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New Mexico Turquoise Care
Medicaid
Turquoise Care is the name of New Mexico's Medicaid Managed Care program offered by UnitedHealthcare Community Plan. It’s for children, families, pregnant women and adults who meet income and other eligibility requirements.
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 Turquoise Care
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Benefits & Features
Behavioral health
If you are currently receiving behavioral health services, please let your UnitedHealthcare Community Plan Care Coordinator know. It is important for them to be aware of all the services you are receiving or need.
Also, please let your behavioral health provider know that you are enrolled in UnitedHealthcare Community Plan’s Turquoise Care program. They may have questions about the services you are receiving through Turquoise Care and how we can work together to help you get the care you need.
Behavioral Health screenings are performed as medically necessary for diagnosis and treatment. We cover:
Behavioral Health Services
- Individual, group, and family therapy
- Outpatient behavioral health services
- Inpatient behavioral health services
- Specialized behavioral health services for children with autism
Substance Use Disorder Services
- Outpatient opioid (pain medication) treatment
- Residential treatment
- Targeted case management
Additional health resources can be found at myuhc.com/CommunityPlan. Find the balance, support, and care you need to live the healthiest life possible.
If you believe you need access to behavioral health services, talk with your PMP or call Member Services for help.
Care coordination
If you have a chronic health condition, like asthma or diabetes, you may benefit from our Care Coordinator program.
We can help with a number of things, like scheduling doctor appointments and keeping your providers informed about the care you get. To learn more, call 1-877-236-0826, TTY 711.
Community benefit
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
Dental care
Getting a yearly dental check-up is important to your health. Your coverage includes:
- Two exams and cleanings per year
- Bitewing X-ray once every 12 months and one complete set of X-rays every three years
- Minor restorations such as filling
- Major restorations such as crowns and root canals (one of each per 12 months)
- Deep cleanings and surgical treatment for gum disease
- Partial or full dentures, and repairs to partials or full dentures
- Sedation and nitrous oxide (known as laughing gas) if medically necessary
Early and Periodic Screening, Diagnostic and Treatment (EPSDT)
What are EPSDT services?
The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children younger than age 21 who are enrolled in Medicaid. Follow the EPSDT schedule for all eligible UnitedHealthcare Community Plan members up to age 21, including pregnant members. EPSDT screening including the following:
- Immunizations
- Hearing
- Vision
- Speech screening and nutritional assessments
- Dental screening
- Growth and development tracking
These exams may include vaccinations or shots. If your child has not had his or her checkup this year, call the doctor and schedule one. We may send you a reminder letter to get your child checked.
Lead testing — The doctor will need to do a blood test to make sure your child does not have too much lead. Your child should be checked at 12 months and 24 months of age or if they have never been checked.
Dental exam — Your child should have their teeth cleaned and receive fluoride treatments every six months.
Private duty nursing — When your child’s doctor wants a nurse to provide care at home or at school.
Personal care services — When your child’s doctor wants a caregiver to help your child with eating, bathing, dressing and toileting.
EPSDT also provides hearing services, vision services, school-based services and more. If you have questions, please contact your Care Coordinator.
Health problems should be identified and treated as early as possible. If your child needs special services like Private Duty Nursing or Personal Care Services, they will be provided under EPSDT through UnitedHealthcare Community Plan.
Please speak with your doctor about any shots your child may need.
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.
Healthy First Steps
Healthy First Steps® (HFS) is a specialized case management program designed to provide assistance to all pregnant members and those experiencing an uncomplicated pregnancy. It also helps manage medical, behavioral and social risks. The goal is improving birth outcomes and lowering NICU admissions by managing prenatal and postpartum care needs of pregnant members.
To enroll
Members self-enroll on a smartphone or computer at uhchealthyfirststeps. com and click on “Register” or call 1-800-599-5985.
Hospitalization (Hospital care)
This plan pays for all hospital expenses related to a hospital stay, so you can focus on resting and healing.
Our plan covers:
- Inpatient care
- Outpatient care
- Labs, X-rays and other tests
And after you leave the hospital, you are not alone. We are here to help you get any needed follow-up care to continue healing at home.
Language help
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.
Medicines
Your plan covers prescription drugs for members of all ages. Also covered: insulin, needles and syringes, birth control, coated aspirin for arthritis, iron pills and chewable vitamins.
Nurse hotline
Medical questions can come up at any time. When you have questions about your health, you can call a nurse 24 hours a day, 7 days a week.
Our nurses will:
- Listen to your symptoms
- Help with self-care
- Advise if you can get care care at your next doctor visit or need an urgent care center
- Help you know when it is time to go to the emergency room
Out-of-plan benefits
What services are NOT included in the Turquoise Care benefit package?
- Acupuncture services
- Chiropractic services
- Cosmetic services
- In vitro services
- Inpatient facility room and board — leave of absence
- Routine podiatry services
- Services to intermediate care facilities for the intellectual disability
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.
Pregnancy and infant support
At UnitedHealthcare Community Plan, we want you to have a healthy pregnancy and a healthy baby. We want you and your baby to get all the care you both need. That’s why we have a special program for you — and your baby.
Our maternal child health team will help you learn what to expect when you see your doctor and how to take care of your changing body. Here are some of the things we will help you learn about:
- Local resources
- Nutrition, weight, and well-being
- Fitness
- Sexual health
- Substance abuse
- Domestic violence
When you think you are pregnant, call your local Department of Human Services (DHS) office and Member Services at 1-877-236-0826, TTY 711. This will help ensure you get all the services available to you.
Primary care services
You are covered for all visits to your Primary Care Provider (PCP). Your PCP is the main doctor you will see for most of your health care. This includes checkups, treatment for colds and flu, health concerns and health screenings. Well Visits. Annual checkups to help keep you and your family healthy.
Social Determinants of Health (SDOH) Flex Fund - Emergency Fund
Assistance for non-medical needs that support barriers to vital services required to survive such as Housing and associated costs to remain in housing, Food Assistance, Transportation, gasoline vouchers and clothing vouchers are some examples; use of non-profits.
Specialist services
Your coverage includes services from specialists. Specialists are doctors or nurses who are highly trained to treat certain conditions. You may need a referral from your PCP first.
Transportation
If you need a ride, your benefits include transportation. We cover trips to:
- Medical appointments
- Food bank
- Pharmacy
- WIC appointments
- Medicaid eligibility appointments
Following these simple rules will help you get a ride:
- Call 3+ business days ahead of time
- 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.
Urgent care
Urgent care clinics are there for you when you need to see a doctor for a non-life-threatening condition but your PCP isn’t available or it’s after clinic hours. Common health issues ideal for urgent care include:
- Sore throat
- Ear infection
- Minor cuts or burns
- Flu
- Low-grade fever
- Sprains
If you or your children have an urgent problem, call your PCP first. Your doctor can help you get the right kind of care. Your doctor may tell you to go to urgent care or the emergency room.
Wellness programs
UnitedHealthcare Community Plan has many programs and tools to help keep you and your family healthy, including:
- Classes to help you quit smoking. If you are pregnant or under the age of 21, coaching and medications are available to help you quit smoking.
- Pregnancy care and parenting classes
- Nutrition classes
- Well-care reminders
Your provider may suggest one of these programs for you. If you want to know more, or to find a program near you, talk to your PCP or call Member Services at 1-877-236-0826, TTY 711.