The coming months will be a good time to learn some details about the expansion of the Medicaid program under the Affordable Care Act and how it will affect you and your family.
That’s according Peggy Cote, the director of community services for Sandoval County, who explained what residents should expect at an upcoming series of question-and-answer sessions that will be held all over the county.
The move to New Mexico’s new Medicaid program, now called Centennial Care, is Jan. 1, but those who are eligible can sign up for benefits starting in October, Cote said.
Representatives from the New Mexico Human Services Department (HSD) will explain how Centennial Care will hold 20 question-and- answer sessions across Sandoval County over about two months, starting with two sessions in Bernalillo on Thursday.
In 2014, expanded Medicaid benefits will be available for adults, age 18 to 64, making 138 percent of the federal poverty level or less.
For a home with just one person, the income cutoff is at $15,856 a year, and for a household of four people, it is $32,499. For a more complete explanation and income guidelines, go to aspe.hhs.gov and click on “Poverty and Income Statistics.”
Even people who make more may still be eligible for Medicaid benefits, Cote said. Currently, in New Mexico, pregnant women and children who live in households making 185 percent of the poverty level are also covered. Women are also covered for two weeks after pregnancy. For a family of four, 185 percent of poverty is $43,567.50 a year.
However, that will not be affected by the changes to Medicaid, which are brought on by the Affordable Care Act and include a new Medicaid enrollment process.
States will be required to use a “streamlined” application or approved alternative application beginning on Oct. 1, according to the HSD website.
New Mexico is seeking approval from the federal Centers for Medicare and Medicaid Services to use an single application for Medicaid, the Children’s Health Insurance Program and other insurance affordability programs, as well as for the Supplemental Nutrition Assistance Program (SNAP), Cash Assistance, and Low-Income Home Energy Assistance (LIHEAP) programs.
Cote also pointed out that there are mental and behavioral health benefits for those who qualify for Medicaid as well.
Those who enroll in Medicaid can choose from four managed care-organizations: Blue Cross Blue Shield of New Mexico; Molina Health Care of New Mexico Inc.; Presbyterian Health Plan Inc.; and United Health Care Community Plan of New Mexico. These four companies have contracts with providers and medical facilities to provide health care services to members.
Cote said county and state employees at the upcoming question and answer sessions will not be able to answer some of the specific questions about the care providers.
“A lot of times, what people want to know is what doctors they can go to or how to access pharmacy services,” she said. ” Those are health plan issues. We just do eligibility.”
For those answers, people who already have a health plan should contact their provider. Those who don’t have a health plan may be best served by making an appointment with their preferred provider.
Cote also noted that government employees will not make recommendations for which service provider people should choose.
She does expect that her department will be working with a lot of uninsured and underinsured residents in the near future, so those who are interested in applying should start doing research sooner, rather than later.
“It’s very exciting for folks that haven’t had health coverage,” she said. “I think this is going to be a busy time.”
To learn about what is required by the state, Sandoval County residents can attend local Centennial Care events.
Representatives from the New Mexico Human Services Department will explain how Centennial Care differs from Medicaid and what patients need to do to ensure proper coverage under the new program.
The first event in the county was Saturday at the Haynes Park Community Center.