New Mexico CHIP: Children's Health Insurance Program

Last verified: June 2026

Informational overview of New Mexico CHIP

For current eligibility thresholds and enrollment, visit https://www.hsd.state.nm.us/mad. CHIP and Medicaid applications are processed together in most states — apply once and both programs are considered.

New Mexico's CHIP program extends child coverage above the Medicaid limit of 240% FPL — delivered through the same Turquoise Care MCOs

New Mexico administers a Children's Health Insurance Program (CHIP) under Title XXI of the Social Security Act. New Mexico Medicaid already covers children up to 240% FPL — among the highest Medicaid child thresholds in the country. CHIP covers children whose family income falls above 240% FPL but within the CHIP upper limit. The same YesNM application at yes.nm.gov covers both Medicaid and CHIP for children. Contact HCA at 1-800-283-4465 with questions.

Who qualifies for New Mexico CHIP?

New Mexico CHIP covers children under 19 whose family income is above the Medicaid threshold for children (240% FPL) but within CHIP limits. Because New Mexico's children's Medicaid limit is already so high, CHIP in New Mexico covers a narrower income band than in most states. Many children who would qualify for CHIP in other states qualify for full Medicaid in New Mexico.

Child must be under age 19
Family income above 240% FPL (New Mexico children's Medicaid limit) and within CHIP income limits
Child must be a New Mexico resident
Child must be a U.S. citizen or lawfully present immigrant
Child must be uninsured or have lost coverage
Child must not have access to affordable employer-sponsored health insurance
No asset test

Source: New Mexico HCA at hca.nm.gov; CMS CHIP program requirements. For current upper income limits, call HCA at 1-800-283-4465 or visit yes.nm.gov. Limits are updated annually with HHS poverty guidelines.

What New Mexico CHIP covers

New Mexico CHIP delivers coverage through the Turquoise Care MCOs (BCBSNM, Molina Healthcare NM, Presbyterian Health Plan, and UHC Community Plan NM). Per HCA, the CHIP benefit package is comprehensive and comparable to Medicaid for children. Covered services include:

Well-child and preventive care visits
Primary care and specialist visits
Hospital care — inpatient and outpatient
Prescription drugs
Emergency and urgent care
Dental care (comprehensive)
Vision care — exams and corrective lenses
Mental health and behavioral health services
Physical, occupational, and speech therapy when medically necessary
Lab tests and imaging

Cost sharing for New Mexico CHIP

Federal CHIP rules cap total annual family cost sharing at 5% of income. Families at or below 150% FPL cannot be charged premiums under federal law (42 USC 1397cc). New Mexico's CHIP premiums, if any, apply to families in the higher CHIP income range. Because New Mexico's Medicaid covers children up to 240% FPL at no cost, families in CHIP are relatively high-income compared to Medicaid-eligible families.

Contact HCA at 1-800-283-4465 or visit yes.nm.gov for current premium and copayment amounts. Premiums are tied to family income and are substantially lower than private insurance costs.

Why New Mexico's child Medicaid limit makes CHIP less necessary here

New Mexico covers children in Medicaid up to 240% FPL — well above the national average of around 200%. This means most children who qualify for CHIP in other states qualify for full Medicaid in New Mexico instead. Full Medicaid generally has no premiums and no cost sharing for children, and it's the broader entitlement program. New Mexico's high Medicaid limit reflects a deliberate policy choice: per CMS enrollment data, approximately 40% of New Mexico's population is enrolled in Medicaid, the highest rate in the country.

If your child's income is between 200% and 240% FPL, they qualify for Medicaid — not CHIP — in New Mexico. CHIP coverage applies only above 240% FPL.

What CHIP is

CHIP — the Children's Health Insurance Program — is a federal-state partnership that covers children in families whose income is too high for Medicaid but too low to afford private insurance. Congress created CHIP in 1997 under Title XXI of the Social Security Act. Like Medicaid, CHIP is jointly funded by the federal government and each state, and each state administers its own program.

CHIP serves children up to age 19 (some states cover to 21 for children in foster care). It is not available to adults — CHIP is specifically designed to address the coverage gap for children in working families.

Nationally, CHIP covers approximately 7 million children, according to CMS data. In most states, it is a seamless part of the broader children's health coverage system alongside Medicaid.

What CHIP covers

Federal law requires CHIP to cover certain core benefits. States may add to the list. Standard CHIP coverage includes:

Doctor visits, including well-child checkups and sick visits
Hospital care — inpatient and outpatient
Emergency room and urgent care services
Prescription drug coverage
Mental health and substance use disorder services
Dental care — preventive and restorative
Vision care, including eye exams and glasses
Laboratory and imaging services
Physical, occupational, and speech therapy
Medical equipment, such as wheelchairs or hearing aids when medically necessary

How to apply for New Mexico CHIP

Apply through New Mexico Medicaid — the same application covers both Medicaid and CHIP. Online applications are typically fastest and allow document uploads. You can also apply by phone or in person at a local eligibility office.

See the how to apply page for the complete application process, required documents, and what to expect during review.

CHIP and Medicaid income ranges overlap — apply regardless

If you're not sure whether your child qualifies for Medicaid or CHIP, apply anyway. The eligibility system determines which program applies based on your income. A child who earns out of Medicaid may qualify for CHIP, and vice versa. Don't let uncertainty about which program applies prevent you from applying.