Medicaid agency: HCA / Medical Assistance Division (MAD)
New Mexico Medicaid is administered by the Health Care Authority (HCA), formed July 1, 2024 when the former Human Services Department was renamed and consolidated with the Developmental Disabilities Supports Division and Division of Health Improvement, both moved over from the Department of Health; Medicaid itself sits within HCA's Medical Assistance Division, serving more than 800,000 New Mexicans. New Mexico expanded Medicaid under the ACA and launched Centennial Care, its first comprehensive risk-based managed care program, both effective January 2014; Centennial Care was rebranded Turquoise Care on July 1, 2024, under a continuing Section 1115 demonstration covering four MCOs (Blue Cross Blue Shield of New Mexico, Presbyterian Health Plan, Molina Healthcare of New Mexico, and UnitedHealthcare Community Plan). CHIP runs within this same demonstration and MCO delivery system rather than as a separately administered program. HCA's own site describes the current demonstration as authorized through December 31, 2028 while CMS's own demonstration tracking shows an expiration of December 31, 2029 for the same authority; the four MCOs' current contracts run July 1, 2024 through December 31, 2026, renewable in one-year increments to an eight-year ceiling, with Molina and UnitedHealthcare new to this cycle. Work requirements phase in starting 2027, requiring 80 hours of monthly activity with six-month renewal cycles, and immigration-eligibility restrictions take effect October 1, 2026; New Mexico is a named plaintiff in the multistate lawsuit challenging the CMS rule that narrowed the medically-frail work-requirement exemption, which remains pending ahead of the January 2027 deadline.
CMS's most recent managed care enrollment data, report year 2024, reflects the Turquoise Care transition already under way: four comprehensive MCOs (Blue Cross Blue Shield of New Mexico, Presbyterian Health Plan, Molina Healthcare, and UnitedHealthcare) report combined enrollment of 735,171 members. A separate Program of All-Inclusive Care for the Elderly plan, Total Community Care, dba InnovAge Greater New Mexico PACE, covered 451 members in the 2024 report year.
Long-term services and supports are integrated directly into all four Turquoise Care MCO contracts through the 1115 demonstration's Community Benefit, rather than run through a separate 1915(b) mechanism. New Mexico also administers standalone 1915(c) home- and community-based waivers through the Developmental Disabilities Supports Division (DDSD) within HCA: the Developmental Disabilities Waiver and the Medically Fragile Waiver are both mid-renewal through June 2031, and the Mi Via self-directed waiver runs through September 2030; New Mexico eliminated its DD/Mi Via waitlist under FY2026 funding. Native American members may generally choose between Turquoise Care and fee-for-service, and may use Indian Health Service, tribal, and urban Indian (I/T/U) facilities regardless of which they choose; members receiving the Community Benefit specifically are required to enroll in Turquoise Care. HCA consults with all 12 of New Mexico's federally recognized tribal nations quarterly through its Native American Technical Advisory Committee on Turquoise Care and 1115 waiver matters.
Integrated into managed care
Behavioral health is capitated directly into all four Turquoise Care MCO contracts alongside physical health and LTSS, rather than carved out to a separate vendor.
Carved in
Dental runs through each MCO's own subcontracted network rather than a single statewide carve-out. Blue Cross Blue Shield of New Mexico, Molina, and Presbyterian all subcontract to DentaQuest; UnitedHealthcare's dental administrator is not named on any of the four plans' own public materials.
Each Turquoise Care MCO runs its own pharmacy benefit manager: Blue Cross Blue Shield of New Mexico through Prime Therapeutics, Presbyterian Health Plan through Capital Rx, Molina through CVS Caremark, and UnitedHealthcare through Optum Rx, with Conduent processing fee-for-service pharmacy claims for members not enrolled in a Turquoise Care MCO. HCA implemented a statewide Preferred Drug List effective July 1, 2026; HCA's own PDL page notes it is still procuring a vendor to build the list out further.
Non-emergency medical transportation is subcontracted per MCO rather than through a single statewide broker. Molina's NEMT vendor is Superior Medical Transport; the other three plans' vendors are not named on their own public materials.
Conduent is New Mexico's Medicaid Management Information System fiscal agent, operating Turquoise Claims, the state's claims and eligibility portal at YES.NM.GOV. General Dynamics Information Technology holds a separate Medicaid Enterprise Benefit Management Services contract covering provider enrollment, credentialing, and training.
63 agency updates tracked for New Mexico. Available with Pro.
See them with ProNew Mexico's Behavioral Health Reform and Investment Act Executive Committee on Tuesday approved the final two of 13 regional behavioral health plans, covering regions 4 (Mora, San Miguel, Guadalupe counties) and 12 (Lincoln, Otero counties), completing approval of all 13 regional plans required under the 2025 law. The two plans carry a combined cost of nearly $13.5 million and target workforce recruitment, housing, and treatment infrastructure gaps left after a 2013 fraud scandal drove providers from the state. The law created 13 regions modeled on judicial districts, with local officials identifying behavioral health needs. Despite completing the milestone, some lawmakers and local officials continue to criticize the committee for slow progress, unclear goals, and insufficient coordination with tribal leaders.
Incumbent U.S. Rep. Teresa Leger Fernández (D) faces state Rep. Martin Zamora (R-Clovis) in the Nov. 3, 2026 general election for New Mexico's 3rd Congressional District. In an interview with Source NM, Leger Fernández criticized Trump administration and Republican-backed cuts to Medicaid and food assistance, citing 10,000 New Mexico children who lost federal benefits due to the One Big Beautiful Bill, and said she would prioritize legislation to increase healthcare providers in rural areas. Zamora, who did not respond to interview requests, has campaigned on property rights, energy jobs, crime and border security rather than healthcare. The race will determine representation for a largely rural northern and eastern New Mexico district with significant Medicaid-dependent populations.
The committee tasked with rebuilding New Mexico's behavioral healthcare infrastructure has approved 11 of 13 regional plans, with two regional plans remaining for approval. The chair provided the update to the interim Legislative Finance Committee on Tuesday. The approvals represent progress toward statewide implementation of a restructured behavioral health delivery system. This development directly affects how behavioral health services will be organized and delivered across New Mexico's Medicaid program.
CMS announced a $74 million investment in New Mexico through the federal Rural Health Transformation Program to expand access to specialty, maternal, behavioral health, and chronic disease care in rural, frontier, and tribal communities. The funds support six Regional Hub Organizations leading Healthy Horizons, one component of the state's five-year RHTP strategy. The hubs will begin by coordinating with local providers and community partners to identify needs, set priorities, and develop plans that bring services closer to home. The investment is part of New Mexico's larger fiscal year 2026 award under the $50 billion RHTP and is grant funding, separate from Medicaid demonstration or waiver authority.
The Accountable Produce is Medicine Act of 2026, co-sponsored by Sen. Martin Heinrich (D-N.M.) and introduced in August 2026, would require the Center for Medicare and Medicaid Innovation to conduct a five-year study on whether paying for nutrition assistance programs improves outcomes for Medicaid and Medicare beneficiaries with chronic diseases. The bill would evaluate clinical measures including weight, blood pressure, and blood glucose. Currently, food prescription programs like Presbyterian Healthcare Services' Food Farmacy in New Mexico rely entirely on health system or donated funding because food distribution is not a billable Medicaid or Medicare service. Both House and Senate versions await committee consideration.
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