NMHIX: New Mexico State Health Insurance Exchange 2018 and beyond

NMHIX: New Mexico State Health Insurance Exchange 2018 and beyond

New Mexico (beWellNM) is one of only five states that operates a state-based marketplace on the federal platform, more commonly known as SBM-FP. While this platform has proven to be successful for the last 5 years, the state has recently started looking to revitalize its exchange.

On December 13, 2012, New Mexico submitted a technical implementation letter to CMS to become a state-based health insurance exchange and was approved by CMS on January 3, 2013 to begin to follow and comply with state-based regulations. In an effort to grow into the healthcare era, NMHIX Centennial Care, New Mexico requested an extension on its current 1115 waiver, which is set to expire by December 31, 2018. The waiver, which will renew the state’s Medicaid managed care program, was sent to CMS on December 6, 2017. CMS has acknowledged the letter and confirmed that New Mexico’s extension application has met the requirements.

The waiver, if renewed, will increase enrollment in New Mexico by making improvements such as: continuing to expand to LTSS and maintain the progress achieved in rebalancing efforts, improving integration of behavioral and physical health services, expanding payment reform through value-based purchasing (VBP), simplifying administrative complexities, implementing targeted refinements to eligibility, and more.

Enrollment talk

According to KFF.org, for 2016, the NMHIX’s total population is as follows for each group:

Employer Non-Group Medicaid Medicare Other Public Uninsured Total
740,300 102,800 641,300 281,200 49,500 230,000 2,045,000

From 2017 to 2018 Open Enrollment, enrollment decreased by 8.9% from 54,653 individuals selecting a marketplace plan in 2018 to 49,792 in 2017. Of the 2018 enrollees, 14,221 were new consumers, 25,861 were active re-enrollees and 9,710 were automatic re-enrollees.

Technology and Healthcare

Last month, Softheon demonstrated its state exchange platform to the leaders of the New Mexico exchange and local legislatures. Attendees included BeWell New Mexico’s executive team, Health Action’s executives and specialists from Centro Savila.

Softheon is a leader in health insurance exchange solutions, and Softheon technologies empower state-based marketplaces, Medicaid agencies, healthcare insurers, employers, and brokers to provide a cost-effective member experience with its commercial off-the-shelf (COTS) solutions. Softheon demonstrated:

  • The Exchange consumer experience: With Clarity, members get the tools they need to control and understand their healthcare benefits. Features include: a robust rating engine, the ability to support a wide variety of health and ancillary products, regulatory and compliance requirements, in-depth plan comparison functionality, comprehensive account management capabilities, and a configurable interface for employees and employers.
  • Health exchange enrollment and insurance carrier integration: By leveraging a secure and adaptable integration center with an industry-standard file transfer and validation process, Gateway serves as a powerful solution that protects your system from bad data.
  • Exchange advances analytics: Foundry BI, the solution’s business intelligence component, features configurable, state-of-the-art tools for non-technical users. Providing the ability to “slice and dice” data in near real-time, the reporting and business intelligence suite offers comprehensive analysis of transaction trends and key performance indicators (KPIs), including member demographics, geography, financial data points, and cost comparisons.

To learn more about how Softheon can help state exchanges, contact info@softheon.com.

Sources:

  1. https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/?entry=8029
  2. https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/nm/Centennial-Care/nm-centennial-care-cmpltnss-ltr-121417.pdf
  3. https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/nm/nm-centennial-care-pa.pdf
  4. https://www.abqjournal.com/1175361/state-denies-medicaid-contract-protests.html
  5. https://www.kff.org/other/state-indicator/total-population/?state=NM&dataView=1&selectedRows=%7B%22states%22:%7B%22new-mexico%22:%7B%7D%7D%7D

The views and opinions expressed by the authors on this blog website and those providing comments are theirs alone, and do not reflect the opinions of Softheon. Please direct any questions or comments to marketing@softheon.com. 

Amanda Wolfer

Amanda is the Senior Digital Strategist at Softheon. She works closely with the Marketing team to develop and maintain Softheon’s blog and social media presence. She received her bachelor’s degree in English Language & Literature and Organizational Communication from SUNY New Paltz in New Paltz, New York.

Leave a Reply

Close Menu