Adult day health care is a benefit that helps people stay at home in their communities. It's available for seniors and disabled adults who need extra help during the day. It also benefits caregivers, who can feel better knowing their loved one is cared for during those times they can't be with them. Adult day health may provide:
Social activities and emotional support.
Personal care such as bathing and shaving.
Meals, exercise and education.
Health monitoring and therapies.
Asthma and COPD Support
Individual care to help control asthma or COPD symptoms.
Some members may have trouble managing asthma or COPD symptoms. For them, a nurse who specializes in breathing issues can really help. Members get a customized treatment plan and medicine to:
Help them stay active.
Build a healthy future for you and your baby—and earn great rewards—through Baby Blocks. This online program helps keep you and your baby healthy during your pregnancy and your baby's first 15 months of life.
Baby Blocks includes:
Email appointment reminders.
Fun program to keep track of appointments.
Reward cards for clothing, teething rings and more.
Once you sign up, you can choose either a $20 Old Navy gift card or a stylish diaper bag. The choice is yours.
Behavioral health is as important as physical health. That's why we cover both.
Required care is 100% covered with no copay. This benefit includes:
Substance abuse treatment.
If you or someone you know is in need of crisis services and support, you can call the New Mexico Statewide Crisis Access Line toll-free at 1-855-662-7474.
Our members' well-being is our focus. That's why we provide a care coordinator to help members who need extra care. A care coordinator ensures the needed care and services are provided to help improve the member's health.
The care coordinator:
Understands the member's health and personal care needs.
Creates a care plan to match the member's health care needs.
Coordinates care among the specialists and the primary care doctor (PCP).
Arranges for care and services after the member leaves the hospital.
Choice of Doctor
Most primary care doctors (PCP) care for their patients for a long time. So it is important for you or your loved ones to have a doctor you like and trust. Our members get a primary care physician (PCP). Use the Doctor Lookup tool to see if your doctor is in our network.
For members who don't have a doctor or whose doctor is not in our network, a care coordinator can help find a PCP close by. If a member has special health care needs or a disability, the PCP will work directly with care coordinator to provide the needed care and services.
The PCP is your main doctor for:
Treatment if you are sick or injured.
Referrals to specialists for certain conditions.
Choice of Birth Center
Where you have your baby is an important choice. That's why you can pick from any one of the general hospitals across New Mexico.
We also encourage you to tour the hospital's birthing center. This way you will be familiar with it and be more relaxed when you have your baby.
Cleanings, checkups and dental work are covered.
For members under the age of 21, and for members with special health care needs, exams and cleanings are covered every six months. For members over the age of 21, they are covered every 12 months.
Equipment and Supplies
The health and safety of our members at home are important.
Our plan covers medical equipment prescribed by your health care provider. This includes items like:
Walkers or wheelchairs.
Healthy First Steps
When you're pregnant, you may receive help and advice from your mom, aunts, sisters and girlfriends. Yet every pregnancy is different. This program will support you through your pregnancy.
We can help you:
Find a doctor for both mother and baby.
Learn about nutrition, fitness and safety.
Get supplies, including breast pumps for nursing moms.
Trouble hearing can affect a person's everyday life in many ways. Our plan includes services and support to help protect hearing.
Exams, therapy and tests.
Hearing aids and batteries.
Home and Community Care
Some members may need extra assistance to remain safely in their home. Our plan covers:
Adult Day Health – Community-based care and social activities.
Respite care – In-home care to give caregivers a rest.
Personal care services – Someone to help in-home with activities such as bathing, dressing, meal preparation and feeding.
Home Health Care
Members living with a long-term health condition, disability or coming out of the hospital after surgery or a serious illness may need extra support. This can include help with day-to-day tasks like cleaning, cooking or dressing. They may even need an in-home medical visit to check on how well they are healing. With approval, our plan covers:
In-home medical visit.
Medical equipment like hospital beds, walkers or wheelchairs.
Disposable medical supplies.
Help with personal care or housekeeping.
All expenses related to a hospital stay are covered. Some members have a small copay of $30 or less.
Our plan covers:
Room and board.
Supplies and equipment.
Treatment and therapies.
Diagnostic tests and exams.
And after leaving the hospital, a member is not alone. We make sure follow-up care is available, if needed, to continue healing at home.
Doctor and patient need to understand each other. Not speaking English well makes this difficult. We can arrange for a medical interpreter to be at a member's appointment.
We also have people at our phone centers who speak more than one language. Chances are, we have someone who speaks your language.
Our plan covers prescription drugs and refills. Medicaid members have no copayments for prescription drugs. And we make it easy for members to get their medicine. Prescriptions can be refilled at:
Services that deliver right to their door.
Sometimes a member might need a little help understanding various health care options. With us, members have someone to call 24/7. We'll answer their questions simply and completely.
We also help our members find:
Hospitals or other health facilities.
Our members pay nothing for preventive care or annual checkups covered by our plan. The benefit includes:
Checkups for adults and children.
Care for women expecting a baby.
Routine shots and tests.
Medical questions and situations come at inconvenient times. For questions about health, members or their caregivers can call a trained nurse 24/7.
Our nurses will:
Listen to symptoms.
Help with self-care.
Advise you about getting care at a doctor visit or an urgent care center.
Help you know when to go to the emergency room.
Peer Support Specialist
When you or a family member is dealing with personal problems, it helps to know someone who has "been there." We can connect you with a peer support specialist who:
Knows what it's like to deal with stress, depression, anxiety, a gambling problem, or using drugs or alcohol.
Can help you walk the path of recovery.
Will support you in making the best choices for personal wellness.
Peer Support is available for members who qualify for behavioral health services.
We help our members get needed medical items. Each year, members can get up to $50 back for purchases at pharmacies. This may include items like humidifiers, canes or first aid supplies.
A pregnancy is an incredible journey. It's a journey you will want to make with the help of friends, family and a pregnancy doctor, or OB-GYN.
All recommended prenatal clinical visits and tests are covered by our plan.
At these visits, the clinic will:
Make sure both you and baby are healthy.
Explain what to expect at each stage of your pregnancy.
Answer your questions.
Some members have an unpaid caregiver who helps care for them at home. This can be a hard and time-consuming job, and it's important for caregivers to have a break if they need it. Respite care covers the services of a back-up caregiver who can be available when the unpaid caregiver needs time away.
Most people know the bad health effects of smoking. And they know they need to quit. We support our members while they quit, with coaches and supplies. The only thing they won't get from us is a lecture.
Our plan offers up to $100 back each year for traditional healing items and services. These may include:
Herbal medications or remedies.
Medicine man services.
Sweat lodge services.
Get rides or mileage reimbursement to and from:
Physical health and Behavioral health visits.
Vision, dental and hearing visits.
We give members or others cash back for gas used driving to and from health care visits.
See life more clearly with good vision care. We cover:
For members under age 21, one routine exam every 12 months and new eyeglasses every 24 months.
For members aged 21 and older, one routine exam and new eyeglasses every 36 months.
This service is offered by Vision Service Plan.
Well visits with your doctor can help keep you healthy. These visits can help catch health problems early so they can be treated. Preventive services cover: