1115 Medicaid Waivers in New Mexico
Centennial Care is a statewide 1115 waiver program that covers most of New Mexico’s Medicaid recipients. The program is administered through managed care plans. New Mexico expanded Medicaid under the Affordable Care Act in 2014 through its Centennial Care program. In December 2018, CMS approved the state’s request to make changes to the program for certain higher-income expansion enrollees. The new waiver is now entitled Centennial Care 2.0.
Adult expansion population over 100 percent of the federal poverty level.
- CentennialCare 1115 Waiver renewal application
- CMS approval of CentennialCare 2.0 1115 Waiver renewal
The state charges premiums of between 1 percent and 2 percent of monthly income. Failure to pay premiums within a ninety day grace period results in the suspension of Medicaid coverage for three months. Not all groups are required to pay premiums (for example, Native Americans) and there are hardship exemptions available. Learn more and get advocacy strategies to combat premiums.
The waiver imposes cost-sharing requirements for two services: a $25 co-pay for non-emergency use of the emergency room and a $10 co-pay non-preferred drugs when a preferred drug is available. Learn more and get advocacy strategies to combat cost sharing.
The waiver includes a wellness program that incentivizes members to meet health goals surrounding weight loss, blood pressure and smoking cessation. Rewards would be structured in the form of premium payment relief. There is little detail on how this program is to be implemented in the state’s application and CMS’s approval. Learn more and get advocacy strategies to combat problematic wellness programs.
Coverage for affected enrollees begins the first month they make a premium payment. Coverage does not extend retroactively to three months before the month of eligibility. Learn more and get advocacy strategies to combat waivers of retroactive coverage.