New Mexico

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Managed LTSS Program

In August 2012, the state submitted its Centennial Care §1115 Demonstration Waiver Proposal. Under the demonstration, the state is consolidating its §1915(b) and 1915(c) waivers to create a comprehensive managed care delivery system. Centennial Care's contracted health plans offer acute; behavioral health; institutional; and community-based LTSS. The system features expanded care coordination; a beneficiary reward program to incentivize beneficiaries to pursue healthy behaviors; and a Safety Net Care Pool. Native American Medicaid beneficiaries can voluntarily opt-in; and the state auto-enrolls dually-eligible Native American beneficiaries and those who meet nursing facility level-of-care. (Source: State Centennial Care website; Centennial Care FAQs, 6/19/13)
Waiver application (8/17/2012)

In July 2013, CMS approved the demonstration proposal; and effective January 1, 2014, Centennial Care replaced New Mexico’s previous Medicaid managed care programs, CoLTS and Salud!. The demonstration will be implemented through December 31, 2018. (Source: State Centennial Care website; Centennial Care FAQs, 7/2/2013; Approval Letter, 7/12/2013)

State Demonstration to Integrate Care for Dual Eligible Individuals (Withdrawn)

In August 2012, the state withdrew its demonstration proposal. Under the proposed demonstration, dually-eligibles receiving services through the state’s Developmental Disabilities Waiver would have received regular medical benefits; but LTSS would have remained fee-for-service and carved out of managed care. (Source: Withdrawal Letter to CMS, 8/17/2012; Demonstration Proposal, 5/2012)

Health Homes

CMS has approved the state’s Heath Home Planning Request. (Source: CMS State Health Home Proposal Status website, 6/2014) New Mexico is working under a §2703 planning grant to design a SPA establishing Behavioral Health Homes within Core Service Agencies statewide, coordinating the BHHs with MCOs established under the Centennial Care §1115 demonstration waiver. Once a recipient enrolls in a BHH, MCOs will delegate care management and care coordination responsibilities to the BHH. Over time, the state intends to establish Health Homes for other chronic conditions through the SPA process, continuing to coordinate the Health Homes models with Centennial Care to ensure care integration at all levels. (Source: Centennial Care §1115 Demonstration Waiver Application)

On March 21, 2016, CMS formally approved New Mexico’s Medicaid health home state plan amendment (SPA), which became effective April 1, 2016. The health home initiative will be known as CareLink NM, and will serve adults with serious persistent mental illness, and children with serious emotional disturbance in San Juan County and Curry County. Health homes receive an enhanced per-member per-month (PMPM) payment in order to cover the costs of health home services. (Source: SPA 3/21/2016; NASHP 4/12/2016)

Disclaimer: This project was supported, in part by grant number 90BC0018, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.