Introducing Western Sky Community Cares Provider Accessibility Initiative
Western Sky Community Care continuously works to remove barriers that prevent our members from accessing quality healthcare because we have a responsibility to make it simple to get well, stay well, and be well. To continue this mission, Western Sky Community Care has launched our Provider Accessibility Initiative . The goal of the PAI is to improve member access and health outcomes by increasing the percentage of practitioner locations and services in our network that meet minimum federal and state disability access standards. First, we need to hear from you! complete the survey that is located in the article linked below.
What Does Nm Medicaid Cover And Cost
New Mexico Medicaid covers medical services, prescription drugs, dental, vision, mental health, long-term care, some home health benefits, and transportation services. Transportation services are usually only available to those who do not have their own reliable means of transportation.
Most people with NM Medicaid will not owe any money out of pocket. However, people who qualify under the Working and Disabled waiver may owe copayments of up to $7 for some services, $30 for hospital stays, and $3 for prescriptions.
Apply For Medicaid In New Mexico
Online at the Centennial Care website or healthcare.gov or by phone at 1-800-318-2596 with a paper application or in-person at a NM Human Services Department field office.
Eligibility: The aged, blind, and disabled. Also, adults with income up to 138% of poverty. Pregnant women are eligible for pregnancy-related coverage with household income up to 250% of poverty. Children are eligible for CHIP with income up to 240% of poverty or 300% of poverty .
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Western Sky Community Care Medical Transportation
Western Sky Community Care provides Centennial Care Health Plan members with round-trip rides for appointments to providers for medically necessary services – call 1-844-543-8996, ext. 2 , then ext. 1 . Call Monday-Friday, 8:00 am to 5:00 pm. Must call 3 business days in advance to reserve a ride.
Services
Parent Organization
Western Sky Community Care
Western Sky Community Care is committed to providing solutions for Medicaid beneficiaries throughout New Mexico. Western Sky Community Care, a wholly-owned subsidiary of Centene, in partnership with the New Mexico Human Services Department, will provide coordinated healthcare, long term services and supports, pharmacy, vision and transportation services. Western Sky Community Care will work closely with Primary Care Providers and Centennial Care enrolled members in providing comprehensive care coordination ensuring their medical needs are met. We partner with physicians, specialists, hospitals, and other providers, such as pharmacy and vision, to ensure that each member receives quality healthcare.
How To Get Both Medicare And Medicaid In New Mexico
New Mexicans who qualify for both Medicare and Medicaid may be eligible for a dual-eligible Medicare special needs plan . DSNPs can cover your eligible Medicare and Medicaid benefits at little or no cost to you. To enroll, you must first apply for Medicaid in New Mexico and must enroll in Medicare parts A and B. You can qualify for Medicare A and B by:
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New Mexico Medicaid Eligibility
Parents, pregnant women, kids, women with breast or cervical cancer, and adults under the age of 64 can qualify for New Mexico Medicaid based on income. If you are married and do not have kids, your eligibility will be based on income before taxes and deductions. Income will include wages, services, pensions, annuities, veteran benefits, and Social Security benefits. SSI, tax refunds, and veteran benefits that support dependents will not be considered. Your household income must be below 138% of the Federal Poverty Level to qualify.
Western Sky Community Care Centennial Care
Medicaid managed care provider in New Mexico . Call us today and sign up 1-844-543-8996. For contact info for specific services, members can visit the web page:
Geographic Area Served:
Parent Organization
Western Sky Community Care
Western Sky Community Care is committed to providing solutions for Medicaid beneficiaries throughout New Mexico. Western Sky Community Care, a wholly-owned subsidiary of Centene, in partnership with the New Mexico Human Services Department, will provide coordinated healthcare, long term services and supports, pharmacy, vision and transportation services. Western Sky Community Care will work closely with Primary Care Providers and Centennial Care enrolled members in providing comprehensive care coordination ensuring their medical needs are met. We partner with physicians, specialists, hospitals, and other providers, such as pharmacy and vision, to ensure that each member receives quality healthcare.
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New Mexico Medicaid Application
You can apply for New Mexico Medicaid online, by mail, or in person at your local Human Services Department field office. To apply online, visit Yes New Mexico.
To apply by mail, to download the English application, or to download the Spanish application. At the bottom of the Medicaid app, youll find the applications for other programs like cash assistance, SNAP, and LIHEAP . You can apply for everything at once, or you can apply solely for Medicaid. Once youve downloaded and completed your application, you can either fax it to 1-855-804-8960 or mail it to the Central ASPEN Scanning Area at PO Box 830 Bernalillo, NM 87004.
Nm Managed Care In 2019
The Centennial Care program is managed through four plans in 2019: BlueCross BlueShield of New Mexico, Western Sky Community Care, Presbyterian Health Plan, and UnitedHealthcare Community Plan of New Mexico. The UnitedHealthcare Community Plan is a dual complete plan for members with both Medicare and Medicaid. The coverage through each of the other plans is relatively similar, though they may have different provider networks and offer extra benefits, like:
BlueCross BlueShield of New Mexico:
- Free infant car seats and cribs for eligible members
- Extended adult vision benefits
- Extended lodging for homeless members
Western Sky Community Care:
- School sports physicals for kids ages 12-18
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How Does Medicaid Provide Financial Assistance To Medicare Beneficiaries In New Mexico
Many Medicare beneficiaries receive Medicaid assistance that can help them with the cost of Medicare premiums, lower prescription drug costs, and pay for expenses not covered by Medicare such as long-term care.
Our guide to financial assistance for Medicare enrollees in New Mexico includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.
Western Sky Community Care
Western Sky Community Care is committed to providing solutions for Medicaid beneficiaries throughout New Mexico. Western Sky Community Care, a wholly-owned subsidiary of Centene, in partnership with the New Mexico Human Services Department, will provide coordinated healthcare, long term services and supports, pharmacy, vision and transportation services. Western Sky Community Care will work closely with Primary Care Providers and Centennial Care enrolled members in providing comprehensive care coordination ensuring their medical needs are met. We partner with physicians, specialists, hospitals, and other providers, such as pharmacy and vision, to ensure that each member receives quality healthcare.
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New Mexico Medicaid Enrollment
From the fall of 2013 through July 2016, total enrollment in New Mexico Medicaid increased by 303,355 people, or 66%, and reached 761,033. As was the case in most states, enrollment grew sharply in 2014 and 2015, but had mostly leveled off by 2016. By the end of 2017, New Mexico Medicaid enrollment had dropped slightly, and total enrollment growth stood at 63%
But as of November 2021, total New Mexico Medicaid and CHIP enrollment had grown by another 100,000 people, and stood at 861,297. This was an 88% increase over 2013 levels. This large jump in enrollment since 2016 is mostly due to the COVID-19 pandemic and the Families First Coronavirus Response Act, which provides additional federal Medicaid funding as long as states do not disenroll anyone from Medicaid during the COVID public health emergency.
According to U.S. Census data, the uninsured rate in New Mexico fell from 19.6% in 2010 to 10% in 2019 a drop of almost 50%, versus the national average drop of about 40%.
New Mexico Opted For State Subsidies Instead Of Medicaid Buy
In 2017, Nevada lawmakers passed legislation that would have allowed for Medicaid buy-in, but Governor Brian Sandoval vetoed it. If he had approved it, New Mexico would have been the first state with a Medicaid buy-in program.
U.S. Representative, Ben Ray Lujan, who represents New Mexicos 3rd Congressional District, supports the idea of Medicaid buy-in. And Governor Michelle Lujan Grisham, who was a U.S. Representative until winning her 2018 gubernatorial race, introduced legislation at the federal level in 2017 that would have allowed people to buy into Medicaid. The Health Care Choices and Affordability Act did not advance at the federal level, but creating a Medicaid buy-in program may end up being more feasible at the state level.
In early 2018, lawmakers in New Mexico passed two legislative memorials calling for a cost analysis of a potential Medicaid buy-in program in New Mexico. Lawmakers wanted to get a good idea of the costs of allowing New Mexico residents who arent eligible for Medicaid to purchase Medicaid instead of obtaining private coverage or remaining uninsured. They also wanted feedback from stakeholders in terms of the implications and pros and cons of a Medicaid buy-in program in New Mexico.
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Centennial Care Insurers: Blue Cross Blue Shield Of New Mexico Presbyterian And Western Sky
Under a Medicaid managed care model like Centennial Care, the state contracts with private insurers rather than directly providing Medicaid coverage to residents. The state pays the insurers, and the insurers provide Medicaid benefits to enrollees. As of 2022, there are three insurers in the Centennial Care Medicaid managed care program: Blue Cross Blue Shield of New Mexico, Presbyterian, and Western Sky Community Care.
Four insurers had Centennial Care contracts through the end of 2018: Blue Cross Blue Shield of New Mexico, Molina, Presbyterian, and UnitedHealthcare. But Molina and UnitedHealthcare were not selected to continue to provide Medicaid managed care services in New Mexico starting in 2019. Presbyterian and Blue Cross Blue Shield had their contracts renewed, and Western Sky Community Care also won a contract with Centennial Care. Those three insurers are continuing to provide Medicaid managed care in 2020.
Molina filed a lawsuit against the state, alleging that Western Skys bid win may have been tainted by an official with a conflict of interest, but a judge threw out the lawsuit. Molina initially said that if they couldnt remain in the Centennial Care program, they may leave the state entirely , because Medicaid managed care is the most significant portion of Molinas business in New Mexico. But that did not come to pass, and Molina still offers coverage in the New Mexico exchange.
Lists Of Offices And Service Providers
- Aging and Disability Resource Centers contract with HHS to provide information to Texans who are older or who have disabilities so they can find the right long-term care services. You also can call 855-937-2372.
- Area Agencies on Aging contract with HHS to provide local services to anyone 60 and older and their caregivers. You also can call 800-252-9240.
- Community Services Regional Offices provide administrative support to community services contractors and enroll people in community services programs.
- DSHS Locations includes contact information for the health services regions, community mental health centers, public health organizations, and state hospitals.
- Local Intellectual and Developmental Disability Authorities contract with HHS to provide services to people who have intellectual and developmental disabilities.
- Regulatory Services Regional Offices provide administrative support to Regulatory Services staff in the regions.
- Service and Benefits Offices provides a searchable list of benefit offices around the state.
- State supported living centers provide campus-based direct services and supports to people with intellectual and developmental disabilities at 13 locations around the state.
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How To Apply / Learn More
If already on Medicaid, a beneficiary can talk to his or her managed care organization about receiving services under the Community Benefit.
If Medicaid eligibility has not yet been determined, the Human Services Department eligibility office will serve applicants. The quickest route is to create a login account at the states health care web portal, Yes New Mexico. Alternately, potential applicants can call the HSD Medicaid Expansion Hotline at 855-637-6574 to apply. For questions, one can call the customer service hotline at the states Medicaid Call Center at 997-2583. A list of local HSD offices can be found here.Persons uncertain regarding their Medicaid eligibility, should consult with a Medicaid planner in advance of their application. Read more.
While ideally NM switching to Medicaid managed care should have eliminated wait lists for community based services, some press reports indicate this is not yet the case. That said, approximately 30,000 New Mexican residents are receiving help in their homes through this program.
Get Help Finding Information
Visit our Help Finding What You Are Looking For page where you’ll find contact information for some of our most requested services including:
- Help with your benefits or technical issues with the YourTexasBenefits.com website
- Information on how COVID-19 may affect your benefits
- Questions about your Lone Star Card
- Child care licensing questions
- Long-term care provider licensing information
- Help with downloading a form
- Technical issues with this website
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