New Mexico is fully participating in the Medicaid Expansion under provisions of the Affordable Care Act (ACA). For additional background on the State’s policy decisions regarding the Medicaid Expansion option, see: Background.
Medicaid in New Mexico
The NM Department of Human Services, Medical Assistance Division, administers New Mexico Mediciad. Information about NM Medicaid, including beneficiary enrollment information, can be found at: https://nmmedicaid.acs-inc.com/static/index.htm.
Provider Participation
Providers must enroll in the Medicaid fee-for-service program to receive payments for covered services.
Information about enrolling in the Medicaid fee-for-service program can be found at: https://nmmedicaid.acs-inc.com/static/index.htm.
The Medicaid website provides information about services covered by fee-for-service payments and payment amounts: https://nmmedicaid.acs-inc.com/static/index.htm.
In order to retain access to all Medicaid patients in the state, providers must also connect to the managed care plans individually.
Medicaid Managed Care
Some Medical Assistance Division beneficiaries are enrolled in managed care plans. The program is called, Salud! Basic information about Salud! can be found at: http://www.hsd.state.nm.us/mad/CSaludDetail.html.
Some managed care plans cover individual New Mexico counties and independent cities. The Medicaid website has jurisdictional information: https://nmmedicaid.acs-inc.com/static/index.htm
Medical Assistance Division Beneficiaries Participating in Managed Care
Managed care plans participating in Salud! offer detailed information about covered benefits for individuals enrolling in their plans. This information is available on the managed care websites shown below.
Reporting Problems
The state Medicaid office is primarily responsible for examining and addressing issues with the Medicaid Managed Care plans offered in the state, and for working with the companies that offer them. If you are experiencing problems as a medical provider with the Managed Care plans or companies operating in the state, or if your patients are experiencing problems with the Managed Care plans or companies in the state, including trouble with access to medications, access to preferred providers, navigating the appeals process, excessive costs, or possible discriminatory policies, or any other problems related to the Affordable Care Act, please report these problems to the state Medicaid Office:
http://www.hsd.state.nm.us/mad/index.html
888-997-2583
Additionally, if you are experiencing these or other problems, please report these problems to AAHIVM, so that we may track issues affecting our members, and seek additional policies remedies.
Managed Care Plans Participating in Salud!
Blue Cross Blue Shield of NM
Plan Website: http://www.bcbsnm.com/coverage/medicaid/bluesalud.html
Provider Enrollment: https://www.bcbsnm.com/pdf/forms/app_facility_participation.pdf
Molina Health Care of NM
Plan Website: http://www.molinahealthcare.com/medicaid/members/nm/Pages/home.aspx
Provider Enrollment: http://www.molinahealthcare.com/medicaid/providers/nm/manual/Pages/FAQ.aspx
Presbyterian Health Plan
Plan Website: http://www.phs.org/phs/healthplans/medicaid/presbyteriansalud/
Provider Enrollment: http://www.phs.org/PHS/healthplans/info/join/index.htm
United Healthcare
Plan Website: http://www.uhccommunityplan.com/health-professionals/nm.html
Provider Enrollment: http://www.uhccommunityplan.com/health-professionals/nm.html