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New Mexico Medicaid Managed Care Services Agreement

New Mexico Medicaid Managed Care Services Agreement: What You Need to Know

In the United States, Medicaid is a federal and state-funded program that provides health care coverage to low-income individuals and families. Medicaid Managed Care is a system through which these benefits are provided to Medicaid recipients by private companies that have contracts with state Medicaid agencies. In New Mexico, this system is overseen by the New Mexico Human Services Department (HSD).

Recently, the HSD announced a new Medicaid Managed Care Services Agreement (MCSA) with three private companies: Blue Cross and Blue Shield of New Mexico, Presbyterian Healthcare Services, and Western Sky Community Care. According to the HSD, this agreement will improve the quality of care for Medicaid recipients in the state and save taxpayers money.

So what does this mean for Medicaid recipients in New Mexico? Here are some key points to keep in mind:

– The new MCSA will take effect on January 1, 2022. This means that starting on that date, Medicaid recipients in New Mexico will receive their health care benefits from one of the three private companies listed above, rather than directly from the state.

– Medicaid recipients will be able to choose which of the three managed care organizations (MCOs) they want to receive their benefits from. They can do this during an open enrollment period that will take place from October 1, 2021, to December 15, 2021. If they do not make a choice, they will be automatically enrolled in one of the MCOs.

– The HSD says that the new MCSA will improve the quality of care for Medicaid recipients in a number of ways. For example, the MCOs will be required to meet certain performance standards, and they will have financial incentives to provide high-quality, cost-effective care. Additionally, the HSD says that the MCOs will be better equipped to coordinate care among different providers, which can lead to better health outcomes for Medicaid recipients.

– The HSD also says that the new MCSA will save taxpayers money. According to the department, the MCOs will be paid a set amount per Medicaid recipient, rather than being reimbursed for each service provided. This is intended to incentivize the MCOs to provide care that is both cost-effective and high-quality. Additionally, the HSD says that the new MCSA will reduce administrative costs, because the MCOs will handle many of the tasks that were previously performed by the state.

Of course, no change to a health care system as large and complex as Medicaid is without its potential challenges. Some advocates for Medicaid recipients have raised concerns about the new MCSA, particularly around issues like access to care and provider networks. It will be important for Medicaid recipients to carefully consider their choice of MCO and to stay informed about any changes to their benefits.

Overall, however, the new MCSA represents a significant change to the way that Medicaid benefits are provided in New Mexico. If the HSD`s promises hold true, it could lead to better health outcomes for Medicaid recipients and cost savings for taxpayers. Medicaid recipients in New Mexico should stay informed and be prepared to make choices about their health care benefits in the coming months.