Medicaid Costs and Coverage in New Mexico

You may wonder, “How much is Medicaid in New Mexico?” if you are seeking health care coverage for you and your family. Medicaid cost estimates can vary widely throughout the state as New Mexico was one of the many states who chose to participate in Medicaid expansion after the passage of the Affordable Care Act, and thus more specified kinds of coverage are available in the state than ever before. Your personal Medicaid costs will be determined largely on the eligibility requirements based on household income or household composition and circumstances. The Medicaid program in New Mexico goes by the local name of Centennial Care. Remember, as you examine and consider types of Medicaid insurance, that the New Mexico Human Services Department pays your health care provider directly for your medical needs. There may be significant differences from provider to provider in terms of copayment expectations.

How much does Medicaid cost in New Mexico?

Medicaid cost estimates in New Mexico depend on what type of medical services you are seeking and what subgroup you may fall into with regards to specialized care. For instance, the question of “How much is Medicaid?” will have a very different answer for a person younger than nineteen years of age who may be receiving Medicaid benefits through the Children’s Health Insurance Program (CHIP) than it will for a New Mexico resident of the Working Disabled Individuals Program (WDI). Copayment prices in Medicaid coverage differ depending on household information. After receiving approval when you complete the application process, you will receive a Medicaid membership handbook that will include many details about varying price points for services and copayments. Medicaid cost estimates often exclude certain procedures and services that may be deemed too specialized or expensive. You will need to be prepared to pay the full primary care provider (PCP) price out of pocket, if you should require such services.

What types of Medicaid insurance are available in New Mexico?

The many types of Medicaid insurance available in New Mexico are provided by four managed care plans that the state has placed under contract to supply Medicaid services. New Mexico only recently made the switch to the Centennial Care program in 2014, and some applicants may know it previous names like Salud, CoLTS and/or Optum. Medicaid coverage is provided in New Mexico by:

  • Molina Health Care
  • Blue Cross Blue Shield
  • UnitedHealthcare Community Plan
  • Presbyterian Health Plan

Medicaid cost estimates are affected by which plan you enroll in as the choice of your plan will determine how much coverage you qualify to receive. Medicaid coverage mandates a Health Risk Assessment (HRA) for each participant and this document utilizes information you provide to personally map your distinct medical needs. If you fail to choose a health care plan on your own during the application process, a plan will be automatically chosen for you. Though some coverage is always better than none, an assigned plan is not ideal because an assigned plan will not have the benefit of being selected with your own acute knowledge of your medical needs, current and upcoming, in mind. Every type of Medicaid insurance has an accompanying network of providers from which you can choose to receive your medical services. Any out-of-network needs you may have require pre-authorization in order to be covered by Medicaid.

What services are covered by Medicaid in New Mexico?

The many types of Medicaid insurance available in New Mexico to cover all sorts of preventive and emergent care medical needs. Medicaid coverage can be extended to a wide range of care including, but not limited to, pediatric care, mammograms, colon screening, vaccinations, routine checkups, surgical procedures, family planning and both ground and air ambulance services. Most diagnostic screening, prescription drugs, laboratory screenings and preventive treatments are included in coverage. All non-life-threatening urgent care is covered by Medicaid in New Mexico. When evaluating what services are covered by Medicaid, remember that any services provided by out-of-network practitioners will require prior authorization. Additionally, Native American Medicaid costs vary, as Native Americans can choose to join Centennial Care to receive all the benefits of the program through a particular MCO, or they may receive care through the fee-for-service option, which is only basic Medicaid coverage. Applicants can learn more about Medicaid costs and coverage options by downloading our free guide about national Medicaid.

What does Medicaid not cover in New Mexico?

Medicaid coverage in New Mexico should not be viewed as all encompassing. When evaluating types of Medicaid insurance, there a list of services Medicaid does not cover, even if an applicant meets basic eligibility requirements for Medicaid. Seeking non-emergency medical practitioners or services offered outside of New Mexico represents one such pitfall. Note that Centennial Care only extends to the state of New Mexico and thus if you need services in another place, your benefits will not travel with you in most cases. Medicaid cost estimates in New Mexico likewise do not extend to procedures deemed not medically necessary. Medical “necessity” in New Mexico is defined as relating to physical, behavioral, clinical or rehabilitative health. Though there are a broad range of treatments within those definitions, Medicaid does not cover weight loss programs, untested or experimental equipment/treatments nor any expenses that could be paid by other coverage.

What are some special features of Medicaid coverage in New Mexico?

The expansion of Medicaid coverage brought to New Mexico via the Affordable Care Act came with many additional services and options that were not included in the pre-existing model. Beyond the HRA, which is a new feature, new Medicaid cost estimates in New Mexico now come with the option to be assigned a Care Coordinator for members who may need additional support in managing their complex health care needs. The Care Coordinator can handle everything from scheduling medical appointments to helping choose the right provider. Medicaid coverage now also features vital community benefits such as respite care, adult day health support and personal care options that make long-term care more humane, deeply personalized and less stressful. The goal of the community benefits aspect is to make the services that are covered by Medicaid more home friendly and focused on keeping patients in their communities. When evaluating how much Medicaid costs in New Mexico today, remember that the new Centennial Care plan includes a Member Rewards program. This is designed to reward participants for healthy choices and lifestyle directions. Members earn credits for these healthy behaviors and can then utilize the credits to order items from a catalog.

For complete details on what services are covered by Medicaid, download our comprehensive guide today.