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- LOOKING FOR INFORMATION OVERVIEW
- Emergency Contact Information
- Information for Recipients
- Americans with Disabilities Act
- Eligibility Guidelines
- Health Care
- (HIPAA) Recipient Privacy and Confidentiality
- Resources
- Special Programs
- Brain Injury Services Fund
- Home and Community Based Waivers
- Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID)
- Keeping Kids Healthy (EPSDT)
- Program of All-Inclusive Care for the Elderly (PACE)
- Pre-Admission Screening and Resident Review (PASRR)
- School Based Health Centers
- General Information
- Electronic Visit Verification (EVV)
- Contracts
- Policy Manuals
- Procedures
- Request for Proposals (RFPs)
- Rules and Statues (NMAC)
- Registers/ Rule Changes
- State Plans and Reports
- Centennial Care
- Centennial Care Evaluation Design
- Centennial Care Evaluation Final Report
- Centennial Care Evaluation Interim Report
- Centennial Care 2.0 Evaluation Interim Report Draft
- Centennial Care 2.0 Interim Evaluation Report
- Centennial Care 2.0 Interim Evaluation Report, Appendices
- Centennial Care 2.0 Evaluation Design
- MCO Reviews & Audits
- Consumer Assessment of Healthcare Providers & Systems (CAHPS) Reports
- Centers for Medicare and Medicaid Home and Community Based Services Settings Final Rule
- External Quality Review Organization (EQRO) Reports
- Healthcare Effectiveness Data and Information Set (HEDIS) Reports
- Income Support Division Plans and Reports
- Medicaid Eligibility Reports
- New Mexico Medicaid State Plan
- Medical Assistance Division Pending and Approved State Plan Amendments
- NM Medicaid Access Monitoring Review Plan
- Mental Health Parity Report for Medicaid Managed Care in NM
- Quality Strategy
- Centennial Care
- Medicaid Explained
- Health Care Coverage Innovations – Initiatives
- Office of Fair Hearings – FAQ
- Data Book
- 2020 Census
- Home and Community Based Services (CB)
- Home and Community Based Services (HCBS) American Rescue Plan Act (ARPA)
- Social Impact Home Page
- Disaster Case Management
- Comprehensive Rate Review
- New Mexico Economic Relief Payment 2023
- Health Care Authority
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:
- Reduce premiums and out-of-pocket health care costs for New Mexicans who qualify for coverage on BeWell, the state’s Health Insurance Marketplace;
- Reduce premiums for small businesses and their employees;
- Provide resources for planning, design and implementation of health care coverage initiatives for uninsured New Mexico residents; and
- 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).
Programs
- Health Insurance Marketplace Affordability Program
- New Mexico Premium Assistance
- Turquoise Plans
- Clear Cost Plans
- Medicaid Transition Premium Relief
- Native American Premium Assistance
- Small Business Health Insurance Premium Relief Initiative
Resources
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 2025: Materials
Final 2025 Health Insurance Marketplace Affordability Program Guidance
- 2025 Plan Year Health Insurance Marketplace Affordability Program Policy and Procedures Manual FINAL
- 2025 Plan Year Marketplace Affordability Program FAQs for Issuers (Updated April 26, 2024)
- 2025 Plan Year BeWell Clear Cost Plan Requirements FINAL
- 2025 Plan Year BeWell Clear Cost Plan AV Calculator Screenshots FINAL (Downloads Excel File)
- Non-AVC Clear Cost Benefits Co-Pay Category (Downloads Excel File)
2025 Plan Year Marketplace Affordability Program
For Insurance Carriers and Brokers
Video: Kickoff to PY25 – Updates to Health Care Affordability Fund
PY25 Kickoff – Updates to Health Care Affordability Fund (pdf presentation)
Small Business Health Insurance Premium Relief Initiative
- HCA Bulletin 2024-01 (January 2025-June 2025)
Plan/Program Year 2024: Materials
2024 Health Insurance Marketplace Affordability Program Guidance
- 2024 Plan Year Health Insurance Marketplace Affordability Program Policy and Procedures Manual (FINAL)
- 2024 Plan Year Marketplace Affordability Program FAQs for Issuers (Updated May 10, 2023)
- 2024 Plan Year Supplemental SOPA Template (Downloads Excel file)
- 2024 Plan Year Standardized Health Plan Requirements
- 2024 Plan Year Standardized Health Plan AV Calculator Screenshots (Updated May 10, 2023) (Downloads Excel file)
2024 Plan Year Marketplace Affordability Program Bulletins
2024 Plan Year SOPA Reconciliation Guidance for Health Insurance Issuers
- PY24 SOPA Reconciliation Training Webinar Jan 2025
- PY24 SOPA Reconciliation Training-Jan 2025 (PowerPoint download)
- Final PY24 SOPA Reconciliation Checklist (Excel download)
- FINAL Plan Year 2024 SOPA Reconciliation Guidance
- Final PY24 Template A-Issuer and Plan Level SOPA (Excel download)
- Final PY24 Template B-Policy Level SOPA-Reconciliation (Excel download)
- Final PY24 Template C-SOPA Request for Reconsideration (Excel download)
- Final PY24 Attestation form A for EHB inclusion (Excel download)
- Final PY24 Attestation form B for EHB inclusion (Excel download)
Small Business Health Insurance Premium Relief Initiative
- **NEW** FINAL PY24 Guidance – Small Business
- **NEW** PY24 Annual Reconciliation Template – Small Business (Excel download)
- **NEW** PY24 Annual Reconciliation Examples – Small Business (Excel download)
- **NEW** PY24 Attestation Form – Small Business
Small Business Bulletins
- OSI Bulletin 2024-011 (July 2024-December 2024)
- OSI Bulletin 2024-010 (July 2024-December 2024)
- OSI Bulletin 2023-036 (January 2024-June 2024)
Plan/Program Year 2023: Materials
Health Insurance Marketplace Affordability Program Information for the 2023 Plan Year
2023 Health Insurance Marketplace Affordability Program Guidance
- 2023 Plan Year Health Insurance Marketplace Affordability Program Policy and Procedures Manual
- Marketplace Affordability Program FAQ for Issuers (Updated April 4, 2022)
- Bulletin 2022-022 – MAP Payment Process
- How reporting income changes after Open Enrollment could affect Turquoise Plan eligibility
Final 2023 Plan Year SOPA Reconciliation Guidance for Health Insurance Issuers
- Final SOPA Reconciliation Guidance (Version 2)
- OSI Responses to Carrier Questions Following Jan 2023 SOPA Reconciliation Training – Mar 2023
- Template A – Issuer and Plan Level SOPA
- Template B – Policy Level SOPA-Reconciliation
- Template C – SOPA Request for Reconsideration
- Attestation Form A – EHB Inclusion
- Attestation Form B – EHB Inclusion
- Attestation Form C – Simplified Methodology Forms
Small Business Health Insurance Premium Relief Initiative
OSI
- Bulletin 2023-10 (July 2023-December 2023)
- Bulletin 2022-018 (January 2023-June 2023)
- Bulletin 2022-006 (July 2022-December 2022)
Submit Feedback
HCA wants to hear from you. Submit feedback to HCAFcomments@hca.nm.gov