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Welcome to SALUD!  The New Mexico Medicaid Managed Care Program!

You are entitled to be in SALUD.  You will get your health care from a managed care organization (MCO).  First you need to choose the managed care organization you want to use.  You must choose one of these three:

• Presbyterian Salud,
• Lovelace Community Health Plan, or
• Cimarron Health Plan.

The health care plan you pick will help you choose a doctor to manage your health care.

If you wish to change your health plan, you can do it.  You have until the 25th day of the third month you are in the plan to do it.  After that date you will not be able to change it until you have been with your health plan for the next nine months. 

Two months before the nine months are up you will receive a letter that lets you change your health care plan.  The change will happen when the next sign up starts.

Everyone in your home who is on SALUD! has to choose a health care plan.  You don't all have to be on the same plan.  Here are some things you should know to get the health care you need for you and your family.

WHAT IS A MANAGED CARE ORGANIZATION?

An MCO is a company.  It hires hospitals, doctors and other medical people.  They take care of you when you are sick.  They try to keep you healthy.

The MCO will tell you what hospital will take care of you when you are sick.  It will tell you what doctor will take care of you.  And, it will tell you what other medical people will take care of you.

HOW CAN I CHOOSE THE MANAGED CARE ORGANIZATION THAT IS RIGHT FOR ME?

Here are some things you can do:

• Ask your doctor which Medicaid MCO he/she accepts.
• Ask the M CO's for a list of the doctors that are on their lists.
• Find out which one has most of the doctors you use.
• Ask the Managed Care Organizations for their rules. 
• Decide what is important to your coverage.
• Choose the MCO that gives you what you feel is most important to you.

DOES A NATIVE AMERICAN HAVE TO BE IN SALUD!?

Native Americans do not have to be in SALUD.  They can ignore the letter asking them to choose an MCO.  They will not be put in SALUD. 

Native Americans will get their Medicaid Services under regular Medicaid.  If you want to be in SALUD, you can.  Choose a Managed Care Organization.  You will still be able to have services from INDIAN HEALTH SERVICES or a tribal health center.

HOW ARE SALUD AND REGULAR MEDICAID DIFFERENT?

SALUD includes regular Medicaid.  You also get extra MCO services.  Your services will be handled better.  It will be easier to get services.  The quality of your services will be better. 

Ask the Managed Care Organizations about the extra services.  Their member handbooks will tell you about the extra services.

CAN I STILL GO TO A FEDERALLY QUALIFIED HEALTH CENTER?

You can still go to a Federally Qualified Health Center.  They offer primary health care.  They offer Mental Health services.  They offer dental care and social services.  All this is done in one place. 

You must contact your Managed Care Organization to find out which centers they accept.

CAN I STILL GO TO THE HEALTH CARE PEOPLE I SEE NOW?

If the health care people you are seeing are with the Managed Care Organization, you can go on seeing them.  You have to ask.

You can go to anyone you want for family planning and emergency services.

I DO NOT HAVE A RIDE.  HOW DO I GET TO MY HEALTH CARE APPOINTMENTS?

Your managed care organization has rules about rides and other things.  Call them and ask.  Read the Member Handbook.  Learn what you have to do before you ask about a ride. 

CAN I STILL GO TO THE EMERGENCY ROOM?  CAN I STILL CALL 911?  CAN I STILL CALL FOR AN AMBULANCE?

You can still go to the emergency when there is an emergency.  There is an emergency when you believe your life is in danger.  There is an emergency when you are hurt.  Your good judgment tells you to see a doctor right away. 

I HAVE A COMPLAINT ABOUT MY MANAGED CARE ORGANIZATION.  WHAT DO I DO?

You should call your Managed Care Organization.  The Member Handbook will tell you whom to call.  The MCO will tell you what they will do about your complaint.

You can call Medicaid.  Medicaid will help you work on your complaint with your managed care organization. 

The MCO cuts back on your care.  It does not give you the care you need.  It discriminates against you.  You call the Human Services Department.  The number is 1-888-997-2583.  You ask for a hearing.

GET MORE INFORMATION ABOUT MANAGED CARE ORGANIZATIONS OR THE SALUD! PROMGRAM.

Call one of the numbers listed:

You are a person with a disability. You need this information in another way. Please call 1-888-99SALUD or the New Mexico Relay System at 1-800-659-8331.

Your family has special health care needs. These groups may help you: