1. A. Rules covering the following provisions may be amended as the health care authority determines:

   1. (1) providing enhanced premium and cost-sharing assistance to individuals and families for the purchase of qualified health plans on the New Mexico health insurance exchange. In providing this assistance, the health care authority shall develop health care affordability criteria designed to reduce the amount that individuals pay in premiums and out-of-pocket medical expenses for qualified health plans offered on the New Mexico health insurance exchange; and

   2. (2) establishing income eligibility parameters for the health care affordability criteria for plan year 2023 and each subsequent calendar year based on available funds. New Mexico residents who qualify shall:

      1. (a) have a household income below four hundred percent of the federal poverty level and qualify for the advanced premium tax credit under the federal Patient Protection and Affordable Care Act; or
      2. (b) meet all eligibility criteria for the advanced premium tax credit under the federal Patient Protection and Affordable Care Act except for household income requirements.
2. B. If the federal Patient Protection and Affordable Care Act is repealed in full or in part by an act of congress, invalidated by the United States supreme court or administered by the United States department of health and human services in a way that alters eligibility criteria for the advanced premium tax credit in a manner that would cause significant coverage loss for New Mexico residents, the health care authority may promulgate rules to minimize loss of coverage by expanding eligibility to cover individuals at risk of losing coverage due to such changes, subject to available funds.

3. C. The health care authority, in consultation with the superintendent, the New Mexico medical insurance pool, the department of health and stakeholder groups, including health care providers that serve uninsured residents, health insurance carriers and consumer advocacy groups, may update the plan for extending health care coverage access to uninsured New Mexico residents who do not qualify for federal premium assistance or, except by reason of incarceration, qualified health plans, through the New Mexico health insurance exchange. The plan shall include:

   1. (1) details about health care benefits;
   2. (2) health care affordability criteria designed to reduce the amount that individuals pay in premiums and out-of-pocket medical expenses under the plan and that result in, to the greatest extent possible, health care costs comparable to costs for New Mexico residents for whom assistance is provided under Subsection A of this section; and
   3. (3) income eligibility parameters that prioritize eligibility for New Mexico residents with incomes under two hundred percent of the federal poverty level.

4. D. On or before October 31, 2024 and each October 31 thereafter, the health care authority shall submit a report to the legislative finance committee and the legislative health and human services committee that includes:

   1. (1) a summary of the affordability criteria implemented pursuant to Subsections A, B and C of this section;
   2. (2) the estimated number of uninsured New Mexico residents who enrolled in coverage following implementation of the affordability criteria pursuant to Subsections A, B and C of this section; and
   3. (3) the amount in reduced costs and coverage assistance the initiatives provided in the current and previous calendar years by income level, county and coverage source.

History: Laws 2021, ch. 136, § 5; 2024, ch. 39, § 127; 2025 (1st S.S.), ch. 1, § 2.

ANNOTATIONS

Cross references. — For the federal Patient Protection and Affordable Care Act, see 42 USC 18001.

The 2025 (1st S.S.) amendment, effective October 3, 2025, adjusted eligibility requirements for participating in the New Mexico health insurance exchange, and made certain technical amendments; in Subsection A, in the introductory sentence, after the subsection designation, deleted "After the effective date of this 2024 act", in Paragraph A(2), after "shall", deleted "have an income that is eligible for advanced premium tax credits", and added new Subparagraphs A(2)(a) and A(2)(b); added a new Subsection B and redesignated former Subsections B and C as Subsections C and D, respectively; in Subsection C, after the subsection designation, deleted "After the effective date of this 2024 act"; and in Subsection D, Paragraphs D(1) and D(2), after "Subsections A, B" added "and C".

The 2024 amendment, effective July 1, 2024, authorized the health care authority to amend rules covering the provisions of this section, authorized the health care authority, in consultation with the superintendent of insurance, the New Mexico medical insurance pool, the department of health and stakeholder groups, to update the plan for extending health care coverage access to uninsured New Mexico residents who do not qualify for federal premium assistance, or by reason of incarceration, qualified health plans through the New Mexico health insurance exchange, made conforming amendments, and removed outdated language; deleted former Subsection A, which said "The superintendent, in consultation with the secretary of human services, the secretary of taxation and revenue and the chief executive officer of the New Mexico health insurance exchange, shall promulgate rules to:", and added a new Subsection A; in Paragraph A(1), after "assistance, the" deleted "superintendent" and added "health care authority"; in Subsection B, deleted "The superintendent, in consultation with the human services department" and added "After the effective date of this 2024 act, the health care authority, in consultation with the superintendent", after "advocacy groups" deleted "shall develop a" and added "may update the" and deleted "No later than June 30, 2022, the superintendent shall submit the plan to the legislative finance committee and the legislative health and human services committee that could offer health care coverage for eligible New Mexico residents beginning July 1, 2023"; and in Subsection C, changed "2023" to "2024" and after "October 31 thereafter, the" deleted "superintendent" and added "health care authority".