State to select managed care partners to deliver health care services to half of New Mexicans 

SANTA FE - The New Mexico Human Services Department (HSD) announced today they are soliciting competitive proposals from health insurance companies, known as Medicaid Managed Care Organizations (MCOs), to deliver services to the state’s 969,093 Medicaid members. Managed care organizations work in partnership with the state’s Medicaid program and clinicians to provide access to physical and behavioral health, and long-term care services.  

The announcement comes as contracts with HSD’s current MCOs, Blue Cross Blue Shield of New Mexico, Presbyterian Health Plan, and Western Sky Community Care are set to expire at the end of 2023. Beginning in 2024, the state’s Medicaid program, known as Centennial Care 2.0, will become Turquoise Care and will begin operation with the newly awarded MCOs.  

The department released the Request for Proposals (RFP) for the Turquoise Care Medicaid contracts on Friday, Sept. 30, 2022.  

“With over eighty percent of New Mexico’s Medicaid population receiving care through the managed care delivery system it is essential to select managed care partners that provide access to quality, cost-effective health care — and that can help transform the health care system to deliver measurably improved outcomes to New Mexicans.” said David R. Scrase, M.D., cabinet secretary for the New Mexico Human Services Department. 

Since 2019, the Medicaid program has worked to improve program benefits, provider payments, and access to care. Under Gov. Michelle Lujan Grisham’s leadership, HSD has invested over $800 million in increased provider rates, extended postpartum coverage to 12 months, worked to eliminate the developmentally disabled waitlist for services, removed asset tests that create barriers for older adults, implemented home visiting programs for pregnant women, processed 6,534 Medicaid Provider enrollment applications, and added reimbursement of Adult Accredited Residential Treatment Center (AARTC) services.   

“This request for proposals increases accountability for our managed care partners. The new contract reflects our intent to require our managed care organizations and their subcontractors to work with providers and community partners to improve access, advance health equity, reduce disparities, and deliver comprehensive quality care that results in positive outcomes for New Mexicans.” said Nicole Comeaux, JD, MPH, Director of the New Mexico Medicaid Program. 

This RFP sets forth HSD’s process for soliciting, evaluating, and scoring proposals for and selecting contractors to provide the scope of work requirements identified in the RFP and those in the Model Contract. Going forward, notable improvements in this new contract include: 

• Creating a specialized plan for children in state custody under the Children, Youth and Families Department
• Implementing a uniform prescription drug list and supplemental rebate program
• Providing a minimum reimbursement rate for contract providers at or above the state plan approved fee schedule
• Developing more stringent provider network requirements, including appointment availability standards, provider training, and greater accuracy of provider directory information
• Expanding MCO reporting and monetary penalties for non-compliance
• Requiring that 90 percent of capitation go to payment for delivery of services and efforts to improve quality of care 
• Creating direction to use a single centralized vendor to process applications for credentialing perform primary source verifications
• Taking a population health approach to improve health outcomes and member satisfaction
• Identifying and remediating cultural and linguistic health care disparities
• Focusing on identifying and addressing social determinants of health
• Putting an emphasis on care coordination delivered by community-based individuals and entities
• Enhancing MCO staffing requirements, including qualifications, staffing levels, and training

The Turquoise Care Medicaid Managed Care Organizations Request for Proposals and Procurement Library is available on the HSD website at https://www.hsd.state.nm.us/2022-turquoise-care-mco-rfp-procurement-library/