Current Updates (as of 5/7/2019)
The New Mexico Department of Health (DOH) announced that Governor Lujan Grisham has instructed DOH and the Human Service Department (HSD) to develop a new Medicaid waiver program to serve people with developmental disabilities who are waiting for services. The Medicaid supports waiver program would serve approximately 5,000 people currently on the waitlist for New Mexico’s three other waiver programs.
The work of DOH and HSD will include:
- Researching how other states administer their Supports Waivers and incorporating best practices.
- Looking at program elements such as populations served.
- Funding allotments for service plans.
- Surveying home and community-based services for people on the wait list
(Source: New Mexico Medicaid HCBS Waiver Program, 3-22-2019)
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, link no longer available (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)
The New Mexico Human Services Department (HSD) has released a procurement schedule for MCOs to serve in the Centennial Care Medicaid managed care program, which includes MLTSS. The state proposes the following timeline, but HSD notes that all dates are subject to its discretion:
(Source: Procurement Schedule 6/1/2017)
State Demonstration to Integrate Care for Dual Eligible Individuals (Withdrawn)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)
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, link no longer available)
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)