Written & Reviewed by Akash Biswas, MSW | Former Medicaid Caseworker Trainer | Verified against official New Mexico Health Care Authority (HCA) and Medicaid.gov guidelines | Last Updated: June 2026
The New Mexico Medicaid fee schedule sets the reimbursement rates providers receive for covered services. For most patients enrolled in New Mexico Medicaid, there are no monthly premiums and no copays. This article covers both provider rates and patient costs — plus the biggest program changes for 2026.
Quick Summary:
- ✅ New Mexico Medicaid is now managed by the Health Care Authority (HCA) — formerly HSD
- ✅ Most enrollees pay $0 in premiums or copays under Centennial Care
- ✅ Income limit for a single adult: ~$22,025/year (138% of FPL)
- ✅ All providers must enroll with NM Medicaid by July 1, 2026, or claims will be denied
- ✅ Fee schedules are available at the HCA provider portal
- ✅ Non-citizen eligibility rules change starting October 1, 2026
What Is the New Mexico Medicaid Fee Schedule?
The New Mexico Medicaid fee schedule is a list of rates the state pays doctors, clinics, and other providers for each covered service. Every service has a billing code — called a CPT code — with a set payment amount next to it. In 2026, New Mexico made a major change to how and where these schedules are published.
The former Human Services Department (HSD) is now called the New Mexico Health Care Authority (HCA). All fee schedules, provider portals, and official Medicaid information moved to the new HCA website at hca.nm.gov. If you still have bookmarks for old HSD pages, update them now.
To see how New Mexico’s rates compare nationally, visit our full guide to the Medicaid fee schedule in 2026 across all states.
What “Fee Schedule” Means for Patients
A fee schedule affects what providers get paid — not what patients owe. For most New Mexico Medicaid members, your out-of-pocket cost is $0. No copays. No deductibles. No monthly premium.
What “Fee Schedule” Means for Providers
Providers use the fee schedule to know what Medicaid will reimburse per service. New Mexico does not publish a simple public list of all rates. Providers must log in to the HCA portal and download the current CSV rate files for their service category.
2026 Major Update: HSD Is Now HCA
This is the most important change for 2026. The agency name, website, and all contact portals have changed. The new official website is hca.nm.gov. All fee schedule downloads, provider enrollment forms, and eligibility pamphlets are now housed there.
Who Qualifies for Medicaid in New Mexico 2026?
New Mexico offers Medicaid through its Centennial Care managed care program. You may qualify based on your income, household size, age, disability status, and state residency. New Mexico expanded Medicaid under the Affordable Care Act (ACA), so many low-income adults now qualify — even without children.
For a national overview of eligibility rules, see our full guide to Medicaid eligibility in 2026.
| Category | Who May Qualify |
|---|---|
| Adults (19–64) | Income up to 138% FPL |
| Children (CHIP) | Income up to 235% FPL |
| Pregnant Women | Income up to 250% FPL |
| Seniors (65+) | Income + asset limits apply |
| People with Disabilities | SSI recipients often qualify automatically |
Adults and Families
Single adults earning up to about $22,025 per year may qualify. Families of four with income up to about $45,540 per year may also be eligible. You must be a New Mexico resident and either a U.S. citizen or a qualifying immigrant.
Seniors and Nursing Home Residents
Nursing home (institutional) Medicaid has stricter rules. The income limit is $2,982 per month for an individual. The asset limit is $2,000 for a single applicant. These limits come from the NM HCA Eligibility Pamphlet (January 2026).
Non-Citizen Eligibility Change in 2026
Starting October 1, 2026, eligibility rules will change for some lawfully present immigrants. Affected members will receive mailed notices by September 2026. Visit the HCA benefits page to check your status before that deadline.
New Mexico Medicaid Income Limits 2026
New Mexico uses Modified Adjusted Gross Income (MAGI) to determine eligibility for most groups. The income limits below are based on 138% of the Federal Poverty Level (FPL) for standard Medicaid (Centennial Care). For the full national breakdown, see Medicaid income limits by state in 2026.
Standard Medicaid (Centennial Care) Income Limits
| Household Size | Annual Income Limit | Monthly Income Limit |
|---|---|---|
| 1 | $22,025 | $1,836 |
| 2 | $29,821 | $2,485 |
| 3 | $37,617 | $3,135 |
| 4 | $45,540 | $3,795 |
| 5 | $53,336 | $4,445 |
| 6 | $61,132 | $5,094 |
Source: New Mexico Health Care Authority | Medicaid.gov
Nursing Home / Institutional Medicaid Limits
| Rule | Limit |
|---|---|
| Monthly Income Limit | $2,982/month (per individual) |
| Asset Limit | $2,000 (single applicant) |
Source: NM HCA Eligibility Pamphlet, January 2026
Note on MAGI: Countable income includes wages, self-employment income, and Social Security. Some income is exempt. A tax professional or the HCA office can help you calculate your MAGI correctly.
What Does New Mexico Medicaid Cover?
New Mexico Centennial Care covers a broad range of health services for eligible members. Most services carry zero cost to the patient. Coverage includes both physical health and behavioral health care.
Medical and Preventive Services
- Doctor visits and preventive screenings
- Emergency room care and hospital stays
- Prescription drugs
- Lab tests and imaging (X-rays, MRIs)
- Mental health and substance use treatment
Long-Term and Specialty Services
- Nursing home and long-term care
- Home- and community-based services (HCBS)
- Basic dental care for adults; comprehensive dental for children
- Vision care and eyeglasses
- Telehealth visits at full parity rates
Telehealth Parity in 2026
New Mexico law requires that telehealth services be reimbursed at the same rate as in-person visits. Updated telehealth policies for managed care organizations took effect in March and April 2026 to align with new federal billing codes. This means your video visit costs you nothing more than an office visit would. Learn more at the ACA Medicaid overview at Healthcare.gov.
Provider Fee Schedules: Key 2026 Updates
Providers need to know about two critical 2026 changes in New Mexico. Both affect how claims are filed and paid. Missing these deadlines can mean denied claims.
July 1, 2026 Enrollment Deadline
Effective July 1, 2026, all rendering, ordering, and prescribing providers must be fully enrolled with New Mexico Medicaid. Claims submitted by non-enrolled providers after this date will be denied. This applies to all provider types — physicians, specialists, and prescribers alike. See the full details at the UHC Provider Portal.
How to Access the 2026 Fee Schedule
New Mexico does not publish a single static public rate list. Providers must:
- Go to hca.nm.gov/providers/fee-schedules
- Log in to the provider portal
- Download the current CSV file for your specific service type
If you need the exact reimbursement for a CPT code — such as 99213 for an office visit — you must download the current file from the HCA portal.
Turquoise Care Managed Care Rates
New Mexico’s managed care program is called Turquoise Care. Updated capitation rates are in effect from January 1, 2026 through December 31, 2026. These rates govern what managed care organizations (MCOs) receive per enrollee per month. The updated rates are published at Medicaid.gov.
Workers’ Compensation Fee Schedule (Reference Only)
The New Mexico Workers’ Compensation Administration released its own 2026 Health Care Provider Fee Schedule effective January 1, 2026. This is separate from Medicaid — but providers sometimes use it as a reference point for state medical billing codes. See NM Workers’ Compensation Administration for details.
How to Apply for Medicaid in New Mexico
Applying for New Mexico Medicaid (Centennial Care) is free. You can apply online, by phone, or in person at a local office. Most applicants get a decision within 45 days.
- Estimate your eligibility — Use our Medicaid eligibility calculator in 2026 before you apply. It takes about 2 minutes.
- Gather your documents — You’ll need proof of income, state-issued ID, proof of residency, and household size information.
- Apply online — Visit the New Mexico HCA portal and click “Apply for Benefits.”
- Apply by phone — Call 1-800-283-4465 (New Mexico Medicaid helpline). Staff can help in English and Spanish.
- Apply in person — Visit your local HCA county office. Find locations at hca.nm.gov.
- Submit and save your confirmation — Write down or screenshot your confirmation number.
What Happens After You Apply?
After you submit your application, the New Mexico HCA will review your information. They may contact you if more documents are needed. You should receive a decision within 45 days — or 90 days if your application involves a disability determination.
Application Timeline
| Step | Timeframe |
|---|---|
| Application received | Day 1 |
| Processing begins | Within 5 business days |
| Decision issued | Up to 45 days (90 for disability) |
| Coverage start date | First day of the month you applied |
If You Are Approved
You will receive your New Mexico Medicaid card in the mail. Your coverage usually starts the first day of the month you applied. You will then choose a managed care plan under Centennial Care (Turquoise Care).
If You Are Denied
You have the right to appeal. Your denial letter will explain the reason and the steps to appeal. You can also call the HCA helpline at 1-800-283-4465 to ask for an explanation or request help with your appeal.
Frequently Asked Questions (FAQ)
Q: What is the New Mexico Medicaid fee schedule for 2026?
A: The New Mexico Medicaid fee schedule lists the dollar amounts the state pays providers for each covered service. Providers can download the current schedule directly from the HCA fee schedule portal. New Mexico does not publish a single static public rate list — providers must log in to access current CSV files by service category.
Q: How much does Medicaid cost in New Mexico in 2026?
A: For most enrollees in Centennial Care, New Mexico Medicaid costs $0. There are no monthly premiums and no copays for standard covered services. Higher-income or institutional Medicaid enrollees may have limited cost-sharing depending on their specific program level.
Q: What are the Medicaid income limits in New Mexico for 2026?
A: A single adult can earn up to about $22,025 per year (138% FPL) to qualify for standard Medicaid. A family of four can earn up to about $45,540 per year. Nursing home Medicaid has a stricter limit of $2,982 per month for an individual, with a $2,000 asset cap.
Q: Does New Mexico Medicaid cover dental in 2026?
A: Yes. Children receive comprehensive dental coverage through Medicaid and CHIP, including exams, cleanings, fillings, and extractions. Adults enrolled in Centennial Care receive basic dental benefits. This includes emergency dental care and select preventive services — but not all cosmetic or restorative procedures.
Q: When is the provider enrollment deadline for NM Medicaid in 2026?
A: All rendering, ordering, and prescribing providers must be fully enrolled with New Mexico Medicaid by July 1, 2026. Claims submitted by non-enrolled providers after this date will be automatically denied. Visit the HCA provider portal to start or complete enrollment now.
Q: How long does New Mexico Medicaid take to approve in 2026?
A: Most standard applications receive a decision within 45 days of submission. Applications that involve a disability determination can take up to 90 days. If approved, coverage typically starts on the first day of the month in which you applied — so applying early in the month is beneficial.
Sources & Disclaimer
Official Sources:
- New Mexico Health Care Authority (HCA) — Fee Schedules
- NM HCA Eligibility Pamphlet, January 2026
- Medicaid.gov — NM State Plan & Managed Care Rates
- UHC Provider Portal — NM Medicaid Enrollment Deadline
- Healthcare.gov — ACA Medicaid Overview
- NM Workers’ Compensation Administration — 2026 Fee Schedule
Last Updated: June 2026
Disclaimer: CheckMedicaid.com is not affiliated with any government agency. This content is for educational purposes only. Income limits and program rules are subject to change. For official eligibility determinations, contact the New Mexico Health Care Authority or visit Medicaid.gov.
