LOOKING FOR ASSISTANCE

Turquoise Care is the new name for the New Mexico Medicaid Managed Care program that will begin on July 1, 2024.  Two new and two continuing Managed Care Organizations (MCOs) have been selected to serve the Medicaid Managed Care population.

Most individuals on Medicaid in New Mexico are in managed care.   Native Americans may opt-in to managed care. 

For more information on applying for Medicaid, please visit our website at https://www.yes.state.nm.us/yesnm/home/index  or call 1-800-283-4465.

In April 2024, you will receive a letter in a yellow envelope from the Human Services Department (HSD).  It will tell you about the changes to the MCOs and what you need to do to choose your MCO.  HSD is currently developing a schedule for upcoming outreach events for members and providers.

The MCO you have now will provide services through June 30, 2024.  From the Centennial Care MCOs, Blue Cross Blue Shield of New Mexico (BCBSNM) and Presbyterian Health Plan (PHP) will continue to provide services after June 30, 2024.  Molina Health Care of New Mexico (MHC) and United Health Care (UHC) will be available as new MCOs providing services starting on July 1, 2024.

If you do not select an MCO during the open enrollment period, you will automatically be assigned to an MCO.  Current PHP and BCBSNM members who wish to remain with PHP and BCBSNM do not have to actively select an MCO.  You will be automatically re-enrolled with PHP or BCBSNM if you do not choose a different MCO. 

If you are currently enrolled with Western Sky Community Care and do not select an MCO during open enrollment, you will automatically be enrolled with another Turquoise Care MCO.

Covered services that exist today will remain.   New covered services such as chiropractic services will be added.  Each MCO will also offer Value-Added Services (VAS) that may vary across plans. Please see question 12 for additional information on VAS.  It is important to talk with your primary care and specialty care provider(s) to see if they are contracted with the MCO of your choice. 

Here are the direct links to their NM Turquoise Care websites:
BCBSNM: www.bcbsnm.com/turquoise-care-welcome/
MHC: www.molinahealthcare.com/members/nm/en-US/pages/home.aspx
PHP: www.phs.org/medicaid
UHC: www.uhc.com/communityplan/new-mexico/plans

Once the MCO receives their list of members, they will issue new Medicaid cards within 20 calendar days of being notified of a member’s enrollment in their MCO.

During the open enrollment period  (April 1 through May 31, 2024), you will be able to select an MCO by going to https://www.yes.state.nm.us/yesnm/home/index or you may call 1-888-997-2583.  If you are currently enrolled with BCBSNM or PHP and wish to remain with them, you do not need to select an MCO. 

If you are currently enrolled with Western Sky Community Care and do not select an MCO, you will automatically be enrolled with another Turquoise Care MCO if you do not make a plan selection during the open enrollment period.

You may contact your MCO’s Member Services department or your primary care and specialty care provider(s) office to ask if they are contracted with or plan to contract with your selected MCO.

Each MCO offers a unique set of value-added services beyond what is covered and permitted by Medicaid.  The following are examples of some of the VAS:

• Culturally Responsive Treatments
• Specialized Vision and Specialized Dental
• Housing Support
• Technology
• Transportation/Travel (beyond transportation currently covered for Medicaid such as to medical appointments)
• Behavioral Health (beyond services currently covered for Medicaid)

Yes, during the months of April and May, there will be in-person statewide open enrollment events.  Here is a list of  upcoming events. You do not need to register to attend these events.

HSD will be adding this information to the Turquoise Care page. Please keep in mind that United Health Care and Molina Health Care are in the process of negotiating provider/hospital contracts so this list will be updated regularly.

Yes.  Here are the ways you can select a Managed care MCO:

1. Go to yes.state.nm.us – log into your account to select your MCO or use the chat option and follow prompts to select your MCO.
   1. There are step-by-step instructions on our YouTube channel: https://www.youtube.com/@nmhca
2. Call HSD at 1-800-283-4465 and follow the prompts to select an MCO.
3. Complete the form in the yellow envelope and mail to HSD at: Central ASPEN Scanning Area (CASA) PO Box 830, Bernalillo, NM 87004.

Note:  If you are currently enrolled with BCBS or PHP and do not want to change MCOs, you do not need to do anything.

• Native American and have opted out of managed care and are not in need of Long-Term Care services.
• Receiving care in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID);
• Enrolled only in the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLIMB), or Qualified Individuals program;
• Covered only under the Medicaid Family Planning program;
• Enrolled in the Program of All-Inclusive Care for the Elderly (PACE); and
• Covered pursuant to Emergency Medical Services for Non-Citizens (EMSNC).

If you are enrolled in a Medicare Advantage plan, it is recommended that you enroll with the same Medicaid MCO to ensure adequate coordination of care.

No.  You must select a Medicaid MCO and if you do not select an MCO during open enrollment, you will automatically be assigned to one of the four MCOs.

Turquoise Care MCOs will:

• Provide, at a minimum, a 90- day transition period for members who have an established relationship with a Primary Care Physician
• Allow members that are children in state custody (CISC) to continue receiving services for the duration of their treatment or six months, whichever is first
• Ensure pregnant women in the third trimester or anticipated to deliver within 30 days of the transition are authorized to receive services from their OB provider and deliver at their chosen delivery site
• Honor previously approved authorizations for a minimum of 30 days

Members currently with BCBS, Presbyterian or Western Sky who switch MCOs during open enrollment have 90 days to switch MCOs starting 7/1/24.

On the HSD website at:  Turquoise-Care_MCOs_Value-Added-Services.pdf

You must select a new MCO through any of the following methods:

1. Go to yes.state.nm.us – log into your account to select your MCO or use the chat option and follow prompts to select your MCO.
   1. There are step-by-step instructions on our YouTube channel: www.youtube.com/@nmhca
2. Call HSD at 1-800-283-4465 and follow the prompts to select an MCO.
3. Complete the form in the yellow envelope and mail to HSD at: Central ASPEN Scanning Area (CASA) PO Box 830, Bernalillo, NM 87004.

a. No.  Please check with your MCO to see if they cover acupuncture as a Value Added Service.   

a. No.  The Medicaid Managed Care Rewards program will continue but the name will change to Turquoise Rewards.   

a. Approved prior authorizations must be honored at a minimum  per the schedule below after June 30, 2024: 

i. Pharmaceuticals already approved for the first ninety (90) calendar days after June 30, 2024 (formulary or preferred drug list, prior authorizations), including specialty drugs. 

ii. New Mexico law also requires that if a prior authorization for medications for cancer or rheumatologic diseases was given once, that drug will be approved for the lifetime of the drug. 

a. Western Sky members who have appointments scheduled in July will only be covered if the provider is contracted with your new MCO. 

a. Yes, all four of the Turquoise Care MCOs cover the same physical health, behavioral health, and long-term services and supports. Each MCO offers different Value Added Services (VAS) in addition to the Medicaid covered ———-benefits.   

The newborn will be enrolled into the same MCO as the mother for at least the birth month. The newborn will transition to the designated to Presbyterian Health Plan prospectively when the newborn becomes eligible for Medicaid foster care Category of Eligibility (COE).

A Non-Native American child will transfer from BCBS to PHP if they are placed in state custody.  When they are no longer in state custody and if they are still eligible for Medicaid.  The parents/caregiver will receive a notice that allows them up to three months to change their MCO from PHP to another MCO.

Yes, any child that is taken into state custody will be enrolled in Medicaid.

CISC will automatically be enrolled with Presbyterian Health Plan (PHP). This will be the only MCO managing care for non-Native American CISC.

Native American CISC can choose to enroll in any MCO. If Native American CISC members do not opt-in to managed care, services will be provided via the Fee for Service plan.  Please see the Native Americans section of this document for additional information.

Presbyterian Health Plan was selected as the single health plan for children in state custody so that they can focus on providing health care services that most improve health outcomes and to create a consistent experience for children and their families/caregivers. 

The Health Care Authority will be able to monitor Presbyterian through specific performance measures and tracking measures, including but not limited to: 

• Well child visits, 

• Developmental screenings within first three years of life, 
• Use of concurrent antipsychotics in children and adolescents, and 
• Rate of CISC in out-of-state residential placements. 

Native American children in state custody always have the choice to select any Turquoise Care health plan, or to remain in Fee for Service Medicaid.   

No, the CISC Medicaid Category of Eligibility will end, and the parent(s) may apply for Medicaid for the family and/or child/adolescent.  If the family is already enrolled in Medicaid, they must submit an application to add the child/adolescent to the household. 

The adoptive parents can apply for Medicaid for the family and/or child/adolescent.   Some children/adolescents may be eligible for an adoption category of eligibility up to age 18. 

Medicaid covers former foster care individuals from age 18 up to age 26. Upon turning age 18, an individual who transitions out of foster care may choose any Turquoise Care health plan.  

All Native Americans have the choice of enrolling in Turquoise Care (managed care) or Fee-For-Service Medicaid. Native Americans who receive long-term care services (Community Benefits) such as personal care, and long-term Nursing Facility care are required to be in Turquoise Care.

Under Fee for Service Medicaid, you receive the basic Medicaid benefits package. Under Turquoise Care, you will receive additional services such as expanded care coordination, community benefits, and the value-added benefits that each MCO offers its members.

No.  You must enroll in Turquoise Care and select an MCO to access value-added services.

Yes.  You can continue to see your doctors at Indian Health Services and still be enrolled in Turquoise Care.  The MCO would pay your doctors, lab, pharmacy, etc.

No.  The New Mexico Medicaid program does not require any co-pays. 

Native Americans can choose to opt-out of Turquoise Care at any time by contacting the Customer Service Center at 1-800-283-4465. 

Yes.  Each MCO is required to have people who are trained on Native American culture and traditions who can talk to you about your specific concerns.  Whenever possible, the MCOs will have people who speak your language. 

July 1, 2024.

Yes.  The MCOs will work diligently with you prior to July 1, 2024, to see that you become credentialed and have a contract in place. 

MCOs must ensure that contracts with providers reflect new Turquoise Care requirements and that all federal and state requirements are updated. This can be done through contract amendments or through new contracts.  If credentialing is current, the standard re-credentialing cycle applies for BCBSNM and PHP.

July 1, 2024.

HSD requires the MCOs to share authorizations and other information for members who are transitioning from one MCO to another to ensure a smooth transition. 

Yes. 

The MCOs will not deliver member lists to providers.  The provider must verify Medicaid eligibility for each member.  Each member’s Medicaid card will list their MCO. 

Members will participate in open enrollment during the period of April through May 2024.  Once the Western Sky members have selected or been automatically assigned to an MCO, the member list will be shared with the new MCO prior to July 1, 2024.  The newly assigned MCOs will issue a new member ID card within 30 calendar days of enrollment.

Yes.

Please refer them to the HSD customer portal at https://www.yes.state.nm.us/yesnm/home/index or the HSD customer service call center at 1-800-283-4465.

Most prior authorizations will be honored.  For example, MCOs will also be required to honor pharmacy, durable medical equipment and EPSDT visits for 90 calendar days after June 30, 2024.