New Mexico § 27-2-12.33 - Study of the medicaid forward plan

§ 27-2-12.33. Study of the medicaid forward plan

A. The secretary, in coordination with the superintendent of insurance and in consultation

with the medicaid advisory committee, other stakeholders identified by the secretary

and representatives of Indian nations, tribes and pueblos that are located wholly

or partially in New Mexico, shall study the following operational needs for and effects

of implementing the medicaid forward plan and amending the New Mexico medicaid state

plan, pursuant to the federal act to provide medical assistance to residents who are

under age sixty-five, are not otherwise eligible for and enrolled in mandatory coverage

under the New Mexico medicaid state plan and have a household income that exceeds

one hundred thirty-three percent of the federal poverty level: (1) the effects on the individual, group and self-insured health insurance markets,

including the New Mexico health insurance exchange and the health benefits programs

provided to state or local public employees or public school employees, of providing

mandatory or optional medicaid coverage to individuals who would otherwise be eligible

for health insurance through those markets; (2) the effects on health care providers and health care facilities, including reimbursement

rates needed to maximize access to health care services; (3) the operational needs for administering the medicaid forward plan, including staffing

and technical needs for enrollment and collection of premiums or cost-sharing; (4) the funding plan, including necessary expenditures and total revenue generated; (5) the fiscal effects on recurring and nonrecurring spending in the state budget;

and (6) the financial sustainability, including steps necessary for the department and

the superintendent of insurance to apply for federal waivers to maximize federal funding

and leverage those waivers to ensure affordability for enrollees in the medicaid forward

plan. B. The secretary's proposed program design for the medicaid forward plan shall be

contingent on the results of the study and shall include: (1) a financing plan, which shall include recommended appropriation of state funds,

projected federal funds, savings directly or indirectly attributable to the program

design, a sliding scale for premiums and cost-sharing based on household income for

individuals eligible to enroll in the medicaid forward plan and other potential cost

offsets; (2) information about recommended reimbursement rates to maximize access to health

care services under the medicaid forward plan; (3) details about the department's operational needs for administering the medicaid

forward plan; and (4) information about federal waivers needed to maximize federal funding and ensure

affordability and choice for enrollees. C. By October 1, 2024, the secretary shall submit a report to the legislative finance

committee and the legislative health and human services committee detailing the secretary's

study of, and proposed program design for, the medicaid forward plan.