New Mexico Medicaid Managed Care Organizations: Choosing Your MCO Plan

The Four Turquoise Care MCOs

When New Mexico transitioned from Centennial Care 2.0 to Turquoise Care on July 1, 2024, the state contracted with four Managed Care Organizations to administer Medicaid benefits, including long-term services and supports. For parents enrolled in Turquoise Care managed care, one of these four plans administers their benefits:

• Blue Cross Blue Shield of New Mexico (BCBSNM)
• Presbyterian Health Plan
• Molina Healthcare of New Mexico
• UnitedHealthcare Community Plan

All four MCOs are required to cover the same core Medicaid benefits, including nursing facility care, the Agency-Based Community Benefit (ABCB) for home care, and the Self-Directed Community Benefit (SDCB). The differences show up in provider networks, care coordinator responsiveness, and value-added services that go beyond the Medicaid minimum.

How to Choose the Right MCO

The most important factor is whether your parent's existing doctors, specialists, and preferred nursing facilities are in-network with the MCO you select. A plan with a larger statewide network matters less than one that includes the specific providers your parent already trusts.

To compare networks, call each MCO's member services line or use their online provider directories. The state's MCO enrollment line at 1-888-997-2583 can also walk you through the options.

Beyond network coverage, consider these practical differences:

Care coordinator quality. Each MCO assigns a care coordinator who manages the Comprehensive Needs Assessment, authorizes home care hours, and coordinates transitions between nursing facilities and home-based care. The coordinator is your primary point of contact for everything from adjusting care hours to navigating the 120-day ABCB trial before Self-Directed services become available. Ask other families in your area about their experience with each MCO's coordination team.

Value-added services. MCOs offer benefits beyond the Medicaid floor. Presbyterian Health Plan, for example, provides up to $300 once per calendar year to Native American Turquoise Care members specifically for traditional medicine or tribal ceremonial purposes. Other MCOs offer transportation benefits, meal delivery, or respite care hours that exceed the standard allocation.

Rural access. If your parent lives outside Albuquerque or Santa Fe, some MCOs have significantly thinner provider networks in rural and tribal communities. Verify that home care agencies contracted with your chosen MCO actually serve your parent's county.

Switching MCOs

You can switch plans during the annual open enrollment period. If you experience a qualifying event — like your parent's primary care provider leaving the MCO's network — you may be able to switch outside the enrollment window by calling the state enrollment line.

Before switching, ask the state enrollment unit and both MCOs how your parent's completed ABCB days will be recorded; the 120-day requirement applies to new Community Benefit enrollees.

Why MCO Selection Matters for Long-Term Care

Your MCO choice determines who conducts your parent's Comprehensive Needs Assessment, how quickly home care hours are authorized, and how smoothly a nursing-home-to-home transition works. A poorly matched MCO creates friction at every step — delayed authorizations, out-of-network referrals, and care coordinators who don't return calls.

The New Mexico Medicaid Long-Term Care & Asset Protection Guide includes a step-by-step MCO evaluation checklist and explains how the Turquoise Care system coordinates with nursing facility admissions, the Central Registry waitlist, and the financial eligibility process managed by the Income Support Division.

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