Healthcare Assistance Program (HCAP)
Access to health care reduces long term medial 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 residents 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).
Pursuance to NMSA §1978 27-5-6E, the Otero County Healthcare Assistance Fund must comply with the standard of the Health Insurance Portability and Accountability Act (HIPPA).
The Healthcare Assistance Program (HCAP) is the payor of last resort and is a claims-based program. a patient must have received services from one of our contracted providers.
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:
- Elective surgery or procedures
- Private Physician Services in office
- Private Physician contracted with GCRMC (unless billed directly through GCRMC)
- No Physician payments after insurance
- Deductibles and co-payments
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.
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)).
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).
|Annual Income Amount - 300% FPL||Monthly Income||Household Total|
Assets are not to exceed $20,000. Applicant's owned primary residence and lot are not considered in the assets calculation.
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.
Pursuant to NMSA 1978 §27-5-6G, Otero County Healthcare Services has contracted with the following providers for services for qualified patients domiciled within Otero County:
- *Gerald Champion Regional Medical Center (GCRMC)
- 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.
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.
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 if the hospital services do not occur at GCRMC.
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 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.