Support during New Mexico wildfires
If you have been impacted by the New Mexico wildfires, support is available. You may continue to access care and services as needed. For assistance with medications, appointments, transportation, or other needs, please call Member Services at 1-877-236-0826, TTY 711, 8 a.m.–5 p.m. MT, Monday–Friday.
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.
This plan is available in the following counties:
Bernalillo, Catron, Chaves, Cibola, Colfax, Curry, De Baca, Dona Ana, Eddy, Grant, Guadalupe, Harding, Hidalgo, Lea, Lincoln, Los Alamos, Luna, Mckinley, Mora, Otero, Quay, Rio Arriba, Roosevelt, San Juan, San Miguel, Sandoval, Santa Fe, Sierra, Socorro, Taos, Torrance, Union, and Valencia.
- New Mexico Long-Term Services and Supports (LTSS)
Find Providers and Coverage for this Plan.
Find doctors, hospitals, behavioral health, and other specialists.
Find medications covered by this plan.
Search for behavioral health providers and resources.
Find a pharmacy near you.
Find a dentist near you.
Find a vision center.
Benefits & features
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)
Members can access these online resources by visiting Live and Work Well.
Substance Use Disorder Helpline
Substance Use Disorder (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. Available to all members.
To call the SUD Helpline, dial 1-888-702-2202.
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.
Pregnancy termination and related procedures
Pregnancy Termination and Related Procedures are covered with limits. These services are covered when medically necessary. Other terms, conditions and/or limitations may apply.
Disclaimer: Federal law limits when Federal funds can be used to pay for pregnancy termination and related services. Coverage of pregnancy termination and related services is subject to State Medicaid policy. When a covered pregnancy termination or related service cannot be paid for with Federal funds, it is paid for using State funds only.
Preferred drug list
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
Dental care
Getting a regular dental check-up is important to your health. UnitedHealthcare provides additional coverage for additional Teeth Cleanings, Fluoride, and Varnishing treatments as a Value-Added Benefit.
Your coverage includes:
• Dental Prophylaxis (Teeth Cleanings): 4 Cleanings per year (Standard Medicaid covers 1 per year)
• Fluoride Treatment: 1 treatment every 6 months
• Varnishing Treatment: Ages 20 and under: 1 treatment every 6 months
Ages 21 and above: 1 treatment per lifetime
Provider must be in-network.
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.
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
If you need a ride, your benefits include transportation. We cover trips to:
• Medical appointments
• Food pantries
• Pharmacy
• WIC appointments
• Medicaid eligibility appointments
• Places of worship
• Birthing classes
• Grocery stores
• Laundromats
• Gyms
• Job-related activities (e.g., training, interviews, testing)
• Support group meetings
• Social Security Administration
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). (This is for medical appointments only.)
• 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
• 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. Exceptions may apply.
• Transportation may be limited to a provider near you
• UnitedHealthcare will allow up to three family members or caregivers to accompany members to their appointment, with three-day prior pre-approval
You may also qualify for a bus pass or friends and family mileage reimbursement. Gas mileage reimbursement is available to a friend or family member who drives you to and from physical health, behavioral health, and pharmacy. You cannot be reimbursed for driving yourself or a minor child you are legally responsible for. Transportation may be limited to a provider near you. Trips over 120 miles each way require pre-approval. 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.
UnitedHealthcare provides additional coverage for Refractive Eye Exams, Frames, Lenses, and Contact Lenses as a Value-Added Benefit through March Vision Care.
Benefits for adults aged 19-20:
• Refractive Eye Exam: 1 Exam every 12 months
• Frames: 2 Frames every 12 months (Standard Medicaid covers 1 every 12 months)
• Lenses: 2 Pairs of Lenses every 12 months (Standard Medicaid covers 1 every 12 months)
• Contact Lenses: Covered as needed ages 20 and under
Benefits for all members ages 21+:
• Refractive Eye Exam: 1 Exam every 24 months (Standard Medicaid covers 1 every 36 months)
• Frames: 1 Frame every 12 months (Standard Medicaid covers 1 every 36 months)
• Lenses: 1 Pair of Lenses every 12 months (Standard Medicaid covers 1 every 36 months)
• Contact Lenses: 1 Pair of Contact Lenses every 12 months (Standard Medicaid covers 1 every 24 months)
Provider must be in-network.