Affordable Care Act means some may have to change health plans

October 8, 2013 • Local News

Tess Townsend
Record Staff Writer

This is the second installment of a three-part series about how local residents can adapt to the Affordable Care Act.

Who needs to sign up?
The open enrollment period for health plans on the exchange started October 1 and ends March 31. If you do not enroll in insurance by the end of March, the IRS will garnish money from your tax returns.

Open enrollment will start again in Oct. 15, 2014, and run through December. According to the New Mexico Health Exchange (NMHIX), people who undergo “life events” such as marriage, divorce, or a new child may enroll for care on the exchange between open enrollment periods.

Native American tribal members may sign up for care through NMHIX at any time.

As part of the health care reform, almost everyone is required to sign up for insurance, with few exceptions. However, you are not required to sign up for a plan through the exchange. The uninsured may pursue plans through private providers. Only plans offered on the exchange include subsidized premiums.

If you make up to 138 percent of the Federal Poverty Level, which varies based on family size, you may enroll in Medicaid, renamed Centennial Care under ACA.

If you already have health insurance through your employer, private health care provider, Medicaid, or some state-sponsored plans, you do not have to sign up for a new health plan.

If your job-based health plan is deemed “affordable” under ACA guidelines, you do not qualify for subsidized health insurance.

Small businesses are not required to provide health insurance to employees, [auth] but are permitted to enroll at any time during the year.

Some designated groups are exempt from the health insurance mandate, meaning they are not required to have an insurance plan and will not be fined if they do not enroll in insurance. Exemptions exist for members of Native American tribes and certain religious groups.

What if I’m on a government-sponsored plan?
Some plans financed with government funds will expire following the implementation of the Affordable Care Act.

The New Mexico Health Insurance Alliance will cease to exist Jan. 1. Small businesses and self-employed individuals who utilize NMHIA services will need to purchase services through the exchange. Individuals who are clients of NMHIA may also qualify for Medicaid.

NMHIA will cease renewing existing accounts on January 1. Accounts will stay active until their slated renewal dates in 2014. For example, if an account is set to be renewed in October 2014, it will stay active until that time.

Clients of Federal High Risk Pool and the New Mexico Medical Insurance Pool, which provide coverage for seriously ill patients who do not qualify for Medicaid and cannot afford or are rejected by private insurance companies, will likely have to change health coverage.

ACA provisions theoretically render high risk pools obsolete. The new law bars insurance providers from rejecting clients based on medical history.

The federal pool will expire in January. The New Mexico pool will continue providing coverage until at least the end of 2014.

“Our board has taken the position that we’re the safety net for New Mexico and we need to be there until we’re sure we’re no longer needed,” said Reena Szczepanski, executive director of NMMIP.

Among Chaves County residents, 510 are enrolled in care through the state pool, and 72 are enrolled in the federal pool. Szczepanski expects that about 2,000 enrollees in both pools across the state will qualify for Medicaid under the program’s expansion.
She encourages clients of the New Mexico pool to seek out coverage options through Medicaid or the exchange, despite the fact that the pool will continue to provide coverage for the time being.

The state Human Services Division and the New Mexico pool are working to automatically enroll pool clients who newly qualify for Medicaid in the program, according to Kennicott.

Indigent Healthcare Services of Chaves County partially reimburses hospitals and community health centers for the treatment of low-income, uninsured patients. The program will likely handle fewer claims into the future as a result of the new health care law, due to many of its patients newly qualifying for medicaid, according to Stanton Riggs, who oversees the program as manager of and attorney for Chaves County.

Indigent can cover costs of care for patients who make up to 185 percent of the Federal Poverty Level.

Riggs says that patients who have submitted claims to Indigent in the past but who now qualify for Medicaid must enroll in Medicaid.

Riggs says that despite the anticipated decrease in case load, Indigent is slated at this time to receive the same funding as in the past. The program usually receives about $2.3 million annually from gross receipts tax.

People currently enrolled in any of the 43 Medicaid programs managed by HSD will automatically be enrolled in Medicaid and do not need to pursue new coverage. Medicaid programs in the state of New Mexico include New Mexikids, the Breast and Cervical Cancer Program, and the Family Planning Waiver.

Those covered by State Coverage Insurance may qualify for Medicaid or subsidized plans. SCI expires January 1.
Szczepanski warns against waiting to enroll in health insurance for those whose plans will cease to offer coverage as part of the new health care law. She especially cautions clients of the high risk pools to avoid gaps in coverage.

“The issue is that when someone is really ill, they don’t want a gap in coverage,” she says.

In order to have coverage through the exchange by Jan. 1, applicants must enroll by Dec. 15. To have Medicaid coverage by Jan. 1, applicants must enroll by Nov. 30.

Medicaid enrollment occurs throughout the year. Medicaid applications take up to 45 days to process. If an application for Medicaid is successful, the applicant will receive coverage retroactively beginning the date of application.

Coverage is not retroactive.
Those who apply for a QHP by the 15th of the month will receive coverage by the first of the following month. Those who apply after the 15th will receive coverage starting the first of the second following month. For example, if you apply on Dec. 16, you won’t receive insurance benefits until Feb. 2.

To learn more about the Affordable Care Act online, you can visit,, and

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