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New Mexico Long-Term Services and Supports (LTSS)

Medicaid

Our New Mexico Long Term Services and Supports (LTSS) is a health coverage program for New Mexico residents who meet requirements and who are eligible for Medicaid. LTSS is designed to improve quality of life for members of any age who have functional limitations and/or chronic illnesses. LTSS helps support the member to live or work in the setting of their choice, which may include the person's home, a worksite, provider-owned or controlled residential setting, a nursing facility, or other institutional setting. LTSS provides in-home counseling sessions that focus on solving problems and becoming socially and physically active.

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  • New Mexico Long-Term Services and Supports (LTSS) Steps to enroll

Benefits & features

Traditional healings and alternative treatments

Supports member preference for alternative healing supports and provides resources to promote person-centered care and maintenance of general health. We will provide a $300 annual reimbursement for Native American members and for traditional or healing practices.

This benefit includes but is not limited to:

  • Native American Healing and Ceremonies
  • Curandismo Healing

The member will need to submit the Traditional Healing Reimbursement Form.  For more information or assistance, please contact Member Services at 1-877-236-0826. For hearing impaired: TTY 711.

Home-delivered, medically tailored, culturally appropriate meals to promote better health and support health care. Meals can be tailored for members with regular and specialty dietary needs, and can support puréed, gluten free and vegetarian. This program promotes healthy nutrition and addresses food insecurity or malnutrition. Focus supporting members through transitions of care, including:

  • Post-delivery, for member and up to four household members
  • Post-release meals for justice- involved members
  • Skilled nursing facility (SNF) transition, focused on LTSS members

Exclusions include:

  • Post-delivery: two meals a day for 14 days, for member and up to four household members
  • Post-release meals for justice involved members: two meals a day for 14 days
  • SNF transition, focused on LTSS members: two meals a day for 14 days
  • Community Partner referred members that need food assistance

Prescribed medications are covered. All health plans follow the same rules about the medications that are covered as part of the New Mexico Long Term Services and Supports (LTSS). The same list of approved medications is used. This is called the Preferred Drug List, or PDL.

Our online behavioral health resources connect members to information and resources for overall health and wellness, including specific behavioral health tools, resources and information. For example, our health and wellness library feature 60 centers and over 220 videos focused on topics such as:

  • Physical health, 
  • Mental health, 
  • Substance use, 
  • Recovery tools, 
  • Resiliency skills development, 
  • Caregiving, 
  • Parenting, 
  • Supports for Native Americans, 
  • School and education, 
  • Suicide prevention, 
  • Mindfulness,
  • Disaster planning and recovery that combine resources (e.g., articles, videos, training programs, screeners). 

SUD Helpline

SUD Helpline is an anonymous, confidential, payer- agnostic helpline where community members and their families or friends can call and speak with a licensed behavioral health expert for information on SUD treatment. Members can work with a licensed clinician to plan the next step in their care should they choose to pursue treatment. Avalilable to all members. 

What is the Community benefit?

The Community Benefit (CB) is Turquoise Care’s name for the home and community-based services (HCBS) benefit package. 

  • The Personal Care Services benefit is also part of CB 
  • Community Benefits are services that allow eligible members to receive care in their home or community as an alternative to being placed in a long-term care facility 
  • Community Benefits are intended to supplement natural supports and support community living 

Goals of Community Benefits. 

  • Allow New Mexicans who require long-term care to remain in their homes and in their communities 
  • Reduce the number of unnecessary nursing home admissions 

Community Benefit eligibility. 

  • All members must have a full Medicaid category or have Waiver category of eligibility 
  • All members must meet the nursing facility level-of-care criteria
  • All members must be a resident of New Mexico

If you speak a language other than English, we can provide translated printed materials. Or we can provide an interpreter who can help you understand these materials. You’ll find more information about Interpretive Services and Language Assistance in the section called Other Plan Details. Or call Member Services at 1-877-236-0826, TTY 711. 

Si usted habla un idioma que no sea inglés, podemos proporcionar materiales impresos traducidos. O podemos proporcionar un intérprete que puede ayudar a entender estos materiales. Encontrará más información acerca de servicios de interpretación y asistencia lingüística en la sección Otros detalles del plan. O llame a Servicios para Miembros al 1-877-236-0826, TTY 711.

UnitedHealthcare Community Plan covers hundreds of prescription drugs from hundreds of pharmacies. The full list of covered drugs is included in the Preferred Drug List. You can fill your prescription at any in-network pharmacy. All you have to do is show your member ID card.

Click the link below to download the complete list, or download online at myuhc.com/communityplan/nm.

New Mexico Preferred Drug List

Chiropractic care

Chiropractic care focuses on bones and muscles. It can help ease pain in the limbs, spine and neck. Acupuncture is part of traditional Chinese medicine. Thin needles are put into the body to help relieve pain.

Limited to 5 visits per year and $75 per visit.

Dental care

Getting a yearly dental check-up is important to your health. Your coverage includes: 

  • ACC/Flouride Varnishing Treatment (one per lifetime)
  • Flouride Treatment (treatment every 6 months).

Emergency care

Hospital emergency rooms are there to offer emergency treatment for trauma, serious injury and life-threatening symptoms. Some reasons to go to the ER include:

  • Serious illness
  • Broken bones
  • Heart attack
  • Poisoning
  • Severe cuts or burns

UnitedHealthcare Community Plan covers any emergency care you need throughout the United States and its territories. Within 24 hours after your visit, call Member Services at 1-877-236-0826, TTY 711.

 

Foot Care (podiatry)

Up to 6 routine foot care visits are covered each year. Some services need prior approval. Please see the member handbook for details.

Housing stability

We want members and their families to enjoy safe and affordable housing. We can help with a plan to improve a current home or plan a move to a different home. A Care Coordinator will work to collect goals and share options that address the needs of our members. 

Large provider network

You can choose any PCP from our large network of providers. Our network also includes specialists, hospitals and pharmacies — giving you many options for your health care. Find a complete list of network providers at myuhc.com/communityplan/nm.

Medical equipment and supplies

Coverage is available for medical supplies, equipment, and devices that can be used in the home. A Care Coordinator can help arrange for needed equipment and supplies.

Social Determinites of Health (SDOH) Flex Fund

Help with social needs that affect a person’s ability to maintain their health and well-being. This may include help related to housing, food, transportation, and more. Requests are evaluated and funds disbursed on a case-by-case basis. Assistance may include information and referrals to other resources. Limitations and restrictions apply. Some goods and services may be provided in partnership with other community-based organizations.

SeniorLink

Assist unpaid and family caregivers by providing support services that focus on engaging, empowering, educating and supporting caregivers. Seniorlink coaches design a personcentered program for each member after completing an assessment that evaluates the knowledge, skills and needs of the caregiver and the member’s health risks and behavioral challenges.

Through this person-centered program, SeniorLink builds a care plan specific to unpaid and family caregivers to make sure they have the tools and resources to support members in their homes by supporting their families.

To support all caregivers, especially those in disenfranchised populations, such as those on tribal lands, SeniorLink has invested in developing cultural competency among their care teams in topics such as history, demographics, socioeconomics, government, family relationships, belief systems, verbal and nonverbal communication styles, rural versus urban differences, health care practices and implementation strategies in the Native American community.

Requires evaluation and approval. Eligibility determined on an individual basis. 

Senior.One

Comprehensive care navigation services have been tailored to enhance the healthcare journey for Members enrolled in the Long-Term Services and Supports (LTSS) programs. The mission is to streamline the care navigation process, to ensuring that every senior receives the personalized care and support they deserve.

Available to all seniors, and members with LTSS.

Substance Abuse Treatment

Members can get residential treatment if they are getting help due to alcohol or drug use. This includes overnight stays in a facility. The member’s Care Coordinator can help answer questions or explain any limits or prior approval needed.

Transportation & Tripmaster

If you need a ride, your benefits include transportation. We cover trips to:

  • Medical appointments
  • Food bank
  • Pharmacy
  • WIC appointments
  • Medicaid eligibility appointments
  • Places of worship
  • Birthing classes
  • Grocery stores
  • Job-related activites
  • Support group meetings

Following these simple rules will help you get a ride: 

  • Call 3+ business days ahead of time for local travel
  • Call 2+ weeks in advance for long distance travel (out of state travel or flights)
  • Call 1-877-236-0826, TTY 711 to set up your ride 
  • If you cancel your visit, call 1-877-236-0826 to cancel your ride 
  • Have your Medicaid ID card available 
  • Rides are only for approved reasons 
  • Know the address of your health care provider and the date and time of your appointment 
  • Be specific about where you need a ride to 
  • After your visit, call for a ride home 
  • If your doctor gives you a prescription you can stop at the pharmacy to get it 
  • Let us know if you have special needs like a wheelchair 
  • Members under the age of 16 must have a parent or guardian with them 
  • Transportation may be limited to a provider near you

You may also qualify for a bus pass or friends and family mileage reimbursement. Give Member Services a call to schedule a ride or ask questions about getting transportation services.

This service is for rides planned in advance. If you have a life-threatening emergency, call 911. An ambulance will be provided if you need to be sent to the hospital.

Vision care

Regular eye exams are important. Members are eligible for routine eye exams and prescription eyeglasses. Call your doctor to schedule a routine eye exam. You can schedule an appointment with any participating vision care provider. 

Refractive Eye exam available to all members once every 24 months. 

Member resources

Member resources (opens modal window)

Learn more about New Mexico LTSS