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Medicaid is a state and federal program that provides free or low-cost health insurance based on your income and the size of your family.

Who is Eligible?

In general, low-income individuals and families, children, most pregnant women, and individuals who are blind or have a disability are eligible for Medicaid. If you are age 65 or older, or have ALS (Lou Gehrig’s disease) or end-stage renal disease, you may be eligible for Medicare instead.

To find out if you are eligible for Medicaid, you will need to apply for it. See “Applying for Medicaid” below. Also see the Medicaid & CHIP for American Indians website.

Types of Medicaid

American Indians have a choice between Medicaid Fee-for-Service or a Medicaid Managed Care plan (see descriptions below). However, if you already have Medicare or you need long-term care services (such as a nursing home or in-home care), you will need to select a Managed Care plan.

  • Medicaid Fee-for-Service: If you have Medicaid Fee-for-Service, it means that your healthcare providers are reimbursed by Medicaid for each service that you receive. You will be able to see any healthcare provider that accepts Medicaid Fee-for-Service.
  • Medicaid Managed Care: If you have a Medicaid Managed Care plan (called Centennial Care in New Mexico), it means that your care is paid for by a contract between the state and a Managed Care Organization (MCO) that gets a set payment per month for each member. As of January 1, 2019, Medicaid Managed Care is provided by Blue Cross/Blue Shield of New Mexico, Presbyterian Health Plan, and Western Sky Community Care (Centene Corp.). If you choose Medicaid Managed Care, you will select a plan from one of these organizations when you sign up for Medicaid. You will be able to see any healthcare provider that accepts the plan you choose.

What Medicaid Covers

Medicaid plans will cover:

  • Medical care received in the three months prior to your Medicaid application: You can get this coverage as long as your income was not substantially higher in the three months before you applied for Medicaid. To find out whether you qualify for this coverage, you will want to apply for it right away.
  • Physical health services, including check-ups, diagnostic tests, treatment for illnesses and injuries.
  • Dental care.
  • Behavioral health services, meaning mental health and substance abuse services, like counseling.
  • Prescription medications: If you have Medicaid, there are usually no out-of-pocket costs for medications on your health plan’s “formulary” (a list of medications that your health plan will pay for).
  • Long-term care:
    • Medicaid Managed Care plans will cover nursing home and in-home care for low-income seniors. This benefit is not available for individuals enrolled in Medicaid Fee-for-Service.
    • Institutional Care Medicaid covers nursing home care for individuals who are age 65 or older or who have a disability that is expected to last at least 12 months, who require a nursing home level of care, and whose income is below a certain level.
    • Centennial Care Community Benefit (formerly known as CoLTS) covers many in-home care services for individuals who are eligible for nursing home care but who can receive services at home or in an assisted living facility. However, funding for this coverage is limited and there is usually a waiting list.
  • Medical equipment: Medicaid will cover eye exams and one pair of glasses per year.
    • Medicaid Fee-for-Service will cover hearing aids and other durable medical equipment, such as oxygen equipment, wheelchairs, or blood test strips. Medicaid Managed Care plans may also cover these things if they are “medically necessary,” meaning that your doctor prescribes them to treat an illness or injury.
  • Home modifications: If you require the level of care that is typically required to be in nursing home, you can get help living at home, including home modifications, from a Medicaid Managed Care program called Centennial Care Community Benefit.
  • Transportation: Medicaid will cover ambulance services for emergencies. If you need emergency transportation, call 911. Medicaid also offers transportation services to help you get to and from your medically-necessary, non-emergency medical appointments. Most transportation services require you to make an appointment several days in advance and may only cover transportation to medical services that are covered by your insurance. Some Medicaid plans will reimburse you for transportation costs, including gas and bus fares, and meals and lodging if it is necessary for you to travel away from home overnight.
  • Traditional healing and alternative therapies: Traditional healing for American Indians is covered by Medicaid Managed Care plans up to a certain amount, such as $100, per year. To have a traditional healer’s services covered, you may have to fill out a form certifying that you are using the reimbursement for traditional healing. Other alternative therapies, such as acupuncture, massage, naturopathy, homeopathy, or biofeedback, may be covered by some Medicaid plans.


To find out exactly what your Medicaid plan will cover, call the number on the back of your health insurance card or review your Member Handbook.

Applying for Medicaid

You can apply for Medicaid in person or online. If you would like to apply by yourself, you can see the Medicaid website for further information.

Applying for and renewing Medicaid can be complicated and confusing, so it’s a good idea to get in-person assistance. You can get help from the Benefits Coordinator at your local IHS or Tribal clinic, or a Patient Navigator or insurance broker. In New Mexico, BeWellNM has counselors specifically for American Indians; call (855) 241-8137 or visit their office at 6403 Menaul Blvd. NE in Albuquerque.

When you apply for Medicaid, you may need to provide the following documents or information:

  • Proof of age (for example: birth certificate, driver’s license, passport)
  • Proof of citizenship (for example: birth certificate, passport, Tribal enrollment card, Certificate of Degree of Indian Blood)
  • Proof of all your sources of income (for example: paystubs, Social Security, Supplemental Security Income, Veterans benefits, any other income)
  • Proof of assets (for example: bank statements)
  • Proof of disability
  • Proof of residence (for example: recent mail addressed to you, rent receipts, a copy of your mortgage)
  • Proof of any other health insurance (any other current health insurance cards)

You can also check online to see if you are eligible. See the Medicaid Program, Benefits Category page on the Benefits.gov website. You can also apply on the YesNM page on the New Mexico Human Services department website.


Using Medicaid and Staying Covered

Whenever you go to a healthcare provider, including the IHS, bring your insurance card with you and make sure the provider’s office knows that you have Medicaid (make sure to say whether you have Medicaid Fee-for-Service or a Managed Care plan). If a healthcare provider does not accept your health insurance, ask them to refer you to one who does.

You must renew your Medicaid coverage every year. In the month before your renewal is due, you will receive a renewal application in the mail.

If you, your spouse, or any of your dependents experience changes to your address, income, family size, or other insurance, your eligibility for Medicaid may change. Make sure to read and keep any information you receive regarding your Medicaid in case there are changes that require your attention. Your IHS Benefits Coordinator can help you report changes or see the How to Report Changes to the Marketplace page on the Healthcare.gov website. You can also report changes by logging in to your Healthcare.gov account or by calling (800) 318-2596  or TTY (855) 889-4325.