits.  Although the new administration increased medical provider rates in 2019, there are rumors that these rates may once again be rolled back to try to balance the state budget in the next Legislative session.  

NM has a Health Insurance Exchange (HIX) that was developed as a state-federal partnership, utilizing the federal portal (HealthCare.gov) for individual enrollment and the NM portal (BEWELLNM.com) for the state-run Small Business Health Options Program (SHOP) exchange.  The Exchange provides subsidies for eligible individuals to increase affordability of health insurance; however, anecdotal reports from families show that even with the subsidies the cost of insurance is often seen as unaffordable, especially for families who are just over the Medicaid income level.

The NM Medical Insurance Pool (NMMIP), also known as the High-Risk Pool, continues to operate as a safety net for those with high cost medical conditions who are not eligible for other insurance or who choose not to buy insurance on the Exchange during open enrollment.  Because the state provides the carriers with tax credits to offset their losses from the Pool, the NMMIP has at times been targeted for possible closure; however, it remains one of the strongest of the remaining state high risk pools.  Membership has decreased from a high of over 8,000 to approximately 2,200 now. The DOH continues to rely on the Pool to insure Children and Youth with Special Health Care Needs (CYSHCN) and those living with HIV who are not eligible for Medicaid or any other insurance programs. The NM Title V Director attends the NMMIP Board meetings and serves as a liaison between the Pool and the DOH.

The Navajo Nation is proposing to be the first Indian managed care entity among all tribal nations in the United States, starting in 2021.  They have proposed a new partnership between the Navajo Nation and Molina Healthcare with planned “passive” enrollment for Navajo tribal members in New Mexico.  The NM Human Services Department, which administers the Medicaid program, will still administer all Medicaid eligibility and enrollment activities.