UPDATE: For the year 2020, Medicaid plans will follow the same requirements and application methods.
What are the requirements for Medicaid in New Mexico, and who is eligible for Medicaid coverage? Medicaid eligibility in NM is strongly based on your household size and income. And, since Medicaid eligibility requirements are determined by your state of residence, you must learn the standards of the state to understand how to qualify for Medicaid in New Mexico successfully. In addition, there are other general requirements for Medicaid you must meet on both federal and state levels – unrelated to your income.
Who meets the requirements for Medicaid in New Mexico?
As you review the Medicaid eligibility requirements in New Mexico, you may be wondering if your specific group qualifies for Medicaid or not. What are the Medicaid application guidelines in terms of patient groups? Thanks to the Medicaid expansion, which New Mexico elected to accept, many patients are now eligible for Medicaid that were not before. The following types of patient group qualify for Medicaid benefits in New Mexico:
- Children ages 0 to 6 and children ages 6 to 19 (there are different eligibility requirements depending on your age and if you are applying for CHIP or regular Medicaid benefits)
- Pregnant women
- The blind
- The disabled
- The elderly
- Other adults ages 19 to 65
Note that those grouped in the “Other Adults” group will receive healthcare benefits under the New Mexico Alternative Benefit Plan, or ABP. This just means that it is not through traditional Medicaid benefits, though many of the same medical offerings are honored.
What Are the Income Requirements for Medicaid?
In order to qualify for Medicaid in New Mexico, you must be deemed a low-income individual, first and foremost. The Medicaid income requirements in NM are determined through a system called the Modified Adjusted Gross Income (MAGI) tool. Here, your monthly (or annual) earnings are compared to the current Federal Poverty Levels, along with the size of your household. The MAGI tool determines if the income for your household size is within a specific range of the Federal Poverty Level. You can only apply for Medicaid benefits in New Mexico if you meet the income requirements for Medicaid – among other non-financial Medicaid requirements outlined in the section below.
So, what are the income requirements for New Mexico Medicaid? Adults can earn an income that is no higher than 138 percent of the Federal Poverty Level. The bigger the family, the larger your income limit is, but a general rule for Medicaid qualifications is that earnings must not exceed $16,243 annually. In the event that $44,497 is earned by a six-member family, Medicaid eligibility requirements will still be met. Keep this in mind when learning how to qualify for NM Medicaid, because if earnings are too high, you may not be eligible for Medicaid. In that case, you must shop for health coverage in the private marketplace, which is much more expensive than even partial Medicaid benefits or the Alternative Benefits Program.
Once you have determined that your household income meets the income requirements for Medicaid in New Mexico, there are general requirements for Medicaid to consider. Explore the different Medicaid requirements by downloading our informative guide.
What Are the Non-financial Medicaid Requirements in New Mexico?
What are the Medicaid application guidelines beyond income? Not only is Medicaid eligibility dependent on financial criteria but also, non-financial criteria. If you do not meet the general requirements for Medicaid as well as the financial ones, you may not be deemed eligible for Medicaid. Review the additional Medicaid requirements below.
First and foremost, being a resident of the state in which you are applying for Medicaid benefits is a necessity. This means that your Medicaid benefits eligibility in New Mexico, alone, requires you to prove you are a current resident of the state. In most instances, your valid New Mexico driver’s license or DMV ID card will suffice.
In addition, you can only qualify for Medicaid in New Mexico if you are a United States citizen or a lawful permanent resident. Have proof of your citizenship or legal presence in the country available as part of your Medicaid eligibility.
Last, having a registered United States Social Security Number is mandatory in order to qualify for Medicaid. Your Social Security Number acts as a federal identifier, as well as becoming your primary ID number when it comes to dispensing your Medicaid benefits in NM.
Verification of the beneficiary and any other eligible family members will be required in order to officially meet the Medicaid qualifications of New Mexico. Failure to provide this information means that the applicant(s) will remain ineligible for Medicaid.
Understanding the Medicaid Special Enrollment Period (SEP)
It is hard to control what happens in life. After all, you never know what is around the corner. And, with so many life events shaping one’s path, missing the enrollment deadline for Medicaid benefits in New Mexico is actually quite common. So, what are the requirements for Medicaid if someone fails to elect for healthcare insurance outside of the open enrollment period?
The solution is to confirm your Medicaid eligibility and apply during a Special Enrollment Period (SEP). When the following things apply to the person who is eligible for Medicaid, he or she will have a second chance to fill out an application form and enroll:
- Getting married
- Getting divorced
- Giving birth/becoming a parent
- Losing health coverage
- Relocating on a permanent basis
New Mexico Medicaid eligibility requirements will not be honored any later than 60 days after a Special Enrollment Period (SEP) has occurred. The easiest way to get updated, accurate information about SEP Medicaid eligibility and application guidelines for Medicaid is to contact a Medicaid office in New Mexico and answer some qualifying questions.
Download our helpful guide to learn about the different requirements for Medicaid.