New Mexico Medicaid covers a broad range of services, including doctor visits, hospital care, prescriptions, behavioral health, dental, vision, long-term care, and transportation to medical appointments. The state delivers most of these benefits through its managed care program, now called Turquoise Care, which launched in July 2024 with four health plan options. Whether you’re newly eligible or trying to understand what’s included, here’s a detailed breakdown of what the program covers.
How Turquoise Care Works
New Mexico Medicaid operates primarily through managed care. As of July 2024, members choose from four health plans: Blue Cross Blue Shield, Molina Healthcare, Presbyterian Health Plan, or United Healthcare Community Plan. All four cover the same core physical health, behavioral health, and long-term services. The difference between plans comes down to provider networks and value-added extras each plan offers on its own, such as housing support, specialized dental or vision services, culturally responsive treatments, and additional transportation benefits beyond what standard Medicaid provides.
Core Medical Services
All members have access to the foundational benefits you’d expect from a health insurance plan: primary care visits, specialist referrals, hospital stays (inpatient and outpatient), emergency room care, lab work, imaging, and preventive screenings. Chiropractic services were added as a covered benefit under the Turquoise Care transition.
Prescription drugs are covered with minimal out-of-pocket cost. For preferred medications (those on the plan’s formulary), the copay is $0.50. Non-preferred drugs carry a copay of up to $3.00. Federal law caps Medicaid copays at $4 for preferred drugs and $8 for non-preferred drugs for most beneficiaries, so New Mexico’s costs fall well below those limits. Certain groups, including children and pregnant members, are exempt from copays entirely.
Behavioral Health and Substance Use Treatment
New Mexico Medicaid covers a full spectrum of mental health and substance use disorder services. This includes individual therapy, group therapy, psychoeducation, and psychiatric medication management. For people in crisis, mobile crisis intervention teams are available and required to screen for co-occurring substance use disorders, including opioid use disorder.
For substance use treatment specifically, coverage includes intensive outpatient programs, partial hospitalization, residential treatment, and outpatient withdrawal management using both medication and non-medication approaches. Partial hospitalization programs provide structured counseling and therapy sessions delivered by licensed behavioral health professionals, designed to stabilize acute psychiatric or substance use symptoms while keeping the person connected to their community rather than confined to an inpatient setting.
Children’s Preventive Benefits (EPSDT)
Children and adolescents under 21 receive one of the most comprehensive benefit packages in Medicaid through the Early and Periodic Screening, Diagnostic and Treatment program, known as EPSDT. This benefit is specifically designed to catch health problems early and treat them before they become serious. It includes:
- Physical exams at age-appropriate intervals, including full unclothed examinations
- Developmental screenings to identify delays or concerns
- Immunizations following the nationally recommended vaccine schedule
- Lead screening at 12 and 24 months, plus catch-up testing for any child between 24 and 72 months who hasn’t been tested
- Vision and hearing screening, diagnosis, and treatment, including eyeglasses and hearing aids
- Dental screenings on a regular schedule
- Health education covering child development, healthy habits, and injury prevention
The key feature of EPSDT is that if a screening identifies a problem, Medicaid must cover the diagnostic testing and treatment to address it, even if that service wouldn’t normally be covered for adults. This makes it one of the most protective health benefits available to children in the U.S.
Dental Coverage
Children under 21 get dental exams, cleanings, and fluoride treatments every six months. Orthodontic services, including braces and retainers, are covered with prior authorization when they meet medical necessity criteria. This means braces for purely cosmetic reasons typically won’t qualify, but cases involving bite problems or other functional issues can be approved.
Adult dental coverage is available through the Turquoise Care plans, though the specifics vary. Some managed care organizations offer enhanced dental benefits as part of their value-added services, so the plan you choose can affect what’s available to you beyond the baseline.
Pregnancy and Postpartum Care
Pregnant members receive full prenatal coverage, including routine checkups, lab work, ultrasounds, and delivery. New Mexico expanded postpartum Medicaid coverage in April 2022, extending it from just 60 days after delivery to a full 12 months. This change affects an estimated 17,000 New Mexicans each year and allows new mothers to maintain coverage for chronic conditions like diabetes, depression, heart conditions, and substance use disorder during a critical recovery period. Income limits for pregnancy-related coverage are set separately, with monthly thresholds ranging from $451 for a single-person household to $1,553 for a household of eight under certain eligibility categories.
Long-Term Care and Home-Based Services
New Mexico operates several programs for people who need ongoing support to live independently or who require institutional-level care. The state runs four home and community-based services programs:
- Developmental Disabilities Waiver: serves people with intellectual or developmental disabilities with supports like day programs, residential services, and personal care
- Medically Fragile Waiver: covers individuals with complex medical needs who would otherwise require hospital or nursing facility care
- Mi Via Waiver: a self-directed option that gives participants control over hiring their own caregivers and choosing their services
- Centennial Care Demonstration Waiver (Section 1115): provides community-based long-term services and supports through the managed care plans
These waivers are designed to keep people in their homes and communities rather than in institutional settings. Eligibility depends on both financial criteria and the level of care a person needs. Some waivers have waiting lists, so applying early matters if you or a family member may qualify.
Transportation to Appointments
Medicaid in New Mexico covers non-emergency medical transportation for members who have no other way to get to their appointments. Before the program pays for a ride, you’re expected to exhaust free options first, such as rides from family, friends, volunteer services, or free public transit. If none of those are available, Medicaid will reimburse for ambulance transport when medically required, specialized medical vehicles, common carriers like buses or taxis, or mileage reimbursement for a private car. Out-of-state transportation requires prior authorization. The program always pays for the least costly option that’s appropriate for your medical needs.
Vision Services
Children receive periodic vision screenings as part of EPSDT, with coverage for diagnosis and treatment of vision problems, including eyeglasses. Some Turquoise Care plans include enhanced vision benefits as value-added services for adults, which can go beyond the standard Medicaid benefit. Checking your specific plan’s extras is worth doing if vision care is a priority for you.