New Mexico Medicaid, SCHIP, & Federal Authority

Health Insurance Flexibility and Accountability (HIFA) Demonstration - In 2002, New Mexico received a HIFA waiver to expand coverage to low-income uninsured working adults with incomes up to 200 percent of the federal poverty level (FPL).  Under that program, coverage was purchased with a combination of state, federal, employer and employee funds. 

In July 2005, the state implemented the New Mexico State Coverage Insurance [1] (SCI).  This is a public-private partnership resulting in the creation of a new employer-sponsored insurance program.  The state contracts with managed care organizations to provide the product.  The target population is low-income, uninsured, adults working for small employers with family income below 200 percent of the federal poverty level (FPL). An individual may enroll through his or her employer, as a self-employed individual, or as an individual without employer-sponsored insurance.  The premium is paid through contributions from the employer and employee in combination with state and federal funds.  Individuals and the self-employed must pay the employer as well as the employee portion of the premium. The benefit package is a comprehensive health care benefit with a claims benefit maximum.  The SCI plan features cost-sharing designed to ensure that low-income participants would have access to care. Enrollment in the program began in July 2005 and, as of November 2007, 11,489 participants were enrolled.

Section 1115 Waiver - In 1998, New Mexico received approval for a State Children’s Health Insurance Program (SCHIP) demonstration for implementation of co-payment requirements and a six-month period of SCHIP ineligibility in instances where an applicant’s health insurance was voluntarily dropped.  New Mexico SCHIP covers children up to age 19 in families with income between 185 percent and 235 percent of the FPL.