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New Mexico has taken several important steps to implement the ACA by, for example, designating a central state office of health reform to coordinate its efforts across agencies as well as working with federal officials and state health care stakeholders. Although it has yet to pass legislation or otherwise establish the legal authority to authorize an exchange, New Mexico has signaled that it intends to move forward in implementing an exchange. In addition, the state is pursuing some of the ACA Medicaid demonstration opportunities including health homes and the capitated integrated model for dual eligibles as well as using federal funds to help overhaul its Medicaid eligibility and enrollment processes. While New Mexico is engaged in several health reform activities, the state faces many challenges ahead in implementing reform on time.