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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).

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

• 2024 Report to Legislature: Health Care Affordability Fund 
• 2023 Report to Legislature: Health Care Affordability Fund
• SB317 HCAF Enabling Legislation

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)

Small Business Health Insurance Premium Relief Initiative

• **NEW** 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

• OSI Bulletin 2024-001

2024 Plan Year SOPA Reconciliation Guidance for Health Insurance Issuers

1. **NEW** FINAL Plan Year 2024 SOPA Reconciliation Guidance
2. Final PY24 Template A-Issuer and Plan Level SOPA (Excel download)
3. Final PY24 Template B-Policy Level SOPA-Reconciliation (Excel download)
4. Final PY24 Template C-SOPA Request for Reconsideration (Excel download)
5. Final PY24 Attestation form A for EHB inclusion (Excel download)
6. Final PY24 Attestation form B for EHB inclusion (Excel download)

Small Business Health Insurance Premium Relief Initiative

• 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

• Presentation for Assisters and Producers (October 2022)

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

1. Final SOPA Reconciliation Guidance (Version 2)
2. OSI Responses to Carrier Questions Following Jan 2023 SOPA Reconciliation Training – Mar 2023
3. Template A – Issuer and Plan Level SOPA
4. Template B – Policy Level SOPA-Reconciliation
5. Template C – SOPA Request for Reconsideration
6. Attestation Form A – EHB Inclusion
7. Attestation Form B – EHB Inclusion
8. 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