New Mexico: Chiles, Hot Air Balloons, and PCIP Enrollment

By Arie Stock

Which state is known for having a capital city that is 7,000 feet above sea level, being the “Green Chile Capital of the World,” and hosting the world’s largest hot air balloon fiesta? If you guessed New Mexico, you’re right! But did you know that this southwestern state with a relatively small population of about 2 million is making a giant impression on the world of health care enrollment? That’s important, because one in four New Mexicans is uninsured. Fortunately, the New Mexico Medical Insurance Pool (NMMIP) is working to change that by giving uninsured New Mexicans a place to turn for health insurance coverage they can’t get elsewhere.

The New Mexico Medical Insurance Pool – Federal High Risk Pool is New Mexico’s version of the Pre-Existing Condition Insurance Plan (PCIP) that all states now have because of the new federal health reform law.  It allows uninsured people with certain kinds of pre-existing medical conditions, who are therefore less likely to be able to buy an affordable, comprehensive private insurance plan on their own, to buy health insurance. Although nationwide enrollment in PCIPs is far below projections, New Mexico’s federal high-risk pool has done an impressive job of getting New Mexicans  enrolled in coverage, enrolling more people as of August 31, 2011 than states with three or four times its population. Let’s look at what New Mexico has done:

The state operates both a state-funded high-risk pool and a federally-funded PCIP, and each program has different eligibility criteria. In some states, multiple programs mean multiple applications. But New Mexico has seamlessly integrated the application process for both programs, so individuals with a pre-existing condition who are seeking coverage only need to fill out one application. The state then uses that information to determine which plan best fits the individual’s eligibility and health needs.

New Mexico also makes it easy for individuals to verify their pre-existing conditions. If you have a condition on its qualifying list, which includes over 50 pre-existing medical conditions, from cancer to Crohn’s Disease, you only need to provide a doctor’s note affirming your condition.

Even if it’s easy to apply, cost can still be a barrier. The premium cost of a monthly plan ranges from $140 to $596, which can pose a burden for many people. In response to this, New Mexico provides low income premium subsidies on a sliding scale to help people pay their premiums. These subsidies provide discounts that range from 25 to 75 percent of the premium cost, depending on an individual’s income. For example, an individual living in a family of four with a household income up to $44,700 could qualify for a 75 percent discount, and an individual living in a family of four with a household income up to $89,400 could qualify for a 25 percent discount.

We know that New Mexico’s program will help its residents get health coverage even if they have a pre-existing condition. But how does the state get the word out to New Mexicans? A marketing plan that consists of targeted advertising, agent compensation that rewards brokers by the number of successfully referred individuals, and postcards from the AARP have all contributed to heightened awareness of the plans. Also, if you’re a New Mexico resident who didn’t finish filling out your high-risk pool application, expect a follow-up phone call and letter from the NMMIP staff.

As Sarah Kliff recently wrote in a blog post on the Washington Post’s Wonkblog, PA Fair Care currently leads the pack for sheer numbers enrolled in a federal high-risk pool. But there are also lessons to be learned from smaller states like New Mexico as other states work to ensure that all eligible Americans are enrolled in comprehensive insurance coverage that is now available through the Pre-Existing Condition Insurance Plan.

Special thanks to DeAnza Sapien and Kristina Campbell of the New Mexico Medical Insurance Pool Executive Office for their assistance with this blog.

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