By Steve Hansen
QCS Managing Editor
After years of endless haggling over the merits of the Affordable Care Act (ACA), much of it is on the verge of taking effect, and New Mexico applicants for health insurance benefits may start applying as early as Oct. 1.
Representatives of Health Action New Mexico made a stop in Tucumcari Thursday to prepare social services personnel and others to help income-qualified Quay County residents sign up for ACA’s Medicaid enhancements or for the subsidized benefits under the Health Insurance Exchange, if they don’t have insurance through an employer.
Joe Martinez, Health Action consumer outreach coordinator, told two groups of area residents on Friday that about 83 percent of persons who will be eligible for enhanced ACA benefits under Medicaid don’t know about it.
In addition, he said 20 percent of New Mexicans don’t have health insurance, a rate of uninsured residents that is surpassed only in the state of Mississippi.
Alida Brown, coordinator of the Quay County Health Council, added that an estimated 760 people in Quay County are expected to qualify for Medicaid.
Martinez urged social services workers and others to ensure people were made aware of Medicaid enhancements and options for the exchange. The Tucumcari Income Support Division office, 421 W. Route 66 Blvd., will be the headquarters for people to obtain information and apply for benefits in person, he said.
Accompanying Martinez was Stephanie Grilo, who is collecting stories from applicants about their experiences in filing for health benefits. These stories, she said, will help others who seek to file for benefits to negotiate the hurdles they may encounter.
Martinez also urged individuals who are seeking benefits not to give up if they are rejected the first time.
“Keep trying,” he said.
He urged people to shop carefully among the available health insurance plans to ensure that individual household needs will be met. Some, he said, also include vision and dental plans.
In New Mexico, Medicaid recipients and Heath Insurance Exchange users will be able to choose plans from companies like Blue Cross Blue Shield, Lovelace, Molina, New Mexico Health Connections, United Healthcare and Presbyterian, Martinez said.
If a family already has insurance through an employer, the family should keep that insurance, unless the employee’s share of insurance premiums to cover the employee only totals more than 9.5 percent of the family’s income. Then, he said, the family should check out both the Medicaid programs and the Exchange.
Martinez said there are several websites that can help potential applicants and social services workers learn more about these programs. Medicaid’s own site, he said, is www.yes.state.nm.us/selfservice, but he said this site may not be available until October.
The New Mexico Health Insurance Exchange’s website is www.bewellnm.com.
Health Action New Mexico, he said, is also part of a group called the “You Are Not Alone Teams” that are gearing up to assist applicants for both the Medicaid programs and the Health Exchange.
Participating organizations and their websites and phone numbers include Center on Law and Poverty, http://nmpovertylaw.org; Southwest Women’s Law, www.swwomenslaw.org, (505) 244-0502; Health Action New Mexico, www.healthactionnm.org, (505) 867-1095 VOICES for Children, www.nmvoices.org; and the New Mexico Office of the Supervisor of Insurance Ombudsman Program at (855) 857-0972.
He fielded questions from individuals after both presentations. One asked whether Texas facilities could accept claims from New Mexico Medicaid policy holders.
Martinez said people should look for that kind of information when they are comparing plans. Texas, unlike New Mexico, has refused to operate Medicaid and Health Care Exchange programs in the state. Martinez said that means the federal government will operate those programs in Texas.
Martinez told questioners who asked about obtaining insurance with pre-existing medical conditions that pre-existing conditions can no longer be used to deny coverage.
There were several questions about obtaining coverage through the exchange or Medicaid for families in which one member is insured through a job, but other family members are not. Overall, Martinez said, a family that is insured through an employer should not try to change from employer-provided insurance. If only one member of a household is covered by an employer, however, he said, other household members may apply through either Medicaid or the exchange.
According to information provided in handouts at the session, health insurance under ACA-expanded Medicaid is free to those who qualify based on income, and allows customers to choose from a list of insurance providers. The expansion will mean more families are eligible to receive health insurance under Medicaid, Martinez said.
The Health Insurance Exchange offers health insurance to those who do not qualify for Medicaid but do not have health insurance. The Exchange’s insurance premiums will be priced on a sliding scale based on income.
To qualify for Medicaid expansion, an adult must be between the ages of 19 and 64 and must be a citizen of the U.S. or a lawfully present immigrant, and live in New Mexico, and household income must be less than the following levels, according to household size.
Adults (ages 19-64Income per month / Year
Less than $1,232 / $15,856
Less than $1,785 / $21,404
Less than $2,247 / $26,951
Less than $2,709 / $32,499
Less than $3,172 / $38,047
Less than $3,634 / $43,594
If an adult cannot get Medicaid, children in the household may qualify. While qualifying income levels are likely to change on Jan. 1, here are the current qualifying income levels for children:
Yearly household income
Less than $27,000
Less than $36,499
Less than $45,896
Less than $55,342
Less than $64,790