Doña Ana County leaders consider pilot to cover premiums and out‑of‑pocket costs for high‑need residents
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Summary
County staff proposed expanding the Healthcare Assistance Program to include premium assistance and limited out‑of‑pocket coverage for people with chronic or catastrophic illnesses, recommending a narrow pilot using an existing $200,000 allocation and a medical‑director review process; commissioners asked for refined eligibility language and SOPs before adoption.
Doña Ana County staff on Feb. 3 proposed adding premium assistance and limited out‑of‑pocket coverage to the county’s Healthcare Assistance Program (HCAHPS) and recommended launching the change as a narrowly-targeted pilot.
Staff presented a draft resolution and operational options for commissioners, saying the county could pay a beneficiary’s insurance premium (or remaining premium above an affordability threshold) and certain in‑network out‑of‑pocket costs. "The county has the ability to make decisions around premium and other out of pocket costs related to helping people gain coverage," Jamie Michael, Health and Human Services Department, told the commission.
Why it matters: HCAHPS is a statutorily authorized county program that counties design locally. Commissioners weigh preserving core services — primary care, dental, behavioral health, limited orthopedics/physical therapy and end‑of‑life care — while testing whether premium assistance helps people obtain ongoing specialty care and avoids costly emergency care.
What staff proposed: Michael recommended using the New Mexico Medical Insurance Pool as a single benchmark to test insurance affordability and eligibility, applying an affordability threshold so the county covers premium costs above that level. In a model scenario presented to the board, an individual with $2,000 in monthly income would pay up to 8% of income toward premiums ($160), with the county covering the remainder. Michael noted the county could instead index that percentage to the cost‑of‑living adjustment if commissioners prefer.
Pilot design and budget: Vice Chair Geminis urged starting the pilot with a previously approved $200,000 allocation and using it as a cap while the county learns demand and costs. "If we had this $200,000 that was before and nobody actually has tapped into it, I figured that this would be great," Geminis said. Staff said the $200,000 had been budgeted (with a historic $50,000 per‑person cap tied to a cancer‑care contract) but had not yet been drawn down. Michael advised a ramp‑up period and estimated at least four months from passage to operational launch, with a reasonable target start of July 1.
Eligibility and decision process: Staff recommended limiting premium assistance to county residents who meet HCAHPS income/asset rules and to people with diagnosed chronic or catastrophic illnesses that require specialty care not available through existing HCAHPS contracts. To determine medical necessity for premium assistance, staff proposed contracting with an external medical director or small clinical team to review referrals from primary‑care providers. "The suggestion is just that it is not the medical provider at the clinic and obviously not county staff," Michael said when describing the review role.
Commissioner concerns and next steps: Commissioners raised several operational questions — how to define and verify income for people without tax returns, whether the county should remain the payer of last resort, and how Medicare or other underinsured people should be treated. Staff agreed to compare other county practices, refine language (including potential Medicare exceptions), and bring an updated resolution and an operational SOP draft to the commission in early March. Michael stressed the recommendation to begin narrowly as a pilot to collect data before expanding.
Budget context: Staff reported FY26 HCAHPS revenues a little over $11 million, with $5.1 million sent to the state safety‑net care pool and about $6 million in contracted services. Staff also noted a projected multi‑year increase in gross receipts tax revenue tied to a large construction project (Project Jupiter) could materially increase funds available to the program in the coming years.
The commission did not take a final vote; staff left with direction to return with clarified eligibility, options for the affordability threshold (fixed 8% or a COLA‑indexed figure), SOP language to operationalize premium and out‑of‑pocket assistance, and outreach/contract recommendations.
