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Turquoise Care Overview

Turquoise Care is the new name for the New Mexico Medicaid Managed Care program that will begin on July 1, 2024.

In April 2024, Medicaid members will receive a letter in a yellow envelope from the Human Services Department (HSD). It will tell you about the changes to the Managed Care Organizations (MCOs) and what you need to do to choose your MCO.

MCOs are health insurance companies that provide health care to Medicaid members.

During the open enrollment period (April 1 through May 31, 2024), you will be able to select an MCO by going to www.yes.state.nm.us/ or you may call 1-888-997-2583.

If you do not select an MCO during the open enrollment period, you will automatically be assigned to an MCO. Current Presbyterian Health Plan and BlueCross BlueShield members who do not choose a different MCO will be automatically re-enrolled with PHP or BCBSNM.

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

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Turquoise Care FAQ – Medicaid Members

1. What is Turquoise Care?

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.

2. Who is eligible for Turquoise Care Medicaid?

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.

3. How will I find out about the changes?

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.

4. Can I stay with the MCO I have now?

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.

5. Do I have to select a different MCO for 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.

6. Will my services change with Turquoise Care?

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. 

7. Where can I find more information about the Turquoise Care MCOs who are starting on July 1, 2024?

The following link outlines the selected MCOs:   https://www.hsd.state.nm.us/2023/08/11/human-services-department-announces-intent-to-award-medicaid-contracts/ 

The MCOs are currently working on implementing their individual Turquoise Care websites and HSD will share those links once they are complete.

8. If I change my MCO, how quickly will I receive my new Medicaid MCO card?

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.

9. Will I be assigned a new MCO or am I able to select an 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.

10. How will I know if my doctor/provider is covered by a health plan?

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.

11. How will Turquoise Care impact Medicaid enrollment for Children in State Custody (CISC) through the Children, Youth, & Families Department (CYFD)?

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.

12. What is a Value-Added Service (VAS)?

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)

Turquoise Care FAQs – Native Americans

1. Are Native Americans required to enroll in Turquoise Care?

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.

2. How are services different between Fee for Service Medicaid and 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.

3. Will I have access to Value Added Services if I opt out of Managed Care?

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

4. If I choose to opt-in to Turquoise Care, can I still see my doctors at Indian Health Service (IHS) or my clinic?

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.

5. Will there be co-pays for Native Americans in Turquoise Care if they see a doctor outside of IHS?

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

6. What if I choose to be in Turquoise Care but later, I decide that I don’t like it and want to be in Fee for Service Medicaid?

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

7. Will there be people in Turquoise Care who understand my culture, language, and traditions who I can talk to?

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. 

Turquoise Care FAQs – Providers

1. What is the start date for the newly selected MCOs?

July 1, 2024.

2. Will I (provider) need to have a contract in place with an MCO by July 1, 2024, to have claims paid beginning on 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. 

3. Do providers need to re-contract with current MCOs (BCBSNM and PHP)?

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.

4. When will the MCOs’ websites and payment systems for Turquoise Care be launched?

July 1, 2024.

5. How will prior/service authorizations be transitioned from one health plan to another?

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. 

6. Will the current MCOs maintain the 90-day timely filing requirement after June 30, 2024, for claims submission?

Yes. 

7. When will the MCOs deliver member lists to providers?

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. 

8. How are members being transitioned from Western Sky to other MCOs?

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.

9. Will providers be able to work with Western Sky after July 1, 2024, to resolve billing and other pending issues?

Yes.

10. If a member wants to switch MCOs, who do we refer them to?

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.

11. For members switching from one MCO to another, will previous prior authorizations be honored?

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.

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