Medicaid Changes

WHAT YOU NEED TO KNOW

Federal Medicaid rules are changing. If you are a Medicaid member, it is very important to keep your address and contact information up to date and respond immediately to all notices sent by HCA. When these changes begin in New Mexico on January 1, 2027, many adults who receive Medicaid will need to meet work requirements by completing 80 activity hours in a month and report them when they renew, unless they qualify for an exemption.

THE KEY CHANGES

• Many adults who receive Medicaid will need to complete 80 activity hours in a month and report them when they renew unless they qualify for an exemption.
• Those applying for Medicaid will need to complete 80 activity hours during the month before they apply.
• Activity hours may include work, community service, a qualifying work program, school, or career training at least half-time, or other approved activity. Members can combine activities to total 80 activity hours.
• Many Medicaid members will have to renew their coverage every six months.
• Some lawfully-residing immigrants who are currently eligibile for Medicaid will no longer be covered.
• If HCA cannot verify your activity hours, you will get a notice and time to respond before your coverage ends.
• Keeping your address updated and responding quickly to notices from HCA will be important to help prevent loss of Medicaid benefits.

WHO IT IMPACTS

Starting Jan. 1, 2027, new rule will apply to some Medicaid members ages 19 to 64. These changes do not apply to pregnant people, those who are already on Medicare Part A or B, or those eligible under other Medicaid categories (like people with disabilities, older adults 65+, or those caring for children under the age of 14) or those who qualify for another exemption.

Many adults may already be exempt from activity hours. This may include people who are

• Parent, guardian, caretaker relative or family caregiver of a dependent child under the age of 14 or a disabled individual
• Pregnant women or individuals entitle to postpartum medical assistance
• Entitled to Medicare Part A or enrolled in Medicare Part B
• Foster youth and former foster youth ages 18 up to 26
• American Indian / Alaska Natives
• Veterans with disability rated as total
• Medically frail individuals (blindness or disability, substance abuse disorder, mental disorder, significant physical or intellectual disability)
• Individuals who are participating in a substance use disorder or alcohol use disorder treatment program
• Individuals who are already in compliance with the work requirements under the TANF program or SNAP
• Individuals who are incarcerated or recently released from incarceration within the past 90 days
• Hospitalized or living in a nursing home or similar facility. This exemption must be requested by the individual.
• Individuals having to travel outside their community to receive medical services necessary to treat a serious or complex health condition that are not available in the community of residence.
• An individual living in a county under a federal emergency declaration OR with a high unemployment rate (85 or 1.5 times the national unemployment rate).

IMMIGRATION CHANGES

Beginning on October 1, 2026 some lawfully-residing immigrants who are currently eligible for Medicaid will no longer be covered.

Only the following immigrants will be covered on Medicaid:

• Legal Permanent Residents (subject to the 5-year waiting period)
• Cuban / Haitian entrants
• COFA Migrants
• Lawfully residing children and pregnant women under the CHIRPA 214 option

New Mexico may be able to continue coverage for immigrants no longer eligible for Medicaid using only state funding.

Emergency Medical Services for Non-Citizens (EMSNC) will still be available.

HOW TO PREPARE FOR CHANGES

• Update your mailing address at YES.NM.GOV using the chat
• Watch for letters, renewal forms, and other notices from HCA
• Check whether activity hours apply to you or whether you qualify for an exemption
• Keep records of activity hours or your exemption
• Respond quickly if HCA asks for information

HOW TO REPORT YOUR ACTIVITY HOURS AND WHY THIS MATTERS

Keep proof of each month’s activity hours or your exemption.

If activity hours apply to you and HCA cannot verify them, you will receive a notice of noncompliance and have 30 calendar days to respond. During that time, you have the opportunity to show that

• You completed your activity hours
• You qualify for an exemption
• The rule does not apply to you

Reporting on time and keeping records can help prevent loss of Medicaid benefits.

WHERE TO GO FOR MORE HELP

• Use the Chat at YES.NM.GOV
• Call 1-800-283-4465
• Visit a local HCA Income Support Division office