Summary:

 House Bill186 (HB186) enacts a new Section of the Public Assistance Act to allow the Secretary of Health Care Authority to modify the New Mexico Medicaid Plan to create a state administered health coverage plan and require collaboration between the Health Care Authority and the Office of the Superintendent of Insurance to enroll individuals in the plan. The Act provides for an appropriation. 

Legislation Overview:

 House Bill186 (HB186) proposes to modify the state Medicaid Plan to create a state administered health coverage plan with collaboration between the Secretary of the Health Authority and the Superintendent of Insurance. 
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.
Consistent with the federal act and subject to appropriation and availability of federal and state funds, the Secretary in consultation with the Medicaid Advisory Committee and representatives of Indian nations, tribes and pueblos develop rules that would phase in coverage.
The Secretary is to make sure that communication and collaboration with the indigenous people mentioned above to include information on participation in Medicaid Forward Plan. The Secretary will be charged to promulgate rules to implement the plan.
Both the Secretary and the Superintendent may pursue federal waivers while maximizing federal dollars.
The Secretary and Superintendent shall coordinate with the New Mexico Health Exchange to make the Medicaid Forward Plan available for direct purchase through the New Mexico Health Insurance Exchange platform.
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