New Mexico

SCI Coverage Institute

New Mexico completed a three-year policy-development process which has resulted in a proposal called HealthSOLUTIONS New Mexico. This plan includes: 1) insurance market reforms; 2) a phased-in coverage participation requirement for individuals and employers; 3) a transition to electronic claims and medical records; and 4) the creation of a Health Coverage Authority to implement the plan. They will use Coverage Institute development funds to do modeling of the coverage expansion proposals described above and for staff support.

SCI Demonstration Grant

In 2001 the New Mexico Human Services Department was awarded a SCI Demonstration Grant to design and implement a unique public-private partnership called New Mexico State Coverage Insurance (NMSCI). The grant funds were used for several different pieces of the program including waiver design and submission; designing the benefit package and actuarial work; and implementing the program and outreach activities.

In July 2005, the state began its unique public-private partnership called New Mexico State Coverage Insurance (NMSCI). NMSCI is a premium-assistance program that combines premium payments from the employee, the employer, state, and federal funds to create a commercial benefit package delivered through managed care organizations. The program is available to adults who earn less than 200 percent of the federal poverty level and are not eligible for existing public coverage programs.

Grant Highlights:

• HIFA waiver designed and submitted to CMS in 2002.
• CMS approved New Mexico 's HIFA waiver in 2002.
• The State Legislature fully funded NMSCI with $4 million in 2005.
• In July 2005, NMSCI began enrollment with expectations to cover 10,000 lives in the first year of the program.
• As of September 2005, NMSCI enrolled 2,500 lives.