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Care Coordination
As a member, you may work with a Care Coordinator to help with your health care needs. This includes help with community benefit services, plan benefits, managing health issues, and any other care needs you may have. Care Coordination includes Case Management. It is voluntary and available to you at no extra cost.
Care Coordination helps with:
- Assessing your health care and social needs for things that may affect your health.
- Explaining your doctor’s orders, your health condition(s), your medicines and treatments.
- Creating a care plan to help you meet your health goals.
- Learning how your benefits can improve your health.
- Finding providers and community resources as needed.
- Arranging appointments with doctors and other health care team members as needed.
- Getting care if you have special health care needs.
- Medicaid-covered behavioral health services.
- Making sure you get the right care in the right setting, such as in your home, assisted living, or in a nursing home.
- Guidance before planned admissions, such as surgery.
- Guidance after you leave the hospital after you were admitted.
- Supportive housing to assist members who need to find or apply for housing, get needed household supplies, know renter rights and more.
- Non-emergency medical transportation.
- Assistance with meals and lodging for travel to another city or state for an approved medical appointment.
- Planning in-person visits or phone calls with you. Your Care Coordinator will visit you in your home at least once a year. They will check in with you by phone as needed.
When Should I Get Care Coordination?
Care coordination is really helpful when members have:
- Multiple health issues
- A transplant
- A complex illness
- A high number of emergency room visits or hospital stays because your condition is not under control
A provider’s referral is not needed. You or your caregiver can self-refer. You can opt out of care coordination at any time.
How Do I Find out More About Care Coordination?
Call 1-877-232-5518 to learn more. If you are speech- or hearing-impaired, call the TTY line at 711.
Care Coordination Programs
Waiver Programs
The New Mexico Health Care Authority (HCA) has waiver programs to help Medicaid members with special needs. Those who qualify can get waivers for certain types of health care. This allows members to get care that helps them stay at home. Or it can allow members to live in a community setting. BCBSNM offers care coordination for the waiver programs below.
If you have questions about these waivers, call Member Services at 1-866-689-1523.
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