CurrentNew Mexico Health Care AuthorityPolicy 8.310.16

Abortion Services

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Coverage of medication-assisted abortion, surgical abortion, related behavioral health services, and FDA-approved oral medications for pregnancy termination under New Mexico medical assistance programs.

Policy Summary

PayerNew Mexico Health Care Authority

PolicyAbortion Services

Policy CodePolicy 8.310.16

Change TypeNew policy

Effective DateJanuary 1, 2027

Next Review DateNot scheduled

Key ActionBefore performing abortion services, document informed consent, required counseling, and referral information in the eligible recipient’s medical record.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2Covered abortion modalities

2Medication-assisted encounter formats

13+Minor consent age

FDA-approvedOral medication approval

Covered Abortion Services

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CurrentNew Mexico Health Care AuthorityPolicy 8.310.16

Abortion Services

Customize your policy alerts

Sign up for New Mexico Health Care Authority Policy 8.310.16 alerts

Get alerted when Policy 8.310.16 changes without checking for updates manually.

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Policy Summary

PayerNew Mexico Health Care Authority

PolicyAbortion Services

Policy CodePolicy 8.310.16

Change TypeNew policy

Effective DateJanuary 1, 2027

Next Review DateNot scheduled

Key ActionBefore performing abortion services, document informed consent, required counseling, and referral information in the eligible recipient’s medical record.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2Covered abortion modalities

2Medication-assisted encounter formats

13+Minor consent age

FDA-approvedOral medication approval

Covered Abortion Services

Covered Abortion and Related Services

Covered abortion services include the following when the applicable conditions are met.

Medication-assisted abortion is covered when provided through a face-to-face or telehealth encounter and the provider completes the required informed consent, counseling, and referral-information documentation before performing the service.

The recipient must be a MAP-eligible recipient for the required medical-record documentation.

Surgical abortion is covered when the provider completes the required informed consent, counseling, and referral-information documentation before performing the service.

The required documentation is specified for the MAP-eligible recipient's medical record.

Oral medications for pregnancy termination: FDA-approved oral medications for pregnancy termination are covered when administered by a provider acting within the scope of the provider's practice board and licensure.FDA approval; provider within scope of practice board and licensure

Behavioral health services are covered for a pregnant MAP-eligible recipient.

Consent by Pregnant Minor

Consent for abortion care may be provided by a pregnant minor meeting the stated age requirement.

Minor consent: A pregnant minor 13 years old or older may provide informed medical consent for abortion care without parental permission.Age >= 13 years

Consent, Counseling, and Provider Requirements

Documentation Required

Document consent and counseling before abortion services

Before performing abortion services, include in the MAP-eligible recipient’s medical record standard medical informed consent, counseling regarding the nature of the procedure, risks and benefits, available alternatives, and the right to refuse or delay treatment, and referral information for abortion services.

Document consent and counseling before the abortion service is performed.
Include referral information for abortion services in the medical record.

Denial Risk

Confirm consent and provider licensure

Before performing abortion services, document standard medical informed consent and counseling in the MAP-eligible recipient’s medical record. Oral medications for pregnancy termination must be administered by a provider acting within the scope of the provider’s practice board and licensure.

A pregnant minor 13 years old or older may provide informed medical consent for abortion care without parental permission.
Ensure the administering provider’s practice board and licensure authorize the service.

Policy Scope and Context

This rule establishes New Mexico Health Care Authority coverage for medication-assisted abortion provided through either a face-to-face or telehealth encounter, as well as surgical abortion. It also addresses related behavioral health services for pregnant MAP-eligible recipients and coverage of FDA-approved oral medications for pregnancy termination when administered by a provider acting within the scope of the provider’s practice board and licensure.

Policy Summary

PayerNew Mexico Health Care Authority

PolicyAbortion Services

Policy CodePolicy 8.310.16

Change TypeNew policy

Effective DateJanuary 1, 2027

Next Review DateNot scheduled

Key ActionBefore performing abortion services, document informed consent, required counseling, and referral information in the eligible recipient’s medical record.

SourceLink

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