New Mexicos Covering Kids and Families Program

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New MexicosCovering Kids and Families Program
Health Care and YOU
Making Health Insurance A Priority For All New
Mexicans
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What Type of Health Insurance Is Available?

• The health plans are managed care health plans
  that provide health insurance coverage for
• Women
• Who Are Pregnant
• Family Planning
• Children
• Under 19 years
• To be eligible, the person must be a New Mexico
  resident and a US citizen or have 5 years legal
  residency

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What Plan Am I Eligible For?

• It is based on your income
• No Cost up to 185 of Poverty
• Low Cost (Co-pays) SCHIPS-up to 235 of poverty

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What Are the Income GuidelinesThat Make Me
Eligible?
Please Call New Mexikids 1-888-997-2583 to find
out more about the Program or Covering Kids and
Famlilies 244-9505 x 32 to sign-up for New
Mexikids Health Coverage
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What Happens After You Apply For Health Insurance?

• It will take 30 to 45 days for your application
  to be processed.
• You will receive a letter telling you if you are
  eligible for coverage.
• You will receive a plastic identification card
  for each person eligible.
• You will be eligible for coverage for 1 year for
  your child or for pregnancy related services
  through 2 months after your baby is born.
• Family Planning Services for 1 year.

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When Will You Need to Re-certify?

• One month before eligibility ends you will
  receive a letter from the ISD office asking you
  to provide current family income and to report
  any changes in eligibility.
• After giving birth, notify the ISD office of the
  date, name and sex of your child to have them put
  on Medicaid or SCHIPS. They will be eligible for
  1 year from their date of birth.
• Family Planning is for 1 year. After giving
  birth, ask your case worker to place you on
  family planning services.

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Contact the Income Support Division (ISD) Office
for Any of the Following Changes

• Name
• Address
• Phone number
• Family size
• Changes in other insurance
• Changes in eligibility

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How is Health Insurancein New Mexico Provided?

• In New Mexico, health insurance for the Salud
  Program is provided through a Managed Care Plan.
  
• You may hear words- Medicaid, New Mexi-Kids,
  Salud, or SCHIPS they are all health insurance

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What is Managed Care?

• It is a way to pay for medical and behavioral
  health services for free or at a reduced cost.

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How Does a Managed Care Health Plan Work?

• A managed care health plan creates a network of
  providers
• Doctors
• Hospitals
• Dentists
• Pharmacies
• Etc.
• from which a patient receives his/her health care.

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Choosing a Health Plan?

• Once you are enrolled you may choose your health
  plan.
• There are three health care plan options
• Molina Healthcare!
• Lovelace Salud!
• Presbyterian Salud!

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What to Consider When Choosing a Health Plan

• What health plan is your present provider with?
• Which health plan would best suit your needs?
• Call each plan and ask them questions.
• Molina Healthcare Salud - 1-800-580-2811
• Lovelace Salud - 1-888-232-2750
• Presbyterian Salud - 1-888-977-2333

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How does a Managed Care Health Plan work?

• From this network of providers, the patient
  selects a Primary Care Provider (PCP) who
• Provides preventive health care
• Takes care of illnesses and injuries
• Diagnoses and treats acute/chronic disorders
• Makes referrals to other specialists
• Must be available 24 hours a day to provide
  and/or approve health care services

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Who is Your Primary Care Provider (PCP)?

• Under the Health Plan you must pick a Primary
  Care Provider (PCP).
• This is the person who keeps all your records and
  knows the most about your health.
• If you dont pick a PCP your health plan will
  pick one for you.
• You can get a list of providers from your Salud!
  health plan to help you choose a PCP.

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Picking A PCP

• You have 15 days to pick your PCP
• Your PCP can be a
• General/Family Practitioner
• Pediatrician
• Internist
• OB/GYN
• In some cases a specialist
• If you do not pick a PCP the health care plan
  that you have signed up for will pick one for you
• After you have selected your PCP call and
  schedule an appointment- This is very important

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How Do You Change Your PCP?

• Call Customer/Member Service
• Presbyterian 923-5200 or 1-888-977-2333
• Molina Healthcare342-4681 or 1-800-580-2811
• Lovelace 232-2700 or 1-888-232-2750

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When Going to Your Provider/PCP Always Bring

• Your Identification Health Care Card
• Your drivers license or some other card with
  your picture and name on it.
• Your Medicaid Card

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What Are Some of the Health Insurance Benefits?

• Preventive Care
• Doctor Visits
• Dental Visits
• Hospital/Emergency
• Prescriptions
• Glasses Vision Care
• Well-child Checks

• Transportation
• Prenatal Care
• Child Birth Delivery
• Newborn Care
• Behavioral Health
• Family Planning Services
• X-ray Laboratory fees

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Types of Services You Can Get Without Talking to
Your Provider First

• Dental
• Vision
• OB/GYN
• Family Planning
• Pediatric Services
• Mental Health (Behavioral Health) Services

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What if a Child has Special Needs?

• If a child needs to see a specialist they must be
  referred for the service by their Primary Care
  Provider (PCP), except for behavioral health or
  OB/GYN services.
• If you do not get a referral you may not be able
  to be seen and/or you will be sent a bill and
  would have to pay.

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How Easy is it to Get Behavioral Health Care?

• You do not need to see your Primary Care Provider
  (PCP) to get a referral for behavioral (mental)
  health services or counseling.
• You can call your health care Salud! program and
  set up your own appointment with a Behavioral
  Health Specialist to start your services.

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Prescriptions

• The plan you have has a list of prescription
  (formulary) drugs
• This list is given to providers
• Your provider can tell you if the drugs are on
  the list
• If the drug is not on the list, your provider has
  to get approval
• Your provider must submit the proper form. He or
  she should know what form to submit
• If you have questions call your health plans
  member or customer services numbers

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How to Get a Free Ride to Your Medical
Appointment

• If you dont have a car or a friend that can take
  you to your appointment, you can call your Salud!
  health plan for a free ride.
• You need to call 2 days ahead of time for a ride
  to an appointment.
• If you get sick and the provider wants you to
  come in that day call the ride number and tell
  them when you got sick and when the provider
  asked you to come in.

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Numbers to Call to Get a Ride to an Appointment
Molina Healthcare Salud! 1-888-593-2052
Lovelace Salud! 1-877-735-0111
Presbyterian Salud! 1-888-725-3467
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When Can I Go to the Emergency Room?

• The emergency room is when you need care right
  away
• Examples of Emergency Situations
• Broken bones
• Bleeding that does not stop
• Feel like I am having a heart attack
• Major Burns
• Drug Overdoses
• What to do if you have an emergency
• Call 911 or go to the nearest emergency room.
  Tell the emergency room person who your doctor
  provider is.
• If you go to the emergency room for something
  that is not an emergency, you may get a bill

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When Can I Go to the Emergency Room Cont.?

• Here are some examples of when you should not use
  the emergency room
• Sore Throats
• Cold or the flu
• Back Pain
• Tension headaches
• Do not wait until office hours are closed to get
  care
• All three plans have nurse advise lines to answer
  your questions. They are open 24 hours a day. You
  can also call your doctors office, they are also
  available 24 hours a day or go to an urgent care
  center if it is open

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Rights Presbyterian, Lovelace, and Molina
Healthcare

• You Have the Right to
• Be treated with respect and dignity
• Have your medical records kept confidential
• Have your care and your medical records kept
  private
• See your medical records
• Get a second opinion
• Receive health care without being discriminated
  against
• Have privacy during office visits
• Pick the Primary Care Provider (PCP) that you
  want
• Get emergency care right away
• Have translation services available

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Rights Presbyterian, Lovelace, and Molina
Healthcare Cont.

• Get a regular visit with your doctor or dentist
  in 30 days
• Get a visit for testing in 14 days
• Get a visit in 14 days, when your doctor sends
  you to another doctor
• Wait less then 30 minutes in the provider waiting
  room
• Get a non-urgent medical, mental health dental
  visit in 14 days (LCHP 10 days)
• Get an urgent medical visit with a provider or
  dentist in 24 hours (PHP immediate as determined
  by clinician)
• Get an urgent mental health visit in 6 hours
  (LCHP 24 hrs. PHP immediate as determined by
  clinician)
• Get a call back in 2 hours, when you call your
  doctor with a regular medical or dental problem
  and your doctors office is closed
• Talk with your doctor in 15 minutes, when you
  call with an emergency medical or dental problem
  and the office is closed
• Get your medicine in 40 minutes after giving the
  prescription to the pharmacist
• Get your medicine in 90 minutes after the doctor
  calls the pharmacy
• Have your call answered in an average of 30
  seconds

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What to Do if You Have a Problem with Your Health
Plan

• There is a special way to make complaints if you
  have any problems with your Health Care.
• Call the number to your Health Care Plan and tell
  them what is wrong.
• Molina HealthcareSalud! 1-800-580-2811 or
  342-4681
• Lovelace Salud!1-888-232-2750 or 232-2700
• Presbyterian Salud!1-888-977-2333 or 923-5200

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Easy Steps

• Every time you call your health plan with a
  problem
• Write down the date you called
• Write down the person you spoke with
• Write down the time of the call
• Write down the issue/problem you were calling
  about
• Dont throw this information away- You may need
  it if you have a problem