Benefits and Services

Welcome Molina members!

With your Medicaid benefits, you’ll get standard benefits like those listed below. Some of these benefits will require a Prior Authorization and others will not. Please refer to the Member Handbook for more information.


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Covered Services

When you have Medicaid, you receive important benefits and services including, but not limited to:

  • Preventive services
  • Office Visits
  • Inpatient Hospital services
  • Outpatient Hospital Services
  • Emergency Care
  • Urgent Care
  • Virtual Visits
  • Transportation Services
  • Behavioral Health Services
  • Outpatient Therapy Services
  • Radiology Services
  • Laboratory Services
  • Durable Medical Equipment (DME)
  • Hospice
  • Home Health
  • Vision

For a full list of benefits, please read the “Benefits and Services” section in your Member Handbook  or contact Member Services.

 

 

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Behavioral Health Services

We cover your behavioral health care. It is an important part of your overall health and wellness.

We can help you:

  • Deal with feelings of sadness or worries, substance use disorder, or stress.
  • Get an appointment with a doctor.
  • Get the information you need about behavioral health services.
  • Talk with your doctors about how you are feeling.

Available behavioral health services include:

  • Substance use disorder (SUD) treatment.
  • Outpatient services such as counseling
  • Help with medicines.
  • Day treatment
  • Care management
  • Inpatient treatment (if you and your doctor feel that you cannot be safely treated in an outpatient setting)
  • Certified Peer Support for mental health and substance use disorder.

You do not need a referral from your PCP to get behavioral health services. But we encourage you to talk to your PCP about your behavioral health. They can help make sure you are getting the help, care, and support you need.

If you or someone in the home is in the act of harming themselves or harming someone else, please contact  911 immediately. If you are having behavioral health distress or have thoughts about harming yourself or someone else:

  • Molina operates a Behavioral Health crisis line. Trained behavioral health clinicians are available to assist you 24 hours a day, 7 days a week.
  • You can also get help right away by dialing 988 to reach the National Suicide Lifeline
    • 988 is the National Suicide Lifeline. Anyone in need of suicide or mental health crisis support (or anyone worried about someone else), can get free and confidential support 24 hours a day, 7 days a week, 365 days a year by dialing 988 from any phone.
  • Go to the closest hospital for emergency care
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Dental Benefits

Your Molina Healthcare of New Mexico dental benefits include important services like:

  • Preventive Services like exams and topical fluoride
  • Diagnostic Services like Oral Evaluations & X-rays
  • Restorative Services like Crowns & Root canals
  • Orthodontic Services
  • Emergency service

For a full list of benefits, please read the “Dental Benefits” section in your Member Handbook or contact Member Services.

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Vision Benefits

• One exam and one pair of glasses each year for ages 20 and under
• One exam and one pair of glasses every three years for ages 21 and older
• Vision care for eye injury or disease
• You may also get extra vision benefits using your Molina value-added service for vision. See Value-added services in your Member handbook for more information

For a full list of benefits, please read the “Dental Benefits” section in your Member Handbook or contact Member Services.

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Pharmacy Benefits

Covered Drugs

You get prescription drugs at no cost to you. We cover your medically necessary medicines when filled at a network pharmacy. We also cover some over-the-counter (OTC) medicines with a prescription from your provider.

Generic drugs are drugs that have the same dosage, safety, strength and intended use as a brand-name drug. They usually cost less than brand-name drugs.

We cover all drugs covered by New Mexico Medicaid. New Mexico Medicaid uses a Preferred Drug List (PDL). Our PDL includes both generic and brand-name drugs. It also gives you facts about a drug and lists any restrictions on them. To fill your prescriptions, you must use a network pharmacy. Be sure to take your member ID card with you. Be sure to fill your prescriptions before you travel out of state.

To find a network pharmacy, see our Provider Directory. You can also contact Member Services.

Find our PDL at New Mexico

  

 

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Transportation Benefits

You can get  rides at  no cost to you for your non emergent health care appointments. Contact Superior Medical Transport at (833) 707-7100 (TTY:711)  from Monday through Friday, 6 a.m. to 8 p.m. MST.  Please contact us at least three (3) business days before your healthcare appointment to make sure you get the ride you need.

When you contact Superior to schedule a trip, have these things ready:

    • Your Molina ID number
    • Your first and last name
    • Your home address including ZIP code for the pick-up
    • The name, address, and ZIP code for the healthcare provider you’ll see
    • The date and time of your healthcare appointment

For more information about scheduling transportation check out the
Superior Medical Transport 

 

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With Molina you have additional benefits and services

Value Added Service (VAS)

Description

Eligibility

How to get the VAS

Traditional &

holistic healing

Reimbursement to members or their healers for traditional and

holistic healing. This may include, but is not limited to, therapeutic massage, acupuncture, traditional

ceremonies and services, and curanderismo. Up to $300 per calendar year outpatient benefit,

and up to $250 per calendar year inpatient benefit.

Member must have

completed a Health

Risk Assessment for

the calendar year

and participate in

care coordination.

Contact Member

Services toll

free at

(844) 862-4543

(TTY: 711)

Enhanced services through specialized care coordination

Provides care coordinators with the flexibility to identify and access

benefits and services that are not otherwise covered by Medicaid that

will support the member’s health and wellness journey. Can include

but not limited to:

 

• Enhanced vision

• Enhanced dental

• Housing assistance, per household

• Enhanced transportation

• Enhanced overnight lodging for

medical care

Caregiver support programs

• Enhanced environmental

modifications - grab bars, bath

bench, etc.

• Adaptive technology -

communication devices

• Respite Care Program - for those experiencing homelessness who

have been recently discharge

• Short-term homemaker services

following hospitalization or

rehabilitation

• Pest control

 

Member must have completed a Health Risk Assessment for

the calendar year and participate in care coordination. Benefit amount is identified by the care

coordination team and as approved by Molina.

Contact Member Services toll free at

(844) 862-4543 (TTY: 711).

Women's health extras

Provides assistance for items such as:

• OTC Pregnancy Tests

• Feminine hygiene products

• New baby items: cradle boards, a choice of any size car seat, travel crib or stroller.

Members who have

completed a Health Risk Assessment for the calendar year. In addition to HRA

completion, the new baby items are for pregnant or

postpartum mothers who have completed two or more prenatal or postpartum

well-check visits and two or more well baby checks.

Contact Member Services toll free at (844) 862-4543

(TTY: 711).

Nutritional Support Program

Enhanced nutritional support to include, but not limited to fresh produce boxes, daily meals, cooking classes, and nutrition programs.

 

 

Member must have completed a Health Risk Assessment for the calendar year and participate in care coordination. Benefit amount is identified by the care

coordination team and as approved by Molina

Contact Member Services toll free at

(844) 862-4543 (TTY: 711).

Workforce

development

Services can include:

• GED Vouchers

• Workforce Bucks via Flex Card

for uniforms, tools, etc.

• Court Record Expungement

Member must have completed a Health Risk Assessment for the calendar year and participate in

care coordination. The care

coordination team identifies the benefit amount approved by Molina.

Contact Member

Services toll free at

(844) 862-4543 (TTY: 711).

Activities Bucks

Assistance to pay for activities that help you stay healthy, such as fees for sports,

equipment, shoes, and uniforms, activity clubs, martial arts, dance, cheer and much more.

 

 

Molina Help Finder

 

The Molina Help Finder is your one stop shop for finding low- and no cost

resources near you when you need them. You can use our online search tool to find the help you need in your community. Molina Help Finder can find resources to meet basic needs like:

• Food

• Housing

• Transportation

• Health

• Job training

• Child care

• Education

• Work

• Legal

• And more!

Molina Help Finder lets you self-refer or apply for services using your member portal or MyMolina mobile app. Your provider can also

refer you to services and follow up to make sure you get the help you need.

We offer Molina Help Finder in more than 120 languages to make it

easy for you to find the resource that’s best for you.

With Molina Help Finder, help is just a click away. Visit MolinaHelpFinder.

com to learn more.

 

 

All members

Visit

MolinaHelpFinder.com to learn more. You can also visit a Molina Kiosk to access. These are located across New

Mexico. Call Member

Services to locate a

kiosk at (844) 862-4543 (TTY: 711).

 

Health & Wellness

 

Home delivered meals tailored to member’s nutrition needs; fresh produce; nutritional counseling & Support. Complete an HRA and participate in Care Coordination

 

All members

Annual per household