New Mexico is set to launch its new Medicaid managed care program, Turquoise Care, in 2024, building upon the foundations of the existing Centennial Care 2.0 program. This transition, spearheaded by the New Mexico Human Services Department (HSD), represents a significant step forward in the state’s commitment to providing comprehensive healthcare services to its Medicaid members. Through a new Section 1115 waiver demonstration, Turquoise Care aims to refine and elevate the current Centennial Care Managed Care Program, enhancing the quality and accessibility of care for approximately 800,000 individuals enrolled in Medicaid managed care. Managed Care Organizations (MCOs) will continue to play a central role, delivering physical health, behavioral health, and long-term care (LTC) services under this evolved framework.
Transitioning from Centennial Care 2.0 to Turquoise Care
Turquoise Care is not a radical departure but rather an evolution of the centennial care managed care program. It retains the core principles of managed care while introducing key enhancements designed to address current needs and future challenges in healthcare delivery. The program is structured around a competitive Request for Proposals (RFP) process, through which New Mexico will select three MCOs to administer Turquoise Care contracts. Notably, one MCO will be specifically tasked with a specialized foster care plan, catering to Children in State Custody (CISC) across the state. Enrollment for CISC members is mandatory, with Native American CISC members having the option for voluntary enrollment, demonstrating a commitment to culturally sensitive care within the new program.
Core Goals of the Turquoise Care Program
Turquoise Care is driven by three overarching goals, each strategically designed to strengthen the healthcare system for Medicaid beneficiaries in New Mexico:
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Goal 1: Establishing Dedicated Healthcare Teams: The program aims to ensure every Medicaid member benefits from a dedicated healthcare team. This team-based approach emphasizes accessibility for both preventive and emergency care, promoting a holistic view of health that encompasses physical, behavioral, and social determinants. This goal directly addresses a core component of effective managed care – coordinated and patient-centered service delivery, improving upon the centennial care managed care program’s foundation.
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Goal 2: Promoting Innovative Payment and Value-Based Care: Turquoise Care seeks to strengthen the healthcare system through innovative payment reforms and value-based initiatives. This signifies a move towards rewarding quality and health outcomes rather than just the volume of services provided. By focusing on value, the program intends to optimize healthcare spending and improve the overall effectiveness of care delivery within the managed care framework, a progressive step beyond the earlier iterations of centennial care managed care program.
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Goal 3: Addressing Health Disparities and Promoting Equity: A central tenet of Turquoise Care is to identify and address health disparities experienced by historically disenfranchised groups. This goal underscores a commitment to equitable healthcare access and outcomes. Target populations include:
- Prenatal, postpartum individuals, and parents, including children in state custody.
- Seniors and individuals with long-term services and supports (LTSS) needs.
- Members with behavioral health conditions.
- Native American members.
- Justice-involved individuals.
This focused approach to health equity is a significant enhancement, ensuring that the centennial care managed care program evolves to meet the diverse needs of New Mexico’s Medicaid population.
Key Changes Introduced in Turquoise Care
Turquoise Care introduces several key changes designed to enhance program effectiveness and accountability:
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90 Percent Medical Loss Ratio (MLR): A significant 90% MLR requirement is aimed at channeling more resources directly into quality of care improvements. This measure ensures that a larger proportion of Medicaid funding is spent on healthcare services rather than administrative costs, directly benefiting members within the centennial care managed care program’s successor.
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Enhanced MCO Reporting and Compliance: Turquoise Care mandates expanded MCO reporting and implements monetary penalties for non-compliance. These measures are designed to increase MCO accountability and ensure adherence to program standards, fostering a more robust and reliable managed care system compared to previous iterations of centennial care managed care program.
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Minimum Reimbursement Rates for Providers: The program establishes a minimum reimbursement rate for contract providers at or above the state plan approved fee schedule. This aims to stabilize and strengthen the provider network, ensuring adequate compensation for healthcare professionals participating in the Medicaid program and supporting the accessibility of care within the centennial care managed care program framework.
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Stringent Provider Network Requirements: Turquoise Care implements more stringent provider network requirements, ensuring that MCOs maintain robust and accessible networks of healthcare providers. This focus on network adequacy is crucial for timely and convenient access to care for Medicaid members, a vital aspect of an effective centennial care managed care program.
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Centralized Application Processing: A single centralized vendor will process applications, streamlining the enrollment process and potentially reducing administrative burdens for both applicants and the state. This efficiency improvement aims to make accessing Medicaid benefits smoother and more user-friendly than under the previous centennial care managed care program structure.
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Enhanced MCO Staffing Requirements: Turquoise Care specifies enhanced MCO staffing requirements, including qualifications, staffing levels, and training. This focus on staffing quality and capacity aims to improve the operational effectiveness of MCOs and enhance the member experience within the managed care system, building upon the operational model of the centennial care managed care program.
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Focus on Social Determinants of Health: The program places a greater emphasis on addressing social determinants of health, recognizing the significant impact of factors like housing, food security, and transportation on health outcomes. By integrating social determinants into care delivery, Turquoise Care aims for a more comprehensive and impactful approach to improving health, going beyond the traditional healthcare focus of the centennial care managed care program.
Eligibility and Program Timeline
Approximately 83% of New Mexico’s Medicaid population is enrolled in managed care. Exemptions from mandatory managed care enrollment include specific populations such as Native American members not requiring LTC, individuals in Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID), and those enrolled in certain Medicare beneficiary programs or specific Medicaid programs like Family Planning or PACE. Individuals in Developmental Disabilities or Medically Fragile 1915(c) Waivers will continue to receive HCBS through those waivers but are required to enroll with an MCO for non-HCBS services under Turquoise Care, similar to the arrangements within the centennial care managed care program.
Proposals for Turquoise Care were due on December 2, 2022. Contracts are scheduled to run from January 1, 2024, through December 31, 2026, with potential one-year renewals extending up to a total of eight years. This timeline marks a new chapter for Medicaid managed care in New Mexico, evolving from the centennial care managed care program era.
Current Market Context
As of August 2022, New Mexico’s Medicaid managed care market served 811,732 members, with key players including Blue Cross Blue Shield of New Mexico, Presbyterian Health Plan, and Centene/Western Sky. An additional 163,361 members were under fee-for-service arrangements. Turquoise Care will reshape this market landscape as new contracts are awarded and the program is implemented, continuing the state’s trajectory in managed healthcare that began with the centennial care managed care program.
Conclusion
New Mexico’s Turquoise Care program represents a significant evolution in its approach to Medicaid managed care, building upon the experiences and infrastructure of the centennial care managed care program. With its enhanced focus on quality, value-based care, health equity, and MCO accountability, Turquoise Care is poised to create a more effective and responsive healthcare system for Medicaid members in the state. The program’s emphasis on addressing social determinants of health and strengthening provider networks further underscores its commitment to holistic and accessible care. As Turquoise Care moves towards implementation, it signals a new era of enhanced Medicaid managed care in New Mexico, aiming to improve health outcomes and experiences for hundreds of thousands of residents.
