‘Medicaid Forward’ plan for New Mexico nabs initial approval
February 11, 2025A proposal to dramatically expand state-administered health insurance coverage took a step forward Monday, after more than a year of research and public input.
The House Health and Human Services Committee voted to advance House Bill 186, which would establish “Medicaid Forward,” greatly extending eligibility for Medicaid while capping health care premiums at 5% of a household income.
The bill’s sponsor, House Majority Leader Reena Szczepanski, D-Santa Fe, said the proposal is a “major affordability initiative” for the nearly 200,000 New Mexicans without health insurance.
The proposal secured the committee’s approval in a 6-4, party-line vote.
Republican members voiced considerable concerns about Medicare Forward, including worries it would push health care providers out of the state. They also worried about the measure’s dependence on federal funding to cover over 70% of the costs amid the financial uncertainties surrounding President Donald Trump’s second term.
“As a concept, getting as many New Mexicans insured is a great idea, but I don’t think this is quite the mechanism to do that,” said Rep. Alan Martinez, R-Rio Rancho.
Still, Arika Sanchez, health care director for the New Mexico Center on Law and Poverty, said she’s hopeful the proposal will make it across the finish line during this year’s legislative session after the state invested in two studies to examine the plan’s feasibility.
“We’ve been on this path building up to it,” Sanchez said in an interview. “We know that it’s something that our community is asking for, and New Mexico is in a really unique position to do something like this.”
The initiative would remove Medicaid’s income cap, Sanchez said, which would allow families and individuals making more than 133% of the federal poverty level to enroll in the program.
Medicaid Forward would be free for those making less than double the federal poverty level — equivalent to more than $64,000 for a family of four. Enrollees above that threshold would pay health insurance premiums capped at 5% of their total household income, consistent with an existing Medicaid rule, Sanchez said.
“This bill would allow us to eliminate the Medicaid cliff,” Szczepanski said while presenting the bill Monday. “Currently, too many folks have to really make those hard decisions about whether to seek or accept a pay raise, knowing that that will mean that they will be kicked off of Medicaid.”
The cost of Medicaid Forward would be split between the federal government, slated to pick up about 72% of the cost based on current Medicaid law, and the state left with the remaining 28%. One analysis estimated the state’s share would run about $995 million for more than 290,000 new enrollees.
HB 186 would appropriate an additional $2 million for startup costs to the state Health Care Authority, which would be responsible for implementing Medicaid Forward.
Sanchez noted the program also would bring in some revenue and cost savings through premiums from higher-income enrollees and a reduction in costs from state employees switching to the program. All of that would be reinvested to pay for the program.
The Governor’s Office and the state Health Care Authority are monitoring the bill’s progress, agency spokespeople wrote in emails to The New Mexican.
Under HB 186, the program would have to be up and running by Jan. 1, 2028.
Reps. Nicole Chavez, R-Albuquerque, and Jenifer Jones, R-Deming, voiced concerns Medicaid Forward would pull enrollees from BeWell, New Mexico’s health insurance marketplace under the Affordable Care Act, causing premium prices through the exchange to increase.
One analysis estimated some 56,000 of the more than 70,000 people currently accessing insurance through BeWell might switch to Medicaid Forward, a scenario Chavez worried would drive up BeWell’s prices.
“This is not presented as an alternative to [BeWell]; it is in addition to,” Szczepanski responded during the committee meeting.
Martinez worried about “using more and more and more taxpayer money as a solvency plan for the health care issues.”
“I think five years from now, we’re going to be back here with another plan to take that final step toward single-payer insurance,” he said.
Originally published in Santa Fe New Mexican