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Health Care Coverage Innovations – Initiatives

During the 2021 Legislative Session, the New Mexico Legislature passed and Governor Michelle Lujan Grisham signed Senate Bill 317, which placed a moratorium on out-of-pocket costs for mental health services for state-regulated plans and created a Health Care Affordability Fund to lower health care costs for New Mexicans. The law allows the Fund to be used to:

  1. Reduce premiums and out-of-pocket health care costs for New Mexicans who qualify for coverage on BeWell, the state’s Health Insurance Marketplace;
  2. Reduce premiums for small businesses and their employees;
  3. Provide resources for planning, design and implementation of health care coverage initiatives for uninsured New Mexico residents; and
  4. Provide resources for administration of state health care coverage initiatives for uninsured New Mexico residents.

The Fund and its programs are administered by the New Mexico Health Care Authority (HCA).

Plan/Program Year 2026: Materials 

2026 Plan Year Marketplace Affordability Program 

Final PY26 Clear Cost Plan Requirements

Final PY26 Clear Cost Plan Designs (Excel download)

2026 Plan Year Small Business Health Insurance Premium Relief 

 

Plan/Program Year 2024: Materials

2024 Health Insurance Marketplace Affordability Program Guidance

2024 Plan Year Marketplace Affordability Program Bulletins

2024 Plan Year SOPA Reconciliation Guidance for Health Insurance Issuers

  1. PY24 SOPA Reconciliation Training Webinar Jan 2025
  2. PY24 SOPA Reconciliation Training-Jan 2025 (PowerPoint download)
  3. Final PY24 SOPA Reconciliation Checklist (Excel download)
  4. FINAL Plan Year 2024 SOPA Reconciliation Guidance
  5. Final PY24 Template A-Issuer and Plan Level SOPA (Excel download)
  6. Final PY24 Template B-Policy Level SOPA-Reconciliation (Excel download)
  7. Final PY24 Template C-SOPA Request for Reconsideration (Excel download)
  8. Final PY24 Attestation form A for EHB inclusion (Excel download)
  9. Final PY24 Attestation form B for EHB inclusion (Excel download)

Small Business Health Insurance Premium Relief Initiative

Small Business Bulletins

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HCA wants to hear from you. Submit feedback to HCAFcomments@hca.nm.gov