Frequently Asked Questions
What is Centennial Care?
Centennial Care is the new name of the New Mexico Medicaid program. Centennial Care will begin January 1, 2014 and services will be provided by four managed care organizations (MCOs). These services include physical health, behavioral health, long-term care and community benefits.
What is a Managed Care Organization (MCO)?
A managed care organization (MCO) is an insurance company that contracts with providers and medical facilities to provide healthcare services to its members.
Who are the Managed Care Organizations (MCOs) offering Centennial Care coverage?
- Blue Cross Blue Shield of New Mexico
- Molina Health Care of New Mexico, Inc.
- Presbyterian Health Plan, Inc.
- United Health Care Community Plan of New Mexico
When does Centennial Care start?
Centennial Care starts on January 1, 2014. You will be able to choose a Centennial Care managed care organization (MCO) starting October 15, 2013.
Is Centennial Care the same as the State’s Medicaid Redesign?
Yes. Medicaid’s different programs—Salud, CoLTS and Optum—are being combined into one program, called Centennial Care.
Is Centennial Care available in states other than New Mexico?
No. Each state has its own Medicaid program and Centennial Care is the new name for New Mexico’s Medicaid program.
Why is New Mexico changing its Medicaid program(s) to Centennial Care?
New Mexico is changing to Centennial Care to make it easier for you. You will be able to get the care you need in one place. Whether you need to see your primary care doctor, a mental health provider or if you have long-term care needs, your Centennial Care managed care organization can help you get the care you need.
Who may be eligible for Centennial Care?
Most people who are currently enrolled in a New Mexico Medicaid program will be eligible for Centennial Care. For all Medicaid programs, you have to meet certain federal guidelines. These include citizenship, residency and income requirements. For more information on Centennial Care, please visit our web site at www.CentennialCare.net.
What does the Federal Poverty Level (FPL) have to do with Centennial Care Eligibility?
To be eligible for Centennial Care, you have to be financially eligible. The financial guidelines are set by the US Dept of Health and Human Services and are called the Federal Poverty Levels (FPLs). FPLs are based on your income and your total household size. Different types of coverage in Centennial Care may have different FPL guidelines.
Who will receive services through Centennial Care?
Most, but not all, people who are eligible for New Mexico Medicaid will get their services from a Centennial Care managed care organization (MCO). If you are enrolled in the DD waiver, you will receive acute care services through Centennial Care and continue to receive waiver services as you do now. And, Native Americans who are currently enrolled in CoLTS or who meet a nursing facility level of care will receive services through Centennial Care.
Do I have to be unemployed to get Centennial Care?
No. Most people and families who are eligible for Centennial Care work very hard to support themselves but still meet the financial eligibility guidelines.
Do I have to pay to be enrolled in Centennial Care?
No. There is no cost to enroll in Centennial Care. Some enrollees may pay minimal co-payments for doctor visits, emergency room care and prescriptions.
Do I need to apply for Centennial Care if I am already enrolled in a NM Medicaid program?
No. If you are already enrolled in a New Mexico Medicaid program, you do not need to fill out a new application. But, you will need to pick the managed care organization (MCO) you want to provide your Centennial Care services.
My kids are enrolled in New MexiKids. Do I have to switch them to Centennial Care?
With the exception of Native Americans, all kids currently enrolled in New MexiKids will be enrolled into Centennial Care starting January 1, 2014.
If I have both Medicare and Medicaid, will I have to change my Medicare plan as part of Centennial Care?
No. Your Medicare services and doctors will stay the same. Only your Medicaid coverage will be through Centennial Care. It’s the responsibility of your Centennial Care managed organization (MCO) to make sure that they coordinate your services with your Medicare Primary Care Physician.
What services are covered under Centennial Care?
Centennial Care covers physical health, behavioral health, long-term care and community benefits. Depending on your healthcare needs, the managed care organization (MCO) that you choose to provide your care may assign someone to help you coordinate your care so that you receive all of the services you need.
What is a Community Benefit?
The “Community Benefit” is the name given to a set of services that help to keep people in their homes and communities. Some of these services include: adult day health, respite care and personal care services.
Who can get the Community Benefit?
If you are on Medicaid and have health issues that are serious enough for you to need care in a nursing home, you may be able to get the community benefit.
How do I get the Community Benefit?
If you are on Medicaid, you will talk to your managed care organization (MCO). If you are not on Medicaid, you will go to a Human Services Department eligibility office and they will help direct you to the right place.
Does Centennial Care pay for emergency room visits?
Yes. Centennial Care includes preventative, emergency, specialty care and behavioral health services. Some categories of eligibility may require co-pays for emergency room services.
What happens if I have an emergency while I am traveling outside of New Mexico? Can I still get medical care?
Yes. If you are a Centennial Care member and have a medical emergency while traveling out of state, the doctor or hospital treating you will contact your Centennial Care managed care organization (MCO) to get authorization for your care.
I need to see a specialist, what do I need to do?
Your primary care physician (PCP) must request a referral for you to see a specialist. If you would like additional information, you may contact your managed care organization’s member service unit.
Will I have to pay a co-pay to see my doctor, get a prescription or go to the emergency room?
Some categories of eligibility may require minimal co-payments for doctor visits, emergency room care and prescriptions. You may check the New Mexico Medicaid Portal (https://nmmedicaid.acs-inc.com) or call 1-888-997-2583 to see if you are required to make co-pays.
Will I have a gap in coverage when the state switches to Centennial Care?
No. Your current enrollment in Salud!, CoLTS, and New MexiKids will end December 31, 2013, and you will be enrolled with your Centennial Care managed care organization (MCO) starting January 1, 2014. If your current MCO is different than your Centennial Care MCO, your current one will let the new MCO know about any approved services you already receive.
How will my providers know that I am enrolled in Centennial Care?
Your Centennial Care managed care organization (MCO) will issue a Member ID Card to you. You should show your ID card when you get treatment or when you fill prescriptions.
When do I renew my Centennial Care coverage?
Coverage for most Centennial Care programs must be renewed every 12 months. About 4-6 weeks before your renewal is due, the Human Services Department (HSD) will send you a letter telling you that it’s time for you to renew your coverage. When you renew, you should make sure that the information that HSD has on file for you is up to date and accurate. Any changes you have in address, income, family size or other insurance coverage should be reported to HSD.
When will I be able to choose my Managed Care Organizations (MCOs)?
In the Fall of 2013, you will get a orange envelope from the Human Services Department (HSD) asking you to select a Centennial Care MCO. This letter will let you know how to make your choice on the phone, on-line or through the mail. If the MCO that you have right now is also a Centennial Care MCO, you may be able to re-enroll with them. If you do not choose an MCO, you will automatically assigned to one. Native Americans who do not need of long-term care services are not required to choose and will not be assigned to an MCO since they can remain in fee-for-service.
How can I choose the Centennial Care Managed Care Organization (MCO) that is right for me?
Ask your doctors which Centennial Care MCO(s) they’re contracted with. You should also check each of the MCO(s) provider listings to find out which doctors are part of their network. You may also find out what extra benefits each of the MCOs offer. When you get your orange MCO enrollment letter from the Human Services Department (HSD), it will include a phone number and a website for each MCO so that you can get the answers you need to choose the MCO that is best for you.
Once I choose a Managed Care Organization (MCO), will I be able to change to a different MCO?
Yes. You can change your MCO in the first 90 days after choosing or being assigned to one. You also have the chance to change your Centennial Care MCO each year when it’s time for you to renew your coverage.
I have heard that I can’t change my Centennial Care Managed Care Organization (MCO) after I am “locked in.” What does this mean?
After you pick or get assigned to an MCO, you have 90 days to switch to a different MCO for any reason. After that 90 day period, you are “locked in” to receive services from that MCO and can only change to a different MCO for certain reasons. To request an MCO switch after you are locked in, you must submit the request in writing. For more information on how to submit a request, you may call the New Mexico Medicaid Call Center at 1-888-997-2583.
If I don’t pick a Centennial Care Managed Care Organization (MCO) by December can I still get medical services in January?
Yes. If you don’t pick a Centennial Care MCO, you will be assigned to one (unless you are not required to enroll in managed care) and will get services from that MCO starting January 1, 2014. If you are enrolled with a current New Mexico Medicaid MCO that is also going to be a Centennial Care MCO, you will be automatically assigned to your current MCO.
Will Centennial Care managed care organizations (MCOs) have a list of providers in the state that I can see for care?
Yes. When you choose your MCO, you will receive a provider directory and a member handbook with information that tells you what providers are in the MCO network and how you can get the care you need.
Will my Centennial Care Managed Care Organization (MCO) be different than my Salud! MCO?
It could be different. Centennial Care will have four MCOs to provide services. Some, but not all of them, are the same as the current Medicaid MCOs. In the Fall of 2013, you will get an orange letter from the Human Services Department asking you to pick a Centennial Care MCO. You need to choose your MCO by November 27, 2013 but if you do not, you will be automatically assigned to one.
Can I change my primary care physician (PCP)?
Yes. You can change your PCP at any time but you have to make the change through your managed care organization (MCO). You will need to contact your MCO member services department for assistance in changing your PCP.
Can I still see my same doctors and use my regular pharmacy under Centennial Care?
Your Medicaid doctors and pharmacy need to be contracted with your Centennial Care Managed Care Organization (MCO) for you to get services from them. If you are on Medicare and Medicaid, you can keep seeing your Medicare doctor(s).
How do I know if my doctor is contracted with a Centennial Care Managed Care Organization (MCO)?
Ask your doctors if they are contracted with a Centennial Care MCO. You can also check the provider directories on the MCO websites.
I can’t find a doctor (primary care, dental, vision, etc) in my area. What do I do?
You should contact your Managed Care Organization’s (MCO) member service unit and request help in finding providers.
I am enrolled in State Coverage Insurance (SCI). Do I have to switch to Centennial Care?
In the Fall of 2013, the Human Services Department will send you a letter telling you whether you may be eligible for the new adult expansion category of Medicaid. If you might be eligible, you will get an orange letter from HSD asking you to select a Centennial Care managed care organization (MCO). This MCO may or may not be the same as your SCI MCO.
I have been on the State Coverage Insurance (SCI) waiting list. Can I enroll in Centennial Care now?
You may or may not be eligible for the new adult category of Medicaid. You can apply for the new Medicaid category beginning January 1, 2014. If you are not eligible for this category of Medicaid, you may be eligible to receive federal subsidies on the New Mexico Health Insurance Exchange. You may apply for Exchange coverage during its open enrollment period, beginning in October 2013.
If I have private insurance and Medicaid, do I have to participate in managed care?
Your Medicaid coverage will be provided by your Centennial Care managed care organization (MCO). If you also have private insurance, that is considered your primary insurance coverage and will be billed first. Medicaid may cover some services that your private insurance does not pay for. You should contact your MCO’s member services unit and let them know that you have other insurance so they can help you coordinate the services you need.
Is Centennial Care the same as the Affordable Care Act (ACA)?
No. Centennial Care is the new name for the New Mexico Medicaid program. Under the ACA, some people who are not eligible for Medicaid may be able to receive federal subsidies that can help them buy other insurance coverage on the New Mexico Health Insurance Exchange.
Is Centennial Care the same as Medicaid Expansion for Adults?
Medicaid Expansion is part of Centennial Care. The Expansion provides Medicaid eligibility to adults who are at or below 133% of the Federal Poverty Level (FPL). Adults who qualify for this category will receive their Medicaid services through a Centennial Care managed care organization (MCO). Native Americans who are eligible through the Expansion may enroll in Centennial Care or receive services through fee for service.
I still have questions. Where can I get more information?
For more information about Centennial Care, you may go to the Centennial Care web site at www.CentennialCare.net or call the New Mexico Medicaid Call Center at 1-888-997-2583.
You may look for an updated copy of these FAQs on the Centennial Care Website here.