Choosing a Turquoise Care Health Plan (MCO)
How to choose a Turquoise Care health plan (MCO) in New Mexico when someone in your family is on the DD Waiver or Mi Via. What differs, what doesn't, and what to ask before you pick.
Updated September 21, 2026
If someone in your family has Medicaid in New Mexico, you'll be asked to pick a health plan, also called a Managed Care Organization or MCO. Since July 1, 2024, Turquoise Care members have been able to choose among four health plans, and each plan offers different value-added services. The four are Blue Cross Blue Shield of New Mexico, Molina Healthcare of New Mexico, Presbyterian Health Plan, and UnitedHealthcare Community Plan of New Mexico.
Families often ask whether the choice matters. The honest answer is yes and no.
The short answer
- What's the same: All four Turquoise Care MCOs cover the same physical health, behavioral health, and long-term services and supports.
- What's different: which doctors, hospitals, and specialists are in each plan's network, how each plan handles referrals (including out of state), and the extras each plan offers on top of Medicaid.
- What doesn't change: your DD Waiver or Mi Via services. Those are run through the Developmental Disabilities Supports Division (DDSD) under the DD Waiver and Mi Via programs, not through your MCO. Your caregivers, your case manager or consultant, and your agency (like Lift) stay the same no matter which plan you pick.
For most families, the deciding factor is simple: pick the plan your current doctors and specialists accept.
What your MCO does (and doesn't do) for a waiver participant
Your MCO covers the medical side of life: doctor visits, hospital care, specialists, prescriptions, behavioral health, and rides to medical appointments. Each waiver participant is also assigned an MCO Care Coordinator, who helps assess needs and connects the person to services outside the waiver.
The waiver itself is separate. On the DD Waiver, the DD Waiver Service Standards require your case manager to work with the MCO Care Coordinator so you can get healthcare, medications, medical equipment, and supplies. On Mi Via, the Mi Via Service Standards say the MCO and its Care Coordinator can't change your Service and Support Plan or your budget. So switching MCOs won't affect your Family Living, In-Home Living Supports, or other waiver services.
What to weigh when choosing
| What to consider | Why it matters | How to check |
|---|---|---|
| Your current doctors | Not every provider accepts every Turquoise Care plan. The state recommends talking with your primary care and specialty providers to see whether they're contracted with the MCO you're considering. | Call each provider's front desk and ask which Turquoise Care plans they accept. Double-check in each plan's online provider directory. |
| Specialists and hospitals | Families managing complex medical needs may rely on one hospital system or a specific specialty clinic. | List every specialist, hospital, and pharmacy you use, then confirm each one is in network. |
| Out-of-state care | Some families travel for care (for example, Children's Hospital Colorado). Care outside a plan's network generally needs approval first. For example, Molina covers out-of-network care with prior authorization, such as when no Molina provider can give you the care you need, and requires prior authorization for non-emergency out-of-state providers. UnitedHealthcare requires that services be medically necessary and approved before you see an out-of-network provider. Travel extras also differ: Molina offers overnight lodging for care more than 150 miles from home, and UnitedHealthcare's medical rides can include up to 3 family members. | Call each plan's member services. Ask about the specific facility you use, how out-of-state referrals and prior authorizations work, and what travel help is available. |
| Private insurance | If the participant also has private insurance, choosing an MCO that works well with that insurer can make billing smoother. | Ask your private insurer and the MCO how they coordinate benefits. |
| Medicare | Some adults on the waiver also have Medicare. You won't be automatically enrolled in the Medicaid plan from the company that provides your Medicare Advantage coverage. You need to select a Medicaid MCO yourself. | If you have a Medicare Advantage plan, ask whether the same company offers a Turquoise Care plan. |
| Value-added services | These are extras beyond what Medicaid covers, and they vary a lot from plan to plan. | See the table below and the full state chart. |
A closer look at value-added services
Value-added services are extras each plan offers on top of what Medicaid covers. Some are time-limited, some need approval, and they may change from year to year. Here are the ones from the state's 2026 value-added services chart most relevant to families supporting someone with IDD:
| Plan | Caregiver and respite support | Home, safety, and equipment | Travel and transportation | Kids and school |
|---|---|---|---|---|
| Blue Cross Blue Shield | Friends & Family Circle gift card for a friend or family member who provides respite; Caregiver Thank You Packages; respite bed | Remote monitoring program (tablet, blood pressure cuff, pulse oximeter, scale); shower chairs; meal delivery for up to 7 days after a hospital or facility stay | None listed | $50 toward after-school or sports activities (under 18); Learn to Live online mental health programs for ages 13+ and their caregivers |
| Molina | Additional respite, homemaker services, remote home-based monitoring, extra environmental modifications, and adaptive technology, based on need | Healthy Home Assistance (items like a portable AC, bed, or small refrigerator); short-term personal care after a hospital stay; prepaid cell phone | Prepaid card for rides to medical visits, the pharmacy, the grocery store, and more; overnight lodging for the member and family when care is more than 150 miles from home | Activity Bucks for sports, band, 4-H, dance, and more (all ages) |
| Presbyterian | Enhanced care coordination that may include hippotherapy | Assistive devices (power seat lift, vibrating pill reminder); wander alert door and motion alarms; bedwetting alarm; reader pen; speech tablet (TalkTablet PRO); emergency response device | Rides to wellness activities | School sports physicals (ages 12 to 18); gym membership |
| UnitedHealthcare | SeniorLink support for unpaid family caregivers | Home Modifications for a Healthier Home (grab bars, ramps, air purifiers); enhanced hearing aid benefits; hypoallergenic pillow and mattress cover | TripMaster medical rides for the member plus up to 3 family members | $100 per year clothing allowance per school-age child; OnePass gym access (18+) |
Source: NM Health Care Authority, Turquoise Care MCOs Value-Added Services, January to December 2026 (revised May 1, 2026). Many items require prior authorization or have limits.
A few things to keep in mind. Some of these extras, like respite, home modifications, and assistive technology, overlap with services the DD Waiver or Mi Via may already fund. Your case manager or consultant can help sort out which program should pay for what. Also, value-added services may not follow the same rules as regular Medicaid benefits. Presbyterian, for example, notes that its value-added services are not subject to the appeals process. And a helpful perk is still worth less than keeping the doctors you trust.
Questions to ask before you choose
When you call a plan's member services line (contact information is on each plan's website, linked above), it helps to ask:
- Are my primary care doctor, specialists, hospital, and pharmacy in your network?
- Do you contract with the out-of-state hospital or clinic we use, and how do referrals and prior authorizations work?
- What travel help do you offer if we need care far from home?
- Are the participant's current medications covered?
- How do I reach my Care Coordinator, and how often will they check in?
- Which value-added services would apply to someone like my family member?
How to pick or switch plans
Once you qualify for Medicaid, you can choose an MCO. If you don't choose one, you'll be assigned one. It's worth choosing on purpose. You can choose or change plans online at YES NM or by calling the number on your enrollment letter.
- First 90 days: You can change your MCO within 90 days of your initial enrollment. After that, you need to submit a change request to the Health Care Authority (HCA).
- Each year after that: Members are locked in to their plan for 12 months, and the state mails an open enrollment reminder letter 90 days before each lock-in period ends. If you don't choose a different plan, you stay with your current one for another 12 months.
- Native American members: Native Americans aren't required to enroll in Turquoise Care unless they need long-term care or are dual eligible. Most waiver participants receive long-term services, so check with your case manager or consultant about your situation.
- If you do switch: Turquoise Care MCOs must provide at least a 90-day transition period for members who have an established relationship with a primary care physician.
Frequently asked questions
Will changing my MCO affect my DD Waiver or Mi Via services?
No. Your waiver services, caregivers, and agency stay the same. The MCO covers medical and behavioral healthcare; DDSD runs the waiver. You'll get a new Care Coordinator from the new plan, and your case manager or consultant will coordinate with them, as the DD Waiver and Mi Via service standards require.
Which MCO is best for out-of-state care?
No plan is best for everyone. Each plan decides which out-of-state facilities it contracts with, and non-emergency care outside the network generally needs prior authorization (see the Molina member handbook and UnitedHealthcare's Turquoise Care FAQ for examples). For travel costs, two plans stand out in the 2026 value-added services. Molina offers overnight lodging for members and family when care is more than 150 miles from home. UnitedHealthcare offers medical rides for the member plus up to 3 family members. If out-of-state care matters to your family, call each plan about your specific hospital or clinic before you choose.
Is one plan better than the others?
It depends on your doctors. The plan that keeps your family's current providers in network is usually the right one. If you're starting fresh, compare networks first and value-added services second.
Can I look up how each plan has performed?
Yes. The Health Care Authority posts each MCO's contract and amendments on its Turquoise Care MCO Contracts page, along with a Contract Compliance Actions list that records notices of concern, corrective action plans, and their closures. A notice of concern doesn't mean a plan is a bad choice, but the list can help you ask informed questions.
Sources
- NM Health Care Authority: Turquoise Care Health Plans
- NM Health Care Authority: Turquoise Care Overview and FAQ
- NM Health Care Authority: Turquoise Care MCOs Value-Added Services, January to December 2026 (MAD 906, revised May 1, 2026)
- NM Health Care Authority: Turquoise Care MCO Contracts and Contract Compliance Actions
- NM Health Care Authority: MCO Turquoise Claims Manual (February 9, 2026) and Turquoise Care MCO Systems Manual (August 22, 2024): enrollment, lock-in, and switching rules
- NM DDSD: DD Waiver Service Standards (effective July 1, 2024), Chapters 5 and 8: healthcare coordination and case manager coordination with MCO Care Coordinators
- NM Health Care Authority: Mi Via program and Mi Via Waiver Service Standards: coordination with MCO services
- Plan member materials: Molina Turquoise Care Member Handbook, UnitedHealthcare Turquoise Care FAQ, Presbyterian Turquoise Care, Presbyterian enrollment FAQ, Blue Cross Blue Shield of New Mexico value-added services
This guide summarizes state rules for families and isn't legal or benefits advice. Plan networks and value-added services change. Confirm current details with the Health Care Authority or the plan before making a decision.