Turquoise Care Medicaid Plans

Plan Documents

Turquoise Care Member Handbook Turquoise Care Benefit Guide Provider Directory Turquoise Care Drug Formulary - By Drug Class Traditional Medicine Value Added Service Application

Travel Reimbursement Request Form

Health Plan Member Newsletters

More Forms & Documents (Más formularios y documentos)

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Notices of Privacy Practices

Reporting Critical Incidents

Care Coordination

Care coordination is a service Presbyterian Turquoise Care provides to help you with your healthcare needs. They can help you whether you are in the hospital or at home. This is for members with chronic, long-term, or complex, physical or behavioral health needs. The level of care coordination you get depends on your healthcare needs.

Care coordinators work with you, your family or support system, and your providers. It is one way that we help you avoid the hospital or emergency room. We want to make sure you have all the help you need to stay in your home and live as independently as possible.

Who Might Benefit from Care Coordination?

Care coordination could be an option for you if you need extra help managing your healthcare. Many members who use care coordination have long-term health problems:

They need more services or more complex services than most members
They have physical, social and/or behavioral health needs that limit their ability to function or access health services

Members with complex healthcare needs include those who:

Have ongoing physical, emotional, developmental, and/or behavioral health conditions.
May need more help getting healthcare and related services. This may include the need to see a provider more often, take many different medicines, see many specialists, or use therapies more often.
Need extra help with things like walking, bathing, dressing, and eating.
Are eligible for Supplement Security Income (SSI).
Use in-home and community-based programs.
Receive foster care or adoption assistance support.
Are in foster care or out-of-home placement.
Have a clinical assessment that shows they have complex healthcare needs.

Getting Started with Care Coordination

To find out if you could benefit from extra support, you must first complete your Health Risk Assessment (HRA). If the result of your HRA shows a need for care coordination, we will call you to set up an appointment with a care coordinator. They will help you complete a Comprehensive Needs Assessment (CNA) in your home. The CNA will determine the level of care coordination you need.

Then a care plan is created from the assessment. You, your providers, and others you choose will work together to make your care plan.

If you need care coordination and agree to participate, you will be assigned a care coordinator. Our care coordination staff will give you all the details you need to know about how the care coordination process works. They will share how you can benefit from participation and give you care coordination contact information.

If you think that you or your child has had a change in healthcare needs that requires a higher level of care coordination, you can reach the Care Coordination team Monday through Friday, 8 a.m. to 5 p.m. at (505) 923-8858 or toll-free at 1-866-672-1242. If you already have a care coordinator, you may call them directly or use the number above.

Such services are funded in part with the State of New Mexico.