HEALTH CARE ASSISTANCE PROGRAM

Sandoval County Health Care Assistance Program (HCAP)

1500 Idalia Road, Building B
Bernalillo, NM 87004

Hours of Operation:
Monday through Friday from 8 a.m. to 5 p.m.
Closed from 12:00 - 1:00 for lunch

What is the Sandoval County Health Care Assistance Program?

The Sandoval County Health Care Assistance Program (HCAP) is a program that provides health care services to indigent patients who are residents of Sandoval County and can show proof that they have resided in the County for 90 consecutive days. The patient may qualify for health care services provided through the HCAP if the patient is at or below the 185% of the 2013 Federal Poverty Guidelines.

The health care services available to eligible patients are as follows:

Ambulance
Inpatient Hospital Services - No Emergency Room Visits
Outpatient Behavioral Health Services
Outpatient Primary Care Services
Pharmacy - Prescriptions and Medications per Medicaid formulary. Excluded are all Schedule 2 medications and special $5.00 prescriptions
Cremations

Individuals who meet all eligibility criteria are eligible for the fiscal year which is July 1 through June 30. Individuals must apply each fiscal year to determine their eligibility for HCAP. All payments for services covered under HCAP are paid to the provider not the individual. HCAP pays only a portion of the cost not the billed amount and may change the amount paid from one fiscal year to the next based on funding. Payments are never made to the patient only to the service provider. Please see the limitations listed below:

Service Type Maximum Per Claim Maximum Per Year
Ambulance - 75% of Tariff Rate or $400 whichever is less (per claim.) $400 $800
Inpatient Hospital - 75% of Billed Charges or $1,750 whichever is less (per claim). No emergency room visits are covered. $1,750 $3,500
Outpatient Behavioral Health $150 $500
Outpatient Primary Care - (Includes Lab Test) $150 $500
Pharmacy - Prescriptions and Medications per Medicaid Formulary. Excluded are all Schedule 2 medications and special $4.00 prescriptions $900 $900
Indigent Burial Expense/Cremations $600 $600

Indigent patients may access health care services by designated providers ("Providers"). Providers must be licensed by the State of New Mexico. The services include in-state ambulance, hospitals licensed by the New Mexico Department of Health, licensed non-profit out-patient mental health and primary care, licensed dental providers, pharmacies licensed by the New Mexico Board of Pharmacy and burial services. Not all Providers are eligible to participate in the Health Care Assistance Program, please see below.


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