San Juan County explains health care assistance program for uninsured residents
Uninsured residents can tap San Juan County help for certain bills, but HCAP only covers designated providers and strict deadlines can shut the door fast.
San Juan County residents with unpaid hospital or clinic bills have a county-backed path to help through HCAP, but it only covers designated providers. Applicants must move quickly, meet local residency and income rules, and first seek Medicaid before the county will step in.
How HCAP works
San Juan County’s Health Care Assistance Program is built into county government, not run as a private charity. The Board of County Commissioners sits as the Indigent Hospital and County Health Care Board, and the program’s mission is to improve quality of life by identifying and addressing the health care needs of uninsured residents.
HCAP is a public health tool aimed at promoting health and well-being through programs that improve access to care in the community.
What bills HCAP can help pay
HCAP assistance can cover medical, dental, prescription, mental health and behavioral health bills.
The program does not cover every bill in town. HCAP only works with designated providers, specifically San Juan Regional Medical Center and Presbyterian Medical Services, including the Farmington Community Health Center. Those providers screen applicants, so the first gate is on the provider side of the system, not at the county commission chamber.
Who can qualify
HCAP has several eligibility rules that can become barriers for uninsured residents if they do not act fast. Applicants must apply within 180 days of receiving the bill, must have lived in San Juan County for at least 90 days, and must meet income and personal-asset limits set by the county.
There is also a Medicaid requirement. Applicants must have applied for Medicaid and not qualified, though staff can help with those forms.
- the bill must be from a designated provider
- the application must be filed within 180 days
- the applicant must have lived in San Juan County for at least 90 days
- income and personal assets must fall within county limits
- Medicaid must already have been pursued and denied
For residents trying to figure out whether to apply, the practical checklist is simple:
Where residents apply
Applicants start at San Juan Regional Medical Center or Presbyterian Medical Services, which means the application process begins where many residents already interact with the health system. That setup can help people who are already overwhelmed by billing, but it can also create a hurdle for uninsured residents who do not know which office to contact first.
San Juan Regional Medical Center is the region’s largest health care provider in the Four Corners area, and Presbyterian Medical Services provides health care, children’s services and behavioral health services in San Juan County.
Why the program matters now
A 2024 San Juan County needs assessment found residents face major barriers to accessing care, and a 2023 Georgetown University report put Medicaid enrollment at about 40.4% of county residents. That leaves a large slice of the county depending on a patchwork of insurance, county help and charity care when medical bills arrive.
The financial pressure on uninsured people is steep. A 2022 KRQE report found uninsured New Mexicans can be charged up to ten times more than insured patients for the same medical treatments. In that setting, a single bill from the wrong provider, or a late application, can turn into long-term debt.
HCAP also sits alongside other local health-system pressures. San Juan Regional Medical Center has been developing an internal medicine residency program, and Chief Medical Officer Dr. Robert Underwood said the first residents were expected in two years.
The legal and funding structure behind HCAP
New Mexico law makes counties responsible for ambulance transportation, hospital care or health care for indigent patients domiciled in the county, and it also ties counties to support for the state Medicaid program. Every county must file an annual indigent health care report by October 1, and that report has to spell out eligibility criteria, services, restrictions, reimbursement conditions and revenue sources.
The state also created the Safety Net Care Pool, a treasury fund administered by the New Mexico Health Care Authority and used to make payments to qualifying hospitals. In practice, that makes HCAP part of a larger state-county financing system rather than a stand-alone local program.
A 2014 legislative presentation on San Juan County’s indigent health care program showed the county historically used a second one-eighth gross receipts tax increment to fund indigent care. The same presentation showed the old Sole Community Provider program had been replaced by the Safety Net Care Pool, a shift that reduced the county’s direct relationship between what it paid in and what local hospitals received back.
What changed in 2025
The San Juan County Commission approved updates to its health care assistance guidelines on April 1, 2025. The changes streamlined financial procedures and reaffirmed support for indigent medical care, showing that HCAP is not a frozen policy but a program the county continues to adjust.
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