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June 26, 2013

New Mexico Implements a Hybrid Health Insurance Marketplace

New Mexico will be implementing a “hybrid” health insurance marketplace, in which the state will enroll businesses onto the Small Business Health Options Program SHOP) while the federal government will enroll individuals on the federally facilitated marketplace. The Centers for Medicaid and Medicare Services (CMS) recently announced its intention to propose a hybrid option for establishing the health insurance marketplaces through proposed rulemaking. The new “hybrid” concept is only applicable for the 16 states (CA, CO, CT, DC, HI, ID, MA, MD, MN, NM, NV, NY, RI, VT, WA) that received conditional approval earlier in the year to establish a state health insurance marketplace. Other states must wait until 2015 to request approval for the hybrid arrangement through submission of a blueprint that will be specially developed. States that are trying to establish their own state based health insurance marketplaces are feeling the pressure of the looming October 1, 2013 deadline for open enrollment, and many are concerned that they will not be ready.

New Mexico announced that the state does not have enough time to implement a computer system for enrolling individuals, and New Mexico feels it is better equipped to enroll businesses onto SHOP, which is a smaller scale.  New Mexico plans to handle some of the responsibilities required for enrolling individuals on the health insurance marketplaces, such as providing outreach and education, determining health benefit plans, and regulating prices charged by private insurers for plans.