Health care affordability plan; rulemaking; reporting

requirements. A. Rules covering the following provisions may be amended as the health care authority determines: (1) providing enhanced premium and cost-sharing assistance to individuals and families for the purchase of qualified health plans on the New Mexico health insurance exchange. In providing this assistance, the health care authority shall develop health care affordability criteria designed to reduce the amount that individuals pay in premiums and out-of-pocket medical expenses for qualified health plans offered on the New Mexico health insurance exchange; and (2) establishing income eligibility parameters for the health care affordability criteria for plan year 2023 and each subsequent calendar year based on available funds. New Mexico residents who qualify shall: (a) have a household income below four hundred percent of the federal poverty level and qualify for the advanced premium tax credit under the federal Patient Protection and Affordable Care Act; or (b) meet all eligibility criteria for the advanced premium tax credit under the federal Patient Protection and Affordable Care Act except for household income requirements. B. If the federal Patient Protection and Affordable Care Act is repealed in full or in part by an act of congress, invalidated by the United States supreme court or administered by the United States department of health and human services in a way that alters eligibility criteria for the advanced premium tax credit in a manner that would cause significant coverage loss for New Mexico residents, the health care authority may promulgate rules to minimize loss of coverage by expanding eligibility to cover individuals at risk of losing coverage due to such changes, subject to available funds. C. The health care authority, in consultation with the superintendent, the New Mexico medical insurance pool, the department of health and stakeholder groups, including health care providers that serve uninsured residents, health insurance carriers and consumer advocacy groups, may update the plan for extending health care coverage access to uninsured New Mexico residents who do not qualify for federal premium assistance or, except by reason of incarceration, qualified health plans, through the New Mexico health insurance exchange. The plan shall include: (1) details about health care benefits; (2) health care affordability criteria designed to reduce the amount that individuals pay in premiums and out-of-pocket medical expenses under the plan and that result in, to the greatest extent possible, health care costs comparable to costs for New Mexico residents for whom assistance is provided under Subsection A of this section; and (3) income eligibility parameters that prioritize eligibility for New Mexico residents with incomes under two hundred percent of the federal poverty level. D. On or before October 31, 2024 and each October 31 thereafter, the health care authority shall submit a report to the legislative finance committee and the legislative health and human services committee that includes: (1) a summary of the affordability criteria implemented pursuant to Subsections A, B and C of this section; (2) the estimated number of uninsured New Mexico residents who enrolled in coverage following implementation of the affordability criteria pursuant to Subsections A, B and C of this section; and (3) the amount in reduced costs and coverage assistance the initiatives provided in the current and previous calendar years by income level, county and coverage source.