New Mexico Long-Term Services and Supports (LTSS)

If you have questions about your health plan, please call us. Our toll-free Member Services number is 1-877-236-0826, TTY 711. We are open Monday through Friday, 8 am to 8 pm EST. You can call us at this number 24/7 to get urgent assistance.

UnitedHealthcare Community Plan provides member materials to you in a language or format that makes it easier for you to understand. Our provider network includes many doctors who are multilingual. Our provider directory shows which languages doctors speak. Additionally, many of our Member Services Advocates speak multiple languages, so when you call they will be able to help you or connect you with our interpreter service which covers more than 170 languages.

If you have trouble hearing over the phone you can use a text telephone. This free service allows persons with hearing or speech disabilities to place and receive telephone calls. Call 711, give them the Member Services number, 1-877-236-0826, and they will connect you to us.

You can also get information in large print, Braille or audio tapes. We can also assist with interpreter services, including American Sign Language. To ask for help, please call us Monday through Friday, 8 am to 5 pm MT.

Our toll-free Member Services number is 1-877-236-0826, TTY: 711.

Search for a behavior health/mental health specialist

The New Mexico Preferred Drug List is a list of covered prescription drugs and drugs needing a prior approval. Prior approval is when your doctor must call us before giving you the prescription to see if we will cover it.

The PDL is available in other languages, in large print and Braille. If you have questions or need an alternative format, please call Member Services.

Note that many on our Member Service team speak several languages. We also have an interpreter service, which supports more than 240 languages over the phone, including American Sign Language.

If you have trouble hearing or speaking over the phone, you can use a text telephone. It’s a free service. Call 711 to learn more. Or use the number 1-877-236-0826 to get connected with us.

Search for drugs covered by the State of New Mexico 

Medical questions and situations sometimes happen at inconvenient times. When you have questions about your health, you can call a nurse 24 hours a day, 7 days a week.

Our nurses will:

• Listen to symptoms.
• Help with self-care.
• Advise you about getting care at a doctor visit or an urgent care center.
• Help you know when to go to the emergency room.

Your secure member website. See your covered benefits, search for providers, view your member handbook and much more. Visit MyUHC.com/CommunityPlan to get started.

It’s designed for people on the go and includes many of the same features as the member website. Find it at the App Store or Google Play.

Quit Using Tobacco or Vaping Products

Quitting is hard, but we can help. Did you know that 20 minutes after you quit, your heart rate drops to a normal level? And within 24 hours after quitting the carbon monoxide level in your blood drops to normal.

Talk to your doctor about quitting. Or call 1-800-QUIT-NOW (1-800-784-8669) to get free coaching, counseling and supplies to help you quit.

If you have a life-threatening emergency, call 911. An ambulance will be provided if you need to be sent to the hospital.

If you need a ride, your benefits include transportation. 

We cover trips to:

• Medical appointments
• Food pantry
• Medicaid eligibility appointments
  

Following these simple rules will help you get a ride: 

• Call at least 3 business days ahead of time 
• Call 1-877-236-0826, TTY 711 to set up your ride 
• If you cancel your visit, call 1-877-236-0826 to cancel your ride 
• Have your Medicaid ID card available 
• Rides are only for approved reasons 
• Know the address of your health care provider and the date and time of your appointment 
• Be specific about where you need a ride to 
• After your visit, call for a ride home 
• If your doctor gives you a prescription, you can stop at the pharmacy to get it 
• Let us know if you have special needs like a wheelchair 
• Transportation may be limited to a provider near you
  

You may also qualify for a bus pass or friends and family mileage reimbursement. Give your Member Services Advocate a call to schedule a ride or ask questions about getting transportation services.

This service is for rides planned in advance. 

We offer benefits and extra services, such as: 

SeniorLink

Assist unpaid and family caregivers by providing support services that focus on engaging, empowering, educating and supporting caregivers. Seniorlink coaches design a personcentered program for each member after completing an assessment that evaluates the knowledge, skills and needs of the caregiver and the member’s health risks and behavioral challenges.

Through this person-centered program, SeniorLink builds a care plan specific to unpaid and family caregivers to make sure they have the tools and resources to support members in their homes by supporting their families.

To support all caregivers, especially those in disenfranchised populations, such as those on tribal lands, SeniorLink has invested in developing cultural competency among their care teams in topics such as history, demographics, socioeconomics, government, family relationships, belief systems, verbal and nonverbal communication styles, rural versus urban differences, health care practices and implementation strategies in the Native American community.

Requires evaluation and approval. Eligibility determined on an individual basis. 

Medically tailored and culturally appropriate meals

Home-delivered, medically tailored, culturally appropriate meals to promote better health and support health care. Meals can be tailored for members with regular and specialty dietary needs, and can support puréed, gluten free and vegetarian. This program promotes healthy nutrition and addresses food insecurity or malnutrition. Focus supporting members through transitions of care, including:

• Post-delivery, for member and up to four household members
• Post-release meals for justice- involved members
• Skilled nursing facility (SNF) transition, focused on LTSS members

Exclusions include:

• Post-delivery: two meals a day for 14 days, for member and up to four household members
• Post-release meals for justice involved members: two meals a day for 14 days
• SNF transition, focused on LTSS members: two meals a day for 14 days
• Community Partner referred members that need food assistance

PEARLS - Program to Encourage Active, Rewarding Lives Peer Support

A treatment program designed to reduce symptoms of depression and improve quality of life among older adults and all-age adults with epilepsy. The program consists of six to eight in-home counseling sessions that focus on the following goals: solving problems, becoming socially and physically active and scheduling enjoyable activities.

We will train and use certified provider-based peers to deliver this service.

Limits 6-8 in-home counseling sessions for seniors, tribal members and members with LTSS.

Senior.One

Comprehensive care navigation services have been tailored to enhance the healthcare journey for Members enrolled in the Long-Term Services and Supports (LTSS) programs. The mission is to streamline the care navigation process, to ensuring that every senior receives the personalized care and support they deserve.

Being healthy is not always about your medical needs. Sometimes you need help connecting to resources out in the community. We call these social needs.

These are things like housing, getting food every day, getting to the grocery or feeling safe. We can also help you get access to help with employment or finishing your education. Want to find help on your own? Check out UHCHealthierLives.com. You can also talk to your Care Coordinator or Member Services. They can give you referrals to local organizations.

Getting to the doctor when you are healthy is important. We have guides to help you know what to expect at each well visit. You can also talk to Member Services for support and information.

We also have helpful guides for most health problems and conditions. These materials can be found on https://member.uhc.com/communityplan.

You will find condition-specific and general health topics, including:

Physical Health

• Arthritis
• Asthma
• Cancer
• Children's health
• Chronic pain
• Diabetes
• HIV
• Heart health
• Infertility
• Men’s health
• Traumatic brain injury
• Virtual visits
• Weight management
• Women’s health

Well-Being

• Aging
• Brain health
• Coping
• Exercise & fitness
• Healthy eating
• Mindfulness
• Sleep
  

UnitedHealthcare offers many brochures about health conditions. Talk to your Member Services Advocate about any health needs that you have. We can send you helpful information. We can also connect you with a Care Manager who can help you create a plan of care and make sure you get all the services you need.

Your Ombudsman:

• Is a neutral party and a member advocate. The ombudsman will work directly with the member in order to research and address member concerns.
• Is a resource for finding a solution
• Will work with members to help them understand their rights and their responsibilities

What are the limitations of the Ombudsman?

• The ombudsman will not file appeals or grievances on behalf of the members
• The ombudsman does not have the authority to override policies or procedures
• The ombudsman will not make decisions for the members
• Members have the right to refuse ombudsman services. An exception for ombudsman services to continue without member consent is in a life-threatening event to the member or to others. If this occurs, the Ombudsman will report this event.

Contact information for members:

The direct telephone number to the Ombudsman’s office is 1-877-236-0826, TTY 711.

How can a member reach their UnitedHealthcare Ombudsman?

• By email: NM_Ombudsman@uhc.com
• By phone: Member Services at 1-877-236-0826; TTY 711 for hearing impaired

An advance directive is a set of written steps you want to be taken when you can no longer make health care choices for yourself. It tells what health care you want or do not want. You should talk about your wishes with your doctor, family and friends. These steps will not change your health care benefits. 

What are advance health care directives? 

By State of New Mexico and federal law, you have the right to make an advance directive. It is a document that lets you say exactly how you wish to be treated if you are too sick to make health care decisions. An advance directive will help your doctor and family make choices about your health care. You can also name someone to make your health care decisions. That person is called a surrogate or an agent. He or she has the right to refuse or stop treatment for you in some cases. 

The document could be called an advance health directive, mental health advance directive, psychiatric advance directive or PAD, living will, durable health care power of attorney and/or durable mental health care power of attorney. 

It is UnitedHealthcare Community Plan policy to let all adult Turquoise Care members know they can do this. State and federal law says hospitals, nursing homes, and other providers have to tell you about advance directives. They need to explain your legal choices about medical decisions. The law was made to give you more control during times when you may not be able to make health care decisions. 

UnitedHealthcare Community Plan follows the regulations in the Mental Health Care Treatment Decisions Act [24-7B-1 NMSA 1978] and the federal regulation 42 CFR 489 subpart I and 42 CFR 422.128. 

How do I get an advance directive? 

Contact Member Services or your Care Coordinator at 1-877-236-0826. If you are speech or hearing impaired, call TTY 711. 

You can also call the State of New Mexico Aging and Disability Resource Center: 1-800-432-2080.

We want to hear from our members about any questions, complaints, or concerns you may have. If you have a grievance, please call Member Services toll-free, at 1-877-236-0826, TTY 711.

If you are not happy with your care or treatment by Member Services, Care Coordinator or a provider, you may file a grievance. You may file a complaint or grievance against us (the health plan) or a provider at any time.

Members may file a grievance verbally with Member Services from 8 am to 8 pm EST, Monday through Friday, at 1-877-236-0826, TTY 711. All members can file a grievance through this process. 

You can also send a letter. Please include your name, address, member ID, reason for your grievance, and any other information you think is important. That address is:

UnitedHealthcare Grievances and Appeals
P.O. Box 31364
Salt Lake City, UT 84131-0364

You have other rights that include appeals and a State Fair Hearing. For detailed information about complaints and appeals, contact Member Services or view the Appeals and Grievances section of the Member Handbook.

You have certain rights and responsibilities when you enroll. It is important that you fully understand both your rights and your responsibilities. For detailed information about your rights and responsibilities download here.

Fraud, waste, and abuse are serious problems. There can be penalties under law. To make a report, call the UHC Fraud Hotline at 1-844-359-7736. You can also call Member Services at 1-877-236-0826. We will not use your name in your report. You will not get in trouble for reporting this. We will look into the matter for you. 

For more information about fraud, waste, or abuse, or to make a report online go here.

We have a Notice of Privacy Practices that tells you how health information about you may be used and shared. We are required by law to let you know that the Notice is available, and how you can get a copy of it. View a copy of our Notice of Privacy Practices.