New Mexico Medicaid managed care: what plans must pay

Managed-care plans don't publish their provider fee schedules. What is public is the rule each plan must follow, set in New Mexico's plan contracts, statutes and notices. For 22 of 22 service lines, plans must follow a rule tied to the state's published rates.

Lines with a binding rule: 22of 22
Plans on record: 5
Directed payments: 53
Capitation cells: —not published

Who sets the rate, by service line

Service line	Main rule for plans	Rates	Also applies
Hospital outpatient	Plans must pay at least thisPlans must pay at least the published rate	12,932
Physician & professional	Plans must pay at least thisPlans must pay at least the published rate	7,877
Equipment & supplies	Plans must pay at least thisPlans must pay at least the published rate	3,489
Lab & pathology	Plans must pay at least thisPlans must pay at least the published rate	1,902
Radiology	Plans must pay at least thisPlans must pay at least the published rate	1,719
Pharmacy	Plans must pay at least thisPlans must pay at least the published rate	1,077
Hospital inpatient	Plans must pay at least thisPlans must pay at least the published rate	851
Hospice	Plans must pay at least thisPlans must pay at least the published rate	531
Other	State-directed paymentDirected payments add to plan rates	278	Plans must pay at least thisState sets the plan rate
Dental	Plans must pay at least thisPlans must pay at least the published rate	249
Behavioral health	Plans must pay at least thisPlans must pay at least the published rate	185	Plans expected to pay at least thisState sets the plan rate
IDD services	Paid by the state, outside plansPaid directly by the state, outside managed care	177	State sets the plan rate
Nursing facility	Plans must pay at least thisPlans must pay at least the published rate	141	State-directed payment
Therapy (PT/OT/speech)	Paid by the state, outside plansPaid directly by the state, outside managed care	88	Plans must pay at least thisState sets the plan rate
Transportation	Plans must pay at least thisPlans must pay at least the published rate	55	Paid by the state, outside plans
Vision & hearing	Plans must pay at least thisPlans must pay at least the published rate	49
ABA / autism services	Plans must pay at least thisPlans must pay at least the published rate	48
Other home & community services	Paid by the state, outside plansPaid directly by the state, outside managed care	43	State sets the plan ratePlans must pay at least this
Personal care & attendant	Plans expected to pay at least thisPlans are expected to pay at least the published rate	14	Paid by the state, outside plansState sets the plan rate
Private duty nursing	Paid by the state, outside plansPaid directly by the state, outside managed care	12	Plans expected to pay at least thisState sets the plan rate
Home health	State sets the plan rateThe state sets the rate plans pay	9	Plans expected to pay at least this
Clinics (FQHC/RHC)	Plans must pay at least thisPlans must pay at least the published rate	1

State-directed payments

Payments CMS approved under 42 CFR 438.6(c) that plans must make on top of, or as a minimum for, their negotiated rates.

Program	Amount	Effective
Turquoise Care (New Mexico risk-based Medicaid managed care; BCBSNM, Molina, Presbyterian, UnitedHealthcare)	$82,870,000.00	2026-07-01
Turquoise Care (New Mexico risk-based Medicaid managed care; BCBSNM, Molina, Presbyterian, UnitedHealthcare)	3.9%	2026-07-01
Turquoise Care (New Mexico risk-based Medicaid managed care; BCBSNM, Molina, Presbyterian, UnitedHealthcare)	$29.14	2026-07-01
Turquoise Care (New Mexico risk-based Medicaid managed care; BCBSNM, Molina, Presbyterian, UnitedHealthcare)	$10.20	2026-07-01
Turquoise Care (New Mexico risk-based Medicaid managed care; BCBSNM, Molina, Presbyterian, UnitedHealthcare)	33%	2026-01-01
Turquoise Care (New Mexico risk-based Medicaid managed care; BCBSNM, Molina, Presbyterian, UnitedHealthcare)	33%	2026-01-01
Turquoise Care (New Mexico risk-based Medicaid managed care; BCBSNM, Molina, Presbyterian, UnitedHealthcare)	33%	2026-01-01
Turquoise Care (New Mexico risk-based Medicaid managed care; BCBSNM, Molina, Presbyterian, UnitedHealthcare)	95%	2026-01-01
Turquoise Care (New Mexico risk-based Medicaid managed care; BCBSNM, Molina, Presbyterian, UnitedHealthcare)	$34,000,000.00	2026-01-01
Turquoise Care (New Mexico risk-based Medicaid managed care; BCBSNM, Molina, Presbyterian, UnitedHealthcare)	24.7%	2026-01-01
Turquoise Care (New Mexico risk-based Medicaid managed care; BCBSNM, Molina, Presbyterian, UnitedHealthcare)	$9,940,000.00	2026-01-01
Turquoise Care (New Mexico risk-based Medicaid managed care; BCBSNM, Molina, Presbyterian, UnitedHealthcare)	33%	2026-01-01
Turquoise Care (New Mexico risk-based Medicaid managed care; BCBSNM, Molina, Presbyterian, UnitedHealthcare)	$19,460,000.00	2026-01-01
Turquoise Care (New Mexico risk-based Medicaid managed care; BCBSNM, Molina, Presbyterian, UnitedHealthcare)	$1,840.17	2026-01-01
Turquoise Care (New Mexico risk-based Medicaid managed care; BCBSNM, Molina, Presbyterian, UnitedHealthcare)	$26,000,000.00	2026-01-01
Turquoise Care (New Mexico risk-based Medicaid managed care; BCBSNM, Molina, Presbyterian, UnitedHealthcare)	13.2474%	2026-01-01
Turquoise Care (New Mexico risk-based Medicaid managed care; BCBSNM, Molina, Presbyterian, UnitedHealthcare)	$1,500,000,000.00	2026-01-01
Turquoise Care (New Mexico risk-based Medicaid managed care; BCBSNM, Molina, Presbyterian, UnitedHealthcare)	$2,027.78	2026-01-01
Turquoise Care (New Mexico risk-based Medicaid managed care; BCBSNM, Molina, Presbyterian, UnitedHealthcare)	$972.43	2026-01-01
Turquoise Care (New Mexico risk-based Medicaid managed care; BCBSNM, Molina, Presbyterian, UnitedHealthcare)	$310,000,000.00	2026-01-01

Frequently asked questions

Do New Mexico Medicaid plans have to pay the state fee schedule?

For some services. Plans must follow a rule tied to the state's rates for: Hospital outpatient, Physician & professional, Equipment & supplies, Lab & pathology, Radiology, Pharmacy, Hospital inpatient, Hospice, Other, Dental, Behavioral health, IDD services, Nursing facility, Therapy (PT/OT/speech), Transportation, Vision & hearing, ABA / autism services, Other home & community services, Personal care & attendant, Private duty nursing, Home health, Clinics (FQHC/RHC). For other lines, plans negotiate rates with providers.

Where do these rules come from?

From New Mexico's managed-care plan contracts, state statutes and regulations, provider notices and CMS-approved directed-payment filings. Each rate in the workspace carries its citation.

Can I see what each plan actually pays?

No plan publishes its provider fee schedule. The closest public signals are the binding rules above, state-set rates, directed payments and the state's own payment-level estimates in its directed-payment filings.

← All New Mexico Medicaid rates

New Mexico managed care, rate by rateSee the plan rule on every rate you bill, with the contract citation.

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