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Health Care Services  -

 
Sunday October 22nd, 2017

Healthcare Assistance

Full Healthcare Assistance Application with Information

Purpose

Access to health care reduces long term medical and social costs. An effective health care system must retain local health care efforts, stimulate local innovations for meeting particular health needs, and use existing resources to expand health care options, especially for those citizens unable to pay for their own care. Each individual county in the state of New Mexico is responsible for ambulance transportation, hospital care, or the provision of health care to indigent patients domiciled in the respective county, as determined by resolution of the board of county commissioners, in addition to providing support for the state's Medicaid program. (NMSA 1978 §27-5-2A).

Pursuant to NMSA 1978 §27-5-6E, the Otero County Health Care Assistance Fund must comply with the standards of the Health Insurance Portability and Accountability Act (HIPPA).

The Healthcare Service program previously known as Indigent Fund is the payer of "last resort" and is a claims-based program. A patient must have received services from one of our contracted providers.

Contracted Providers

Pursuant to NMSA 1978 §27-5-6G, Otero County Health Care Services has contracted with the following providers for services for qualified patients domiciled within Otero County:

*Gerald Champion Regional Medical Center (GCRMC)
Presbyterian Hospital, Albuquerque, NM - Call 505-841-1406 for information about financial assistance.
Presbyterian Medical Services, Tularosa, NM
Presbyterian Medical Services, Alamogordo, NM
Presbyterian Medical Services, Chaparral, NM
Sacramento Mountain Medical, Cloudcroft, NM
Memorial Medical Center, Las Cruces, NM

*Prior to application for assistance from Healthcare Services please go to GCRMC's website to download their Assistance Application form. GCRMC is the county's Safety Net Care Pool Provider. Pursuant to NMSA 1978 §27-5-11(B), GCRMC must provide financial assistance.

Clinics:
Primary preventive care is generally covered at the clinic site and bills should be at least fifty dollars to apply for assistance. If qualified under residency and income guideline you may be eligible for one year's approval status for assistance.

Hospital Services:
Services such as emergency room visits, inpatient services, and out-patient services require an application or re-certification depending on status of the itemized bill from the hospital. Bill must be at least $350.00 if the hospital services do not occur at GCRMC.

Diagnostic Tests:
All diagnostic tests done at the hospital are covered as long as they are part of the itemized bill from the contracted hospital.

Ambulance bills:
Ambulance bills from American Medical Response (AMR) are covered but you need to request assistance. We do not automatically file a claim for you. It is not part of the hospital bills.

Program Details

Claim Limits

The maximum amount per assistance claim is $10,000, with an annual cap of $30,000 for medical expenses. The maximum amount for ambulance assistance is $500 per year.(§104-13(D)) All claims for assistance will be denied when caps are reached until the next fiscal year.

Program will not pay:

Please do not hesitate to apply for assistance. We will look at each individual and unique circumstance to assist in any way as allowed by State Statute and County Ordinance.

Time Limits for filling:

Pursuant to Otero County Ordinance §140-12(A), you have 75 days from the date of discharge or once a bill has occurred with any of the contracted medical providers to file for assistance. You have 30 days to provide any and all paper work required and requested. Time may be extended upon request and approval for up to one year for paper work needed to complete the process of your claim(s) (§140-12(F)(2)(b)).

Program Qualifications

Income Limits:

Income limits change annually as the State of New Mexico per capita income is adjusted per NMSA 1978 §27-5-4G. To remain in compliance, Otero County Healthcare Services uses the Federal Poverty Limits (FPL)

Income Amount - 300% FPL Household Total
$35,640 Household of 1
$48,060 Household of 2
$60,480 Household of 3
$72,900 Household of 4
$85,320 Household of 5
$97,740 Household of 6

Resource Limits:

Assets are not to exceed $20,000. Applicant's owned primary residence and lot are not considered in the assets calculation.

Residency

Pursuant to the Otero County Ordinance §140-5, an applicant must be domiciled in Otero County for a minimum of 90 days preceding the provision of medical services.