Alternative Benefit Plan vs. State Plan Comparison Chart

Alternative Benefit Plan (ABP)
ABP Cost-Sharing & Comparison to Standard Medicaid Services

Most adults who qualify for the Medicaid category known as the “Other Adult Group” receive services under the New Mexico Alternative Benefit Plan (ABP). The ABP covers doctor visits, preventive care, hospital care, emergency department and urgent care, specialist visits, behavioral health care, substance abuse treatment, prescriptions, certain dental services, and more. Some recipients will have to pay small co-pays for certain services, depending on their income.

Medicaid recipients in the Other Adult Group who have special health care needs may qualify to receive Standard Medicaid services without any co-payments, except for unnecessary use of brand name drugs or the emergency department. Individuals who have a serious or complex medical condition, a terminal illness, a chronic substance use disorder, a serious mental illness, or a disability that significantly impairs their ability to perform one or more activities of daily living, may choose to receive services under the ABP or under Standard Medicaid.

Individuals who believe they have special health care needs should contact their Centennial Care managed care organization (MCO). Native American individuals who are not enrolled with a Centennial Care MCO should call the Qualis Health Third-Party Assessor (TPA) toll-free at (866) 962-2180. Qualis Health will help determine if the individual has special health care needs and is eligible to receive Standard Medicaid services. Individuals with special health care needs may choose whether they want to receive services under the ABP or under the Standard Medicaid program.

The table below offers a comparison of the ABP services package to the Standard Medicaid services. Since ABP coverage is only available to individuals age 19-64, the comparison to Standard Medicaid coverage in the table below is limited to that same range (age 19 and above).

ABP Cost-Sharing & Comparison to Standard Medicaid Services