In 2009, a woman came to our office who had been referred to us by a divorce attorney. She was a mother whose 6 year old son was born with a chromosomal defect. The family is an honest hard working family. Dad worked in construction and mom had recently taken a part time job as a home health aide. Neither parent had health insurance. She had been to see the divorce attorney to see if getting divorced would be a way to get her son health insurance coverage!
Their two children had qualified for children’s Medicaid because of the family’s low income. The son had had several surgeries since birth and was seen regularly by specialists in the Presbyterian Health Care system. When this family filed their 2008 annual income tax returns, Medicaid ruled that the part-time income of mom resulted in the family having too much income for Medicaid coverage for the children.
So they applied for coverage under New MexiKids, the Children’s Health Insurance Program (CHIP) for New Mexico, available to low income families who have too much income for Medicaid. The healthier child was insured, but Presbyterian Health Care denied coverage for the son because he had a pre-existing condition. The denial was sustained on an appeal, even though the lack of coverage may have been life threatening.
On September 23, 2010, a provision of the new Patient Protection and Affordable Care Act, which became law on March 23, 2010, went into effect. Health insurance companies are no longer allowed to deny coverage to children who have pre-existing conditions.
In 2014, health insurers will not be able to deny coverage to ANYONE who has a pre-existing condition. Until then, for adults who have been denied coverage or kicked off coverage because they got sick, New Mexico has two high risk insurance pools that are available until no longer needed in 2014. You can access them at http://www.nmmip.org/hrp1/.