NMHIX seeks to prevent insurance coverage gaps

November 16, 2013 • Local News

Above: Graph showing how New Mexican residents are using the federal health insurance exchange. Below: Graph showing usage of the Small business Health Options Program (SHOP). SHOP is overseen by NMHIX and offers exchange plans to businesses with fewer than 50 employees. Enrollment in SHOP is optional for employers. (Steve Stone Graphics)


The New Mexico Health Insurance Exchange (NMHIX) board of directors focused its Friday meeting at ENMU-Roswell on trouble shooting possible gaps in insurance coverage for some groups. The anticipated gaps stem from many being unable to enroll in health plans through the federal health exchange.

The exchange was created as part of the Affordable Care Act and offers subsidized health plans to households that make up to 400 percent of the federal poverty level. New Mexico currently runs on the federal exchange, but will adopt its own exchange within the next year. NMHIX will run the state exchange.

The board moved to request the federal government allow the state to extend the life of State Coverage Insurance (SCI) and pledged to [auth] work to deter coverage gaps for members of the Federal High Risk Pool.

“We are working with [the federal government] to come up with any alternative that can be provided if the website does not go up and people cannot enroll,” said NMHIX Interim CEO Mike Nunez.

SCI is a state-run health plan providing coverage for low-income New Mexicans who do not qualify for Medicaid. The program falls under the umbrella of Medicaid and requires a waiver from federal agency Centers for Medicare and Medicaid Services (CMS) to operate. The waiver ends Dec. 31.

The deadline for Jan. 1 coverage through the exchange is Dec. 15. However, glitches in the exchange website have prevented SCI members from enrolling.

Sidonie Squier, secretary of the state Human Services Department (HSD), which oversees Medicaid programs in the state, said about 10,000 of SCI’s 50,000 members qualify for subsidized plans through the exchange. The rest will qualify for Medicaid, which is being expanded as part of ACA.

“Unless they let us extend the SCI, people are not going to have insurance,” said Squier.

Squier and Nunez said their organizations would file requests for an extension of the waiver in order to allow patients to stay on SCI until the federal exchange runs smoothly.

Reena Szczepanski, executive director of New Mexico Medical Insurance Pool (NMMIP) said roughly 500 of the federal pool’s 1,248 members qualify for subsidies through the exchange but, like SCI members, risk gaps in coverage.

NMMIP oversees the New Mexico High Risk Pool and the federal pool in New Mexico. The pools provide coverage for seriously ill patients who do not qualify for Medicaid and cannot afford or are rejected by private insurance companies. The federal pool expires Dec. 31. The state pool is not slated to expire.

Szczepanski said one possible solution is applying exchange subsidies to premiums after patients purchase plans directly from insurers, as opposed to through the exchange website.

At the meeting, the board also asked software vendor GetInsured to determine whether it is possible to extend deadlines for enrollment in plans offered on the Small business Health Options Program (SHOP). SHOP is overseen by NMHIX and offers exchange plans to businesses with fewer than 50 employees.

Enrollment in SHOP is optional for employers. Enrollment is on a rolling basis, but employers were required to choose plans by Oct. 31 in order for employees to have coverage by Jan. 1.

Board member Dr. Martin Hickey, CEO of nonprofit health plan New Mexico Health Connections, said he would like small businesses to have until Nov. 30 to choose benefits levels and for employees to have until Dec. 15 to choose providers.

Shankar Srinivasan, COO and chief technology officer of GetInsured, said the vendor would look into whether the deadlines can be extended without damaging system code. He said he plans to respond to NMHIX by Monday or Tuesday.

GetInsured’s contract with NMHIX is slated to be finalized within the next week, according to Nunez. The vendor developed the software for SHOP and is working on software for the state exchange.

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