MEDICAID & AFFORDABLE CARE ACT ENROLLMENT

Eligibility & Community Outreach Workers (ECOs) assist families with a variety of services offered.

    1. Certified PE/MOSAA Determiners assist Medicaid recipients with the Medicaid application process for the following categories:
       
      1. Coverage for Adults: Alternative benefit coverage, Income must be under 133% FPL, No resource standard and No Medicare.
      2. Pregnancy Service Only: Pregnancy Services, Income must be under 250% FPL, 2 months post partum, No resource standard.
      3. Coverage for Pregnant Women: Full coverage for Pregnant Women, Full Medicaid, Income must be under Standard of Need, 2 months post partum, No resource standard.
      4. Parent Caretaker: Full Medicaid, Income must be under fixed standard, Household must have a relative child in household, No resource standard.
      5. Medicaid for Children: Children under 19 years of age, Income under the following FPL: Children ages 0-5---0% -240%, Children ages 6-18---0%-190%, No resource Standard, Eligible even if children have health insurance or have voluntarily dropped insurance.
      6. Children's Health Insurance Program (CHIP): Full Medicaid, Income under the following FPL: Children ages 0-5---240%-300%, Children under ages 6-18---190%- 240%, Do NOT, have existing insurance, Co-payments on doctor visits, prescriptions, etc, Native American children do not make co-payments.

      The recipient may qualify for anyone of the New Mexico Affordable Care Eligibility Category groups if the recipient is at or below the Affordable Care Medicaid Programs.

    2. The ECO's are also certified Health Care Guides (HCG's) that are available to help educate consumers on the Affordable Care Act and the New Mexico Health Insurance Exchange. They educate consumers about their insurance options and assist with enrolling during open enrollment.
       
    3. The ECO’s are also available to answer questions about the Sandoval County Health Care Assistance Program (Indigent Program) and assist potential applicant’s review required documentation to determine eligibility
       
    4. The ECOs provide families and individuals with needed referrals such as those listed below:
    5. Other Services offered at the Health Commons
      • General Information for the Health Commons call (505) 867-2291 Ext. 1725
      NM Department of Health DOH:
      • Women, Infant & Children (WIC) (505) 867-2291 Ext. 1717
      • NM Department of Health Family Planning (505) 867-2291 Ext. 1707
      • Children Medical Services (505) 867-2291 Ext. 1713
      Family Dental Care
      • PMS Sandoval County Health Commons Dental Services (505) 404-5894
      Community Health Program
      • Sandoval County Medicaid Enrollment (505) 867-2291 Ext. 1725
      • Sandoval County Affordable Care Act Enrollment (505) 867-2291 Ext. 1725
      • Sandoval Health Care Assistance Program (Indigent Program) (505) 867-2291 Ext. 1725