N.M. Stat. § 59A-18-31
Accident and health policy or certificate provisions
relating to individuals who are eligible for medical benefits under
the medicaid program.
A. Each individual or group policy or certificate of accident or health insurance that
is delivered, issued for delivery or renewed in this state shall include provisions that
require benefits paid on behalf of a child or other insured person under the policy or
certificate to be paid to the human services department [health care authority
department] when:
(1)
the human services department [health care authority department] has
paid or is paying benefits on behalf of the child or other insured person under the state's
medicaid program pursuant to Title XIX of the federal Social Security Act, 42 U.S.C.
1396, et seq.;
(2)
payment for the services in question has been made by the human
services department [health care authority department] to the medicaid provider; and
(3)
the insurer is notified that the insured individual receives benefits under
the medicaid program and that benefits must be paid directly to the human services
department [health care authority department].
B. The notice required under Paragraph (3) of Subsection A of this section may be
accomplished through an attachment to the claim by the human services department
[health care authority department] for insurance benefits when the claim is first
submitted by the human services department [health care authority department] to the
insurer.
C. Notwithstanding any other provisions of law, checks in payment for claims
pursuant to any individual or group policy or certificate of accident or health insurance
for health care services provided to insured individuals who are also eligible for benefits
under the medicaid program and provided by medical providers qualified to participate
under the policy or certificate shall be made payable to the provider. The insurer may be
notified that the insured individual is eligible for medicaid benefits through an
attachment to the claim by the provider for insurance benefits when the claim is first
submitted by the provider to the insurer.
D. No individual or group accident or health policy or certificate delivered, issued for
delivery or renewed in this state on or after the effective date of this section shall
contain any provision denying or limiting insurance benefits because services are
rendered to an insured who is eligible for or who has received medical assistance under
the medicaid program of this state.
E. To the extent that payment for covered expenses has been made pursuant to the
state medicaid program for health care items or services furnished to an individual, in
any case where an insurer has a legal liability to make payments, the state is
considered to have acquired the rights of the individual to payment by the insurer for
those health care items or services.