Medicaid: Is it right for you?
Medicaid: Is it right for You?
Medicaid is a government-sponsored health care insurance, paid for by taxpayers.
New Mexico's Medicaid program is called Centennial Care. Its services include physical health, behavioral health, long-term care and community benefits. Centennial Care uses four existing insurance companies to provide this coverage.
Medicaid's mission is to provide no-cost or low-cost health insurance coverage to financially eligible citizens. Even if you didn't qualify before getting pregnant, you may qualify for maternity coverage now. Medicaid is expanding to cover more people.
Confused about Medicaid?
Many people are! But it's easy once you get into it. You only need to know if you qualify, and then complete an application. You can do both from this page.
Just add up the gross pay on your household's paychecks (the amount before taxes, insurance and everything else is taken out), and come up with the total for an average month.
If it's less than the numbers below*, you can qualify for Medicaid.
- Up to $3,384 for a pregnant woman and her unborn baby (family of 2)
- Up to $4,255 for a pregnant woman and unborn baby plus one (family of 3)
- Up to $5,125 for a pregnant woman and unborn baby plus two (family of 4)
- Add $871 for each additional family member
*These numbers are good through the end of March 2018.
Start the application process immediately if you think you may qualify for Medicaid. See below. It can take 45 days for coverage to be set up, and while you wait, your appointments may or may not be covered by Medicaid.
Find out for sure if you can get Medicaid, and apply today
You can find out for sure whether you qualify for any Medicaid program in New Mexico several ways. Choose the option that's easiest for you:
- Still not sure if you qualify? Check your eligibility and apply for a variety of state assistance programs, including Medicaid, food stamps, cash assistance, and help with home heating at YesNM!
- Talk to Health Care Guides through the NM Health Insurance Exchange (NMHIX), who can help you find the best path to becoming insured.
- Call NMHIX and see if they'll take your application over the phone: (855) 996-6449
- Seeing a state caseworker in person is often the fastest and easiest way to complete the process. You may hate the idea of going to the Income Support Division (ISD) or Human Services Division (HSD) office, but you'll get all the trouble out of the way at once if you can deal with a real person there. Try to arrive just before they open in the morning so you'll be seen first. Later in the day you may wait for hours. Click here to find a field office near you. And see below for the list of things to bring.
- Fill out a federal HealthCare.gov application online
- Complete the HSD's Medicaid application online and find instructions for mailing the application to HSD
- Get Medicaid coverage right away by applying for Presumptive Eligibility (PE) at almost any hospital in town. PE can cover your medical expenses for up to 60 days, starting on the day that you apply. PE doesn't cover birth, but your application for PE will be used to switch you to full coverage, which does include birth. That switch may take up to 45 days. Don't worry, it can cover you retroactively too.
- Even if you don't qualify for maternity benefits, you may be able to get your baby on Medicaid and/or get other benefits after birth. Ask your ISD/HSD caseworker about New Mexikids insurance and the WIC program (Women, Infants and Children). And contact the office manager at Dar a Luz to find out what other options we have for making your care here affordable.
Before you go for Medicaid ... 5 things to know
1. Before you start an application, gather these:
- Social security numbers of the family members to enroll
- Employment and income information -- paystubs, tax return, W2 forms
- Policy numbers, if you currently have health insurance (this doesn't affect your eligibility)
- The first date of your last menstrual period
- Though they are not supposed to require it anymore, they may ask for a "proof of pregnancy" letter from your midwife or doctor
2. If you qualify for Medicaid, you will be asked to select a Managed Care Organization (MCO) to administer your care. We accept all four MCOs (BCBS, United, Molina, Presbyterian), but you get the best deal with Molina.
If you choose Molina, you will pay the least at Dar a Luz. Molina Centennial Care covers almost all of our fees. The others do not cover our birth center services fee.
Each MCO has the same coverage for most things: certified nurse-midwife fees related to maternity, lab work, ultrasounds, hospital admission, doctor visits, specialist visits, other medical care, behavioral health, long-term care, prescriptions, emergencies, vision, dental, certain kinds of rehabilitation, and x-rays.
However, not all providers accept all MCOs. Call your favorite providers and find out if your choice will matter to them.
What else makes the MCOs different? They may have different value-added services, such as free carseats, cribs, and mileage reimbursement for trips to provider offices. And only Molina covers our facility fees. Visit their websites to find out what else they offer:
You can request an MCO change by calling the Insure New Mexico! Solutions Center at (888) 997-2583 or (800) 283-4465, or by contacting the MCO you want. For example, Molina makes it easy to switch: Request a callback here or call (877) 373-8986.
3. If you have other health insurance, don't be afraid to report that to Medicaid. They don't use that information when determining your eligibility for pregnancy coverage. And if you fail to report it to them, it could mean big trouble later ... insurance fraud. You could also be stuck paying your own medical bills plus fines for the extra handling of claims.
4. Pregnancy Medicaid is usually back-dated to the beginning of your pregnancy. So if you've been told that you are eligible, your prenatal care at Dar a Luz will likely be covered no matter when you start seeing us. We can hold our claims for a short time while you wait for your coverage to be ready, but you must keep us informed of the progress.
And it's important to know that even with insurance or Medicaid, you could be billed for your visits if your coverage falls through (this is rare).
5. Whatever you decide to do, please keep us informed. Tell us about all of your insurance policies. Tell us whenever anything changes. After your baby is born, add him or her to your Medicaid coverage within 30 days and tell us when it's done.
If you have questions about how Medicaid works at Dar a Luz, send an email to our billing specialist, Erica at firstname.lastname@example.org.
To file a complaint about Medicaid or any insurance, call the NM Superintendent of Insurance at (505) 827-4601. Phone numbers for other states' Departments of Insurance can be found online.