January 1, 2014 Affordable Care Act (ACA) Categories:

COE / COE Description / Federal Poverty Level (FPL)
100 / Adult Group Ages 19-64 / 0% up to 133% FPL
200 / Parent/Caretaker Relative / 0% up to 47% FPL
300 / Full Medicaid for Pregnant Women / 0% up to 138% FPL
301 / Pregnancy-Related Services Only / 138% up to 250% FPL
400 / Children Ages 0-5 / 0% up to 200% FPL
401 / Children Ages 6-18 / 0% up to 138% FPL
402 / Children Ages 0-5 / 200% up to 240% FPL
403 / Children Ages 6-18 / 138% up to 190% FPL
420 / CHIP Children Ages 0-5 / 240% up to 300% FPL
421 / CHIP Children Ages 6-18 / 190% up to 240% FPL
A 5% income disregard is applied to COEs in some instances

Affordable Care Act Impact on Existing Categories:

COE / COE Description / Change
027 / Four months transitional Medicaid / COE 027 was provided to individuals due to loss of COE 072 due to increased child or spousal support. COE 027 is now provided due to loss of COE 200 due to increased spousal support only. Child support is no longer countable under ACA rules.
028 / 12 months transitional Medicaid / COE 028 was provided to individuals due to loss of COE 072 due to increased earnings. COE 028 is now provided due to loss of COE 200 due to increased earnings.
029 / Family Planning / Family planning individuals were transitioned to an ACA category. Those not eligible for an ACA category remain on family planning and are referred to the Exchange for minimum essential coverage.
030 / Full Medicaid Pregnant
Women / COE 030 is replaced by the new COE 300 category. COE 030 was around 25% FPL. The new COE 300 provides full Medicaid up to 138% FPL.
031 / Newborns / No changes.
032
036
071/1 / Children’s Medicaid / COE 032, 036, and 071/1 children will be replaced by the new 400 series categories for children at recertification over the next year.
035 / Pregnancy-Related Only / COE 035 is replaced by COE 300 and COE 301. More women will qualify for full Medicaid for pregnant women due to the increase in FPL.
062
063
064 / State Coverage Insurance (SCI) / SCI ended 12/31/2013. Individuals were transitioned to an ACA category or placed on family planning and referred to the Exchange for minimum essential coverage.
072 / Family Medicaid / COE 072 will be replaced by COE 200 as individuals currently on COE 072 recertify over the next year. COE 200 is for adults only. Children on COE 072 will transition to children’s Medicaid at recertification.
085 / Emergency Medical Services for Aliens (EMSA) / No changes. EMSA is available for all individuals eligible for any of the new ACA categories.

Non Modified Adjusted Gross Income (MAGI) Categories/No Changes:

COE / COE Description
001, 003, 004 / Supplemental Security Income (SSI)
041 / QMB over age 65
042 / QI1s
044 / QMB under age 65
045 / SLIMB
049/059 / Refugee Medicaid
052 / Breast and Cervical Cancer
074 / Working Disabled Individuals (WDI)
081, 083, 084 / Institutional Care Medicaid
090, 091, 092, 093, 094, 095, 096 / Home and Community-Based Waivers

CYFD Categories:

COE / COE Description
017 / Adoption Subsidy established by other states
037 / Adoption Subsidy in state
047 / Adoption Subsidy placed out of NM
066 / Foster Care
086 / Foster Care with state other than NM

Recertification:

Medicaid recipients on Medicaid prior to January 1, 2014, who have a recertification due from January 1, 2014 through March 31, 2014, will be evaluated for another twelve month recertification under their existing category (COE 032, 036, 071/1 and 072) and not an ACA category. An ACA category evaluation would only occur if the recipients were found ineligible under their existing category at recertification.

Medicaid recipients on Medicaid prior to January 1, 2014, who have a recertification due April 1, 2014 or after, will be evaluated for eligibility for an ACA category and not under their existing category.