N.M. Stat. § 27-2-23 (2026)

A. The income support division of the department shall make reasonable efforts to
ascertain any legal liability of third parties who are or may be liable to pay all or part of
the medical cost of injury, disease or disability of an applicant for or recipient of medical
assistance pursuant to the provisions of Chapter 27 NMSA 1978.
    B. When the department makes medical assistance payments on behalf of a
recipient, the department is subrogated to any right of the recipient against a third party
for recovery of medical expenses to the extent that the department has made payment.

   C. Health insurers, including self-insured plans, group health plans, service benefit
plans, managed care organizations, pharmacy benefit managers or other parties, that
are, by statute, contract or agreement, legally responsible for payment of a claim for a
health care item or service, as a condition of doing business with New Mexico, shall:

        (1)    provide, with respect to individuals who are eligible for or are provided
medical assistance under the medicaid program, upon the request of the state,
information to determine during what period the individual, the individual's spouse or the
individual's dependents may be, or may have been, covered by a health insurer and the
nature of the coverage provided by the health insurer, including the name, address and
identifying number of the plan;

       (2)     accept New Mexico's right of recovery and the assignment to New Mexico
of any right of an individual or other entity to payment from the party for an item or
service for which payment has been made under the medicaid program;

       (3)     respond to any inquiry by New Mexico regarding a claim for payment for
any health care item or service that is submitted no later than three years after the date
of the provision of such health care item or service; and

        (4)    agree not to deny a claim submitted by New Mexico solely on the basis of
the date of submission of the claim by the provider, the type of the claim form or a
failure to present proper documentation at the point-of-sale that is the basis of the claim,
if:

          (a) the claim is submitted by New Mexico within the three-year period
beginning on the date on which the item or service was furnished; and

        (b) any action by New Mexico to enforce its rights with respect to such claim
is commenced within six years of New Mexico's submission of such claim.

   D. Nothing in this section shall be construed to preclude the application of common
law principles in determining equitable reimbursement from any third-party source for
New Mexico or a health insurer, including self-insured plans, group health plans, service
benefit plans, managed care organizations, pharmacy benefit managers or other
parties.

History: 1953 Comp., § 13-1-20.1, enacted by Laws 1969, ch. 232, § 1; 2007, ch. 246,
§ 1.

                                     ANNOTATIONS
Cross references. — For medical assistance programs generally, see 27-2-12 NMSA
1978.

For liability for repayment of public assistance, see 27-2-28 NMSA 1978.

The 2007 amendment, effective June 15, 2007, added Subsections C and D.

Department's subrogation is right of recovery subject to equitable principles. White v.
Sutherland, 1978-NMCA-076, 92 N.M. 187, 585 P.2d 331, cert. denied, 92 N.M. 79, 582
P.2d 1292.

Circumstances held not to justify complete reimbursement. — Although this
section shows an intent that medical assistance payments be repaid, it says nothing as
to 100 percent repayment regardless of the facts. Where the settlement proceeds in a
medical malpractice suit would constitute but a small fraction of a medical assistance
recipient's actual damages and any money which the department might recover would
be due to a very large extent to the energies expended in pursuing the malpractice
claim by the recipient and her attorneys, who were charging a contingent fee of 25
percent of the recovery, the department was not equitably entitled to complete
reimbursement for its payments to the recipient. White v. Sutherland, 1978-NMCA-076,
92 N.M. 187, 585 P.2d 331, cert. denied, 92 N.M. 79, 582 P.2d 1292.

Equitable reduction. — Subsection G of Section 27-2-28 NMSA 1978, providing for
assignment to the department of a recipient's right to recovery against a tortfeasor, as
reconciled with this section and federal law, does not convey the right to full
reimbursement in every case, but permits an equitable reduction. Kahrs v. Sanchez,
1998-NMCA-037, 125 N.M. 1, 956 P.2d 132, cert. denied, 124 N.M. 589, 953 P.2d
1087.