Centennial Care Overview
Centennial Care is the name of the New Mexico Medicaid program. Centennial Care began on January 1, 2014 with services provided by four managed care organizations (MCOs). These services include physical health, behavioral health, long-term care and community benefits.
Eligibility for all Medicaid programs requires that individuals meet certain federal guidelines. These include citizenship, residency and income requirements.
To apply for Centennial Care Medicaid, check eligibility, or enroll in or switch your managed care organization (MCO), visit the YesNM Online Portal.
To complete an application or for general questions please call the Consolidated Customer Service Center at: 1-800-283-4465
What does Centennial Care mean to you?
When you receive Medicaid, you select a Managed Care Organization (MCO):
Blue Cross/Blue Shield of New Mexico
Western Sky Community Care
How to access Centennial Care 2.0
The person selects their MCO when they enroll in Medicaid (or complete the annual Medicaid recertification). Then the MCO assigns a Care Coordinator. The Care Coordinator does a phone assessment which assigns Level 1, Level 2, or Level 3 to the Member. The assigned level relates to service and support needs.
When a person has Level 2 or Level 3 this means they need more services and may be eligible for Agency Based Community Benefit (ABCB) or after receiving ABCB for 120 days they can access Self-Directed Community Benefit (SDCB). Self-Directed Choices (SDC) provides Support Broker services and supports to members on Self-Directed Community Based services and supports.
If you receive the Developmental Disabilities Waiver, Medical Fragile, Mi Via Waiver or Supports Waiver the MCO will provide your medical resources and supports.
Although, if you don’t receive one of the above Waivers you may qualify for Agency-Based Community Benefit (ABCB) services and supports and Self Directed Community Benefit (SDCB) services and supports.
Under either model, the services available are determined by the funding or reimbursement options that your program has access to. For example, if state programs, such as Medicaid, play a large role in your program's funding, allowable services will be influenced by your state's definition of allowable services.
Self-Directed Community Benefit
- Self Directed Community Based (SDCB) services and supports are intended to provide a community-based alternative to institutional care that facilitates greater member choice, direction and control over covered services and supports.
- Philosophy of Self Direction Self-direction: is a tool that leads to self-determination, through which members can have greater control over their lives and have more freedom to lead a meaningful life in the community.
- Within the context of SDCB, self-direction means members choose which covered services they need, as identified in the most recent Comprehensive Needs Assessment.
- Members also decide when, where and how those SDCB covered services will be provided and who they want to provide them.
- Members decide who they want to assist them with planning and managing their SDCB covered services within a managed care environment.
Self-direction means members have more choice, control, flexibility, freedom and responsibility in directing their Community Benefits.
SDCB Care Plan Development Processes
The SDCB care plan development process starts with person-centered planning. In person-centered planning, the SDCB care plan must revolve around the individual SDCB member and reflect his/her chosen lifestyle, cultural, functional, and social needs for successful community living. The goal of the SDCB care plan development process is for the SDCB member to achieve a meaningful life in the community, as defined by the SDCB member.
What is a Comprehensive Needs Assessment?
CNAs must be performed through the utilization of an assessment tool that has been approved by HSD for assessing the member’s medical/PH, BH, LTC, and social needs. The assessment tool may include the identification of targeted needs related to improving health, functional outcomes, or quality of life outcomes (e.g., related to targeted health education, pharmacy management, or increasing and/or maintaining functional abilities, including provision of covered services). Any changes to the assessment tool must be approved by HSD 30 calendar days prior to use by the MCO or its delegate. The CNA must be conducted in the member’s primary place of residence or facility for members reintegrating back into the community.
Self-Directed Choices serves you as a Support Broker?
Self-Directed Choices contracts with Blue Cross/Blue Shield New Mexico (BCBSNM) and Western Sky Community Care (WSCC). We have also serve a limited number of Presbyterian (PRES) Members. We provide Support Broker services to Members to educate, assist and guide them in developing and accessing their individual Self Directed Community Based (SDCB) Plans.
Self-Directed Choices provides Person-Centered Planning and Monitoring by
Contacting you within 5 days of receiving your selection form
Scheduling your Enrollment Meeting within thirty (30) calendar days to Educate you on SDCB services
Check in with you and the Care Coordinator to submit the Care Plan thirty (30) calendar days before the begin date.
Guide you to setup services and supports which are approved on the SDCB Care Plan and Budget.
Check in with the Member Monthly to answer any questions, provide additional assistance and supports.
Quarterly In-Person Visits except during Public Health Emergencies
Assist you with Monitoring Spending Reports
Meet with you and Care Coordinator to complete annual SDCB Care Plan and Comprehensive Needs Assessment
Annual Working Plan Shell opened within 90 calendar days from the expiration of the current plan
Annual SDCB Care Plan submitted within 30 calendar days of the expiration of the current SDCB Care Plan