[HISTORY: Adopted by the Board of County Commissioners of Doña Ana County 6-8-2010 by Res. No. 2010-53. Amendments noted where applicable.]
ADDITIONAL INFORMATION
The County Manager is authorized to approve all nonmaterial changes to this policy that may be required or recommended in the future. A summary of such administrative clarifications is included at the end of this chapter.
A. 
Doña Ana County is the responsible agency for ambulance transportation, hospital care, and health care of indigent patients domiciled in Doña Ana County. (NMSA § 27-5-2A)
B. 
The law of the State of New Mexico defines indigent patients as persons who can normally support themselves and their dependents on present income and liquid assets available to them but, taking into consideration this income and those assets and their requirement for other necessities of life for themselves and their dependents, are unable to pay the cost of ambulance transportation or medical care, or both. (NMSA § 27-5-4C)
C. 
It is in the best interests of Doña Ana County to ensure that moneys dedicated to the health care of the County's indigent residents are used in accordance with state law and criteria established by the Board of County Commissioners for Doña Ana County.
[Amended 6-28-2016 by Res. No. 2016-46]
Doña Ana County shall be the payer of last resort. Those individuals eligible for any other health coverage shall not be covered by the County's assistance program for the same type of care.
[Amended 9-27-2011 by Ord. No. 235-2011; 6-25-2013 by Res. No. 2013-55; 6-24-2014 by Res. No. 2014-69; 6-28-2016 by Res. No. 2016-46; 6-12-2018 by Res. No. 2018-47; 8-22-2023 by Res. No. 2023-68]
The Board of County Commissioners hereby directs staff to develop policies and procedures consistent with the following:
A. 
Identification: An applicant must provide one of the following forms of photo identification:
(1) 
U.S. Passport;
(2) 
Government-issued ID;
(3) 
School ID;
(4) 
Dependents age 17 and younger, or age 18 and enrolled in high school, may use the parent/guardian declaration of identity in lieu of a photo ID; or
(5) 
Individuals may use the health-care provider declaration of identity in lieu of a photo ID.
B. 
Residency: To qualify for indigent care, an applicant shall reside in Dona Ana County. To establish residency, an applicant shall produce at least one of the following documents:
(1) 
Rental, lease, dorm, or residential agreement;
(2) 
Property tax statement;
(3) 
Residential utility bill;
(4) 
Affidavit from Community of Hope or Gospel Rescue Mission;
(5) 
Current government-issued ID, such as a driver's license;
(6) 
Bank or credit card statement;
(7) 
Pay stub;
(8) 
Local property tax statement;
(9) 
Mortgage statement;
(10) 
Insurance bill, card, or binder.
C. 
Annual income: To qualify for indigent care, an applicant (or parent/guardian) shall not have annual household income that is 50% greater than the per-capita personal income for New Mexico for the most recent year as published by the U.S. Department of Commerce. To establish annual income, the applicant must produce one of the following:
(1) 
Latest federal or state income tax return (for the most recent tax return for the immediate preceding tax year);
(2) 
Calculate based on current monthly income only if applicant is not required to file income taxes;
(3) 
Annual Form SSA-1099 of previous year only if applicant is not required to file income taxes.
D. 
Current income: To establish current income, an applicant shall produce most recent document(s) of any or all of the following:
(1) 
Pay stub or pay voucher from employer;
(2) 
Self-employment record or CRS forms;
(3) 
Personal wage record;
(4) 
Worker's compensation statement;
(5) 
Short-term or long-term disability statement;
(6) 
Retirement income statement;
(7) 
SSA/SSI statement;
(8) 
Student financial aid statement;
(9) 
Temporary Assistance for Needy Families statement;
(10) 
Unemployment benefits statement;
(11) 
Child support or alimony checks or statements;
(12) 
Department of Defense income statement.
E. 
Payer of last resort: If it is determined by the contractor that the individual is not eligible for other coverage, or is excluded from the New Mexico Health Insurance Exchange, the County's Healthcare Assistance will be considered the payer of last resort. The contractor must document one of the following circumstances as part of the enrollment process allowing people to qualify for the County's program:
(1) 
Hardship exemptions:
(a) 
Being homeless.
(b) 
Having been evicted in the previous six months or were facing eviction or foreclosure.
(c) 
Received a shut-off notice from a utility company.
(d) 
Experienced domestic violence.
(e) 
Experienced the death of a close family member.
(f) 
Experienced a fire, flood, or other natural or human-caused disaster that caused substantial damage to their property.
(g) 
Filed for bankruptcy in the last six months.
(h) 
Had medical expenses they could not pay in the last 24 months.
(i) 
Experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member.
(2) 
Other exemptions:
(a) 
Those for whom the premiums for the lowest-priced coverage would cost more than 8% of household income.
(b) 
Those who have been uninsured for less than three months within year due to changes in coverage status.
(c) 
Members of a federally recognized tribe.
(d) 
Members of a recognized health-care sharing ministry.
(e) 
Members of a recognized religious sect with religious objections to insurance, including Social Security and Medicare.
(3) 
Excluded from Health Exchange or other coverage:
(a) 
People who have not worked (and/or whose spouses have not worked) an adequate number of quarters.
(b) 
Legal immigrants who have been in the United States for less than five years.
(c) 
Undocumented immigrants.
(4) 
Exclusions related to immigration status allow people to qualify for the program; however, immigration status will not be documented or retained as part of the enrollment process.
F. 
False/Incorrect information/documentation: If an applicant provides false or incorrect information as to identification/residency/income, the application shall be denied for one year from the date of discovery.
[Amended 9-27-2011 by Ord. No. 235-2011; 6-25-2013 by Res. No. 2013-55; 6-24-2014 by Res. No. 2014-69; 6-28-2016 by Res. No. 2016-46; 6-12-2018 by Res. No. 2018-47; 8-22-2023 by Res. No. 2023-68]
A. 
The County shall contract with health-care providers for the delivery of services. Services included as part of the program are:
(1) 
Primary care;
(2) 
Oral health;
(3) 
Behavioral health;
(4) 
End-of-life;
(5) 
Physical therapy; and
(6) 
Long-COVID treatment.
B. 
Health-care providers with whom the County has contracted for the health care assistance program shall use the County's designated enrollment system to enter data indicating the applicant has satisfied the criteria and provided the documentation in § 52-3 above.
C. 
Once the health-care provider has entered the data based on the appropriate documentation, the enrollment system will issue an approval letter or denial letter on behalf of the Board and contractor.
D. 
Health-care providers with whom the County has contracted for the health care assistance program shall require the following audit analysis:
(1) 
At least once a fiscal year, the health-care provider shall contract with a third-party, professionally licensed audit firm to conduct an alternative assessment of a random and statistically valid representative group of applications to verify compliance with the indigent criteria and documentation thereof.
(2) 
The independent audit firm shall report to the County the findings of the alternative assessment.
(3) 
If the findings indicate an error/noncompliance rate exceeding 2%, the County shall issue a thirty-day cure notice.
(4) 
Once the thirty-day cure notice is issued, the health-care provider shall have its independent audit firm perform another alternative assessment to report limited assurances that the health-care provider's error rate is not exceeding 2%.
E. 
The County's Health and Human Services Department shall continue to pay claims from out-of-County hospitals and the associated physician groups, and air ambulance providers, that provide medically necessary care that is not available through in-County Safety Net Care Pool qualifying hospitals and with whom the County does not have a contract. Those claims that comply with the indigent criteria shall be paid up to a cumulative cap of $50,000 per person, per fiscal year, at 36.1% of the current New Mexico Medicaid rate.
F. 
The County's Health and Human Services Department shall contract with cancer treatment providers in Dona Ana County to provide treatment for patients who qualify. Those claims that comply with the indigent criteria shall be paid up to a cumulative cap of $50,000 per person, per fiscal year, at the rate defined in the contracts, but not to exceed the New Mexico Medicaid rate.
[Added 5-27-2014 by Ord. No. 270-2014]
Pursuant to the Indigent Hospital and County Health Care Act, NMSA 1978, § 27-5-2 et seq., as amended, effective July 1, 2014, an amount equal to a gross receipts tax rate of 1/12% applied to the taxable gross receipts reported during the prior fiscal year by persons engaging in business in the County is hereby dedicated to the Safety Net Care Pool fund. For the purposes of this section, the County may use public funds from any existing authorized revenue source of the County.
[Added 5-27-2014 by Ord. No. 270-2014]
By the last day of March, June, September and December of each year for three years, the County shall transfer to the Safety Net Care Pool fund an amount equal to 1/4 of the County's payment that is dedicated under the preceding section.