SUMMARY OF MEDICAID POPULATIONS AFFECTED BY HR1
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Summarizes New Mexico HCA program and operational changes driven by federal H.R. 1 affecting non-citizen Medicaid eligibility and program rules for the MAGI Other Adult (COE100) population, including exemptions and administrative processes. Applies to New Mexico Medicaid members described in this summary.
Some lawfully present non-citizen non-pregnant adults currently enrolled in Medicaid will no longer be eligible for full-benefit Medicaid starting October 1, 2026.
Most adults 19-64 in MAGI Other Adult COE100 must meet 80 hours of work/activity per month (or claim exemption), renew every 6 months, and receive 1 month of retroactive coverage starting January 1, 2027.
New Mexico will exempt specific populations (American Indians, former foster care, institutionalized, substance use treatment participants, HCBS waiver recipients, and certain veterans) from work/activity or renewal rules.
Coverage Criteria and Exemptions
Coverage criteria and exemptions
Coverage and eligibility stance for specific populations under H.R.1 and COE100 operational changes:
Lawfully present non-pregnant non-citizen adults
- Affected groups include refugees, asylees, victims of trafficking, humanitarian parolees, and other non-citizens who currently have Medicaid; New Mexico will create a state program to continue coverage for these individuals and they do not need to take action to continue coverage.
Children and pregnant individuals
- Children under 21 and pregnant individuals who are lawfully present remain fully eligible for Medicaid without a five-year waiting period.
MAGI Other Adult COE100 members (ages 19-64)
- Must meet 80 hours of work or activity in any month during the renewal period or in the month prior to application, or notify HCA of an exemption.
- Must renew Medicaid every 6 months instead of 12 months.
- Are eligible for only 1 month of retroactive coverage when first applying for MAGI Other Adult Medicaid beginning Jan 1, 2027.
Exemptions — American Indians/Alaska Natives
- Exempt from work/activity rules and the 6-month renewal requirement; Medicaid coverage will continue to renew every 12 months.
- Verification of American Indian or Alaska Native blood is generally not required; exemption is based on individual attestation; members who did not self-attest may be required to comply with COE100 rules unless they contact HCA to update information.
Exemptions — Former foster care individuals
- Former foster care individuals ages 18 through 25 are exempt from Medicaid Work and Activity Rules.
Exemptions — Institutionalized or hospitalized individuals
- Members or applicants living in a hospital, nursing facility, similar institutional/residential care setting, or receiving non-institutional/outpatient services that would otherwise keep them from being institutionalized are exempt from Work and Activity Rules for the duration of institutionalization.
- Exemption is short-term and ends once the member is no longer institutionalized; members must request this exemption; HCA will accept self-attestation; members traveling 45 miles or more from residence for at least 24 hours may also qualify for the exemption for the duration of travel/treatment.
Exemptions — Substance use treatment participants
- Members or applicants actively participating in a drug addiction or alcohol treatment and rehabilitation program are exempt from Work and Activity Rules for the duration of their treatment.
Exemptions — HCBS Medicaid waiver recipients
- Work and Activity Rules do not apply to individuals receiving services through an HCBS Medicaid Waiver (including HIV/Aids, Disabled and Elderly, Medically Fragile, and Developmentally Disabled).
- Members eligible for Medicaid Waivers cannot receive retroactive Medicaid coverage; Other Adult COE100 members receiving Community Benefit Waiver services with an approved Level of Care may qualify for the Medically Fragile exemption; HCA will accept self-attestation of medical frailty in calendar year 2027 if data are not available.
Exemptions — Veterans with qualifying disabilities
- Veterans with a 100% VA rated disability (permanent or temporary) may qualify for an exemption; temporary disabilities must be reconfirmed every 12 months; veterans with 100% VA compensation may qualify and reconfirmation is required every 12 months.
- Veterans whose disability prevents all work activity (including those with TDIU) may qualify; verification is required to confirm the disability prevents all work; veterans must provide a VA Benefit Summary Letter or VA Award Letter as proof.
- Veterans enrolled in Other Adult MAGI COE100 will renew every 6 months and may be eligible for one month of retroactive Medicaid when applying on or after Jan 1, 2027.
Key Thresholds and Codes
Verification, Notices, and Member Contact
HUMAD notice and 30-day response for unverifiable work/activity
If HCA cannot automatically verify a member's completion of required work or activity hours, HCA will send a Help Us Make a Decision (HUMAD) notice. The member has 30 calendar days to respond and may submit proof of completion or documentation that they qualify for an exemption.
- HUMAD is a notice of noncompliance sent when automatic verification fails.
- Member has 30 calendar days to respond with either proof of completion of hours or evidence of an exemption.
Contact HCA — phone and agent hours
Members and providers may call the HCA customer service line at 1-800-283-4465. The automated phone service is available 24 hours a day, 7 days a week; live customer service agents are available Monday–Friday, 7:00 a.m. to 6:30 p.m.
- Main HCA phone: 1-800-283-4465
- Automated service: 24/7
- Live agents: Mon–Fri, 7:00 a.m. – 6:30 p.m.
Member contact methods — phone and chat availability
Members can use the phone automated service (1-800-283-4465) or the online chat for assistance 24 hours a day, 7 days a week; to speak with a live agent, contact HCA Monday–Friday, 7:00 a.m. to 6:30 p.m.
- Automated phone: 1-800-283-4465 (24/7)
- Online chat: available 24/7 via the Medicaid portal web page
- Live agents by phone: Mon–Fri, 7:00 a.m. – 6:30 p.m.
SMS support via CCSC text line
Text the CCSC at 601-401-4995 for general information; the text service is available 24 hours a day, 7 days a week. Standard messaging rates may apply.
- CCSC text line: 601-401-4995
- Availability: 24/7
- Note: Standard messaging rates may apply
Email support for customer inquiries
For customer inquiries, email NM.Customers@hca.nm.gov.
- Email: NM.Customers@hca.nm.gov
Definitions and Affected Populations
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