What Does New Mexico Medicaid Cover?
Learn what healthcare services are covered by New Mexico Medicaid (Centennial Care) and how to navigate your benefits effectively.
New Mexico Medicaid, known as Centennial Care, is a comprehensive healthcare program for eligible residents across the state. This joint federal and state effort broadens healthcare access for individuals and families with limited income and resources. Its primary purpose is to ensure eligible New Mexicans obtain necessary medical services and support, promoting overall health and well-being.
Primary Medical and Hospital Coverage
New Mexico Medicaid provides fundamental medical services for health maintenance and acute care. Beneficiaries have access to visits with healthcare providers, including physicians and nurse practitioners, for routine medical care. These services encompass diagnostic procedures such as laboratory tests and X-rays, crucial for identifying health conditions and guiding treatment.
The program covers hospital services, including inpatient and outpatient care. Inpatient services are for overnight stays, while outpatient services are for procedures without hospital admission. Emergency room services are included. Medical transportation is also covered, helping beneficiaries reach appointments.
Specialized Health Services
Beyond general medical care, New Mexico Medicaid covers various specialized health services. Mental health services include therapy, counseling, and psychiatric care. This covers conditions like stress, depression, anxiety, and care coordination through case management. Inpatient hospitalization for mental health treatment is available when medically necessary.
Substance use disorder (SUD) treatment is covered, providing services such as detoxification, residential rehabilitation, and outpatient programs. Medication-assisted treatment (MAT) is included for opioid use disorders. These services aim to offer a comprehensive solution for individuals seeking long-term recovery.
Prescription medications are covered, often managed through a preferred drug list or formulary. Some may require prior authorization. Vision care covers eye exams and glasses.
Dental care is a benefit for adults and children. Coverage includes routine exams, cleanings, and X-rays. Procedures like fluoride treatments, sealants for children, crowns, extractions, and root canals are covered. Orthodontics may be covered for individuals under 21 with prior authorization and medical necessity.
Maternity and newborn care are covered, with New Mexico Medicaid covering a high percentage of births. Postpartum coverage for new mothers extends to a full year, providing continued access to care. Home visiting programs offer support to new families, including guidance on prenatal and postpartum care.
Long-Term Care and Support
New Mexico Medicaid covers long-term care services, which address chronic conditions and disabilities. Nursing facility care is available for individuals who meet a nursing facility level of care. This includes payment for room and board, alongside necessary medical and non-medical goods and services within the facility.
Home and Community-Based Services (HCBS) allow individuals to receive care in their homes or community settings rather than in institutions. These services are offered through programs like the Centennial Care Community Benefit and various waivers such as Mi Via and the Developmental Disabilities Waiver. HCBS can include adult day health services, respite care for caregivers, and modifications to make homes safer and more accessible.
Personal care services offer assistance with daily living activities, such as bathing, dressing, and eating. These services are crucial for individuals with functional limitations or disabilities. The Personal Care Options (PCO) program, part of Centennial Care, aims to prevent institutionalization and support individuals in maintaining their independence within their own homes.
Navigating Your New Mexico Medicaid Benefits
Most individuals receive services through one of the state’s managed care organizations (MCOs), which coordinate all aspects of a person’s healthcare. To find a Medicaid provider, beneficiaries can use online directories provided by their specific MCO or the New Mexico Medicaid Portal.
A primary care provider (PCP) is typically assigned or chosen, serving as the main point of contact for routine care and referrals to specialists when needed. Care coordinators are also available through MCOs to help members navigate their physical and behavioral health needs and connect with appropriate services. This coordinated approach aims to ensure integrated care and better health outcomes.
Services covered by New Mexico Medicaid come with minimal or no out-of-pocket costs for beneficiaries. For instance, mental health therapy sessions may involve a copay, ranging from $0 to $75 per session, depending on the plan. Not all services are covered, particularly experimental treatments or those deemed not medically necessary. Services already provided by other sources are typically excluded from coverage to prevent duplication.