Written by a parent, not a doctor. Nothing here is medical advice.

Childhood Cancer Lantern
Search Saved

New Mexico program

Health insurance for your child (Turquoise Care)

New Mexico’s Medicaid coverage for children under 19 can sit behind insurance you already have.

What it is

New Mexico’s Medicaid coverage for children under 19 can sit behind insurance you already have.

Turquoise Care covers children under 19 whose household meets the income rules. The limit is higher before age 6. New Mexico decides who counts in your child’s household and which income counts.

Eligibility rules
  • Your child must live in New Mexico and be under 19. Savings are not an eligibility factor.
  • HCA determines your child’s Medicaid household using tax-filer and nonfiler rules, which may differ from everyone at your address. The test generally uses current monthly countable income. Annual income divided by 12 is only an estimate.
  • A child under 6 qualifies up to 300% of the poverty line (about $8,250 a month for a family of four in 2026); a child aged 6 to 18 up to 240% (about $6,600). If your child already has other insurance, the lower line applies instead: 240% under 6 and 190% from 6 to 18.
  • The 2026 BeWell reference chart shows $6,830 monthly for three people and $8,250 for four at 300% of poverty. At 240%, it shows $5,464 and $6,600. HCA confirms the current application limits and their effective dates.
  • HCA applies the five-percentage-point allowance when needed to establish eligibility. This can include the lower Medicaid-funded limit when other coverage bars CHIP. HCA confirms the current dollar table, household, countable income and coverage category.
  • Children must meet the citizenship or immigration rules for their coverage category. New Mexico covers qualifying lawfully residing children without the usual five-year wait; emergency-services coverage is a different route. A financial counselor can help identify the child’s category and any verification exceptions. The participating hospital must explain the rules and end date for any temporary hospital coverage.
What you get
  • Coverage for hospital care, chemotherapy, medicines and clinic visits.
  • Dental and vision care are included.
  • Rides and approved nursing at home can help during treatment.
  • Earlier eligible bills can be covered.
What this includes
  • Medicaid’s child benefit review [EPSDT] applies under age 21 within federal Medicaid benefit categories. It does not guarantee every requested service.
  • Home nursing and personal care require clinical review and approval. Transport has separate booking and long-trip rules.
  • Private insurance is billed first. Under New Mexico's rule the clinic must then accept what the two insurers pay as payment in full.
  • For covered, properly authorized care from a participating Medicaid provider, you generally cannot be billed the private plan’s remaining deductible, coinsurance or copay—even when Medicaid pays $0 because the other plan already paid more than Medicaid allows. A bill may need corrected insurance or authorization information. Noncovered care or a valid, specific advance agreement can be different; the financial counselor can review the bill before you agree to pay it.
  • For example, suppose the private plan allows $10,000 with a $3,000 unmet deductible and no coinsurance. It pays $7,000, while Medicaid allows $6,000. Medicaid pays $0, but the family owes $0 for that covered, properly authorized claim from a participating provider. These are hypothetical amounts, not a fee schedule.
  • The financial counselor can confirm the current child cost-sharing rules and review any unexpected charge.
If you decide to apply
  1. Ask the hospital’s financial counselor about applying through YES New Mexico, online or at 1-800-283-4465.
  2. The financial counselor can explain needed records and any alternatives for missing identification or other documents.
  3. Ask whether a participating hospital can open temporary coverage while the full application is reviewed.

HCA confirms eligibility, the Medicaid number, coverage dates and how your child receives coverage · 1-800-283-4465 · Official page ↗

After you apply
  • Ordinary applications generally have a 45-day decision standard, or 90 days when a disability determination is needed. Limited documented extensions can apply. The posted New Mexico rule requires a decision within three working days after complete verification arrives.
  • A participating hospital can check whether temporary hospital coverage is available while the full application is reviewed. The hospital’s written notice should identify when that temporary coverage starts and ends and any deadline for the full application.
  • Through 2026, eligible coverage can reach back three months before the application month. Applications from January 1, 2027 have a two-month lookback for children.
  • Children approved before age 6 can generally keep coverage until age 6, with at least 12 months of continuous coverage even when enrollment starts shortly before that birthday. Children ages 6–18 generally have 12 months. Limited exceptions apply.
  • The approval notice gives the coverage dates and delivery arrangement. If your child uses a Turquoise Care plan, the counselor can check its hospital, oncology and pharmacy network.
Good to know

The Medicaid-funded part can work with private insurance. The upper CHIP-funded part has a separate rule about other coverage.

Other details
  • Keeping both plans means managing two insurers and any work-plan premium. Removing one child may not reduce a family premium.
  • A Turquoise Care appeal generally has a 60-calendar-day filing window. The plan’s decision is due within 30 calendar days, or 72 hours when delay risks health. A permitted extension can add up to 14 days. Missing the plan’s decision deadline can open the state-hearing route. HCA Fair Hearings can confirm the hearing deadline on your notice.
  • If the plan reduces or stops an existing authorized service, keeping it requires an appeal and a continuation request. Both are due by the later of 10 calendar days after the notice is sent or the proposed change date. The service must have been ordered by an authorized provider, and its authorization must not have expired.
  • After an unfavorable plan appeal, a hearing request and another continuation request are due within 10 calendar days after that decision is sent. The social worker can check the dates and possible repayment if the final decision is unfavorable. These deadlines do not automatically start a newly requested service.

Federal background: Medicaid and Medicaid as second insurance.

Official sources
Ask your social worker

“Could Turquoise Care help cover our child’s treatment? What are the benefits and drawbacks with any insurance we already have, and would you help us apply if you recommend it?”

Why I’m asking: We want to understand what treatment would cost and how another insurer would fit with our care.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

File at yes.nm.gov, report this month’s income and any insurance, and name the months that already have bills.

Your social worker

The oncology social worker or financial counsellor helps you file, asks whether the hospital can open temporary coverage that day, and chases the 45-day decision.

The care team

Nothing is needed from the doctors for ordinary child coverage.

Who decides
The New Mexico Health Care Authority checks income. A Turquoise Care health plan you choose then runs the coverage.
Ask your social worker
“Can you help me file at yes.nm.gov today, ask whether this hospital can open temporary coverage while we wait, and list the bills from the three months before we apply?”

How to apply

First step: Apply at yes.nm.gov or call 1-800-283-4465 this week, and ask the hospital counsellor today whether it can open temporary coverage.

  1. Apply at yes.nm.gov this week.
  2. Ask the hospital whether it can open temporary coverage today.
  3. List the months that already have bills so the three-month look-back covers the admission.
  4. Pick a Turquoise Care plan the hospital and the oncology group take.

Official application / program page ↗

Where it starts: Apply at yes.nm.gov or call 1-800-283-4465. Ask the hospital’s financial counsellor on the same day whether it is a participating hospital that can open temporary coverage while the office decides.

What to gather

  • Your child’s birth certificate or ID and Social Security number
  • A New Mexico address
  • This month’s income for each parent in the tax household
  • Insurance cards, if any
  • Hospital bills from the three months before you apply

How long: Ordinary processing is generally 45 days, or 90 for a required disability determination. A participating hospital can check temporary coverage and explain its written start/end dates and full-application deadline.

What a yes looks like

A notice with coverage dates and a choice of Turquoise Care plan. Check the hospital and the oncology group are in that plan before you choose.

What a no looks like, and the next move

Read whether the office said no on income, on a document or on a category. Ask what the answer would be with the five percent allowance applied, and appeal by the date on the notice.

Watch out

  • New Mexico takes five percent of the poverty guideline off your income before comparing, and prints no dollar figure for it. Apply even if you look a little over.
  • Your child can keep private insurance and have this too. Do not cancel the work plan to apply.
  • There is no savings test here at all, so money in the bank is not a reason to skip it.

Dates that change this

2026-01-13: The dollar figures are the state marketplace’s 2026 reference cells for the percentages the regulation sets. The Health Care Authority’s own 2026 children’s table could not be opened, so treat the cells as close rather than exact. (not yet confirmed against the final rule)

2027-01-01: Coverage reaches back up to three months before the application month now. Federal law cuts that to two months for applications made on or after January 1, 2027, and New Mexico has published nothing of its own about it.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Full covered child services through the applicable Medicaid or CHIP-funded band. The 2026 BeWell reference chart shows $8,250 for four people at 300% of poverty and $6,600 at 240%; those are not verified agency implementation dates or insurance-aware eligibility decisions.

  • $8,250/month — Under age 6, household of 4, published line (300 percent of poverty)
  • $6,600/month — Ages 6 to 18, household of 4, published line (240 percent of poverty)
  • $6,830/month — Under age 6, household of 3, published line
  • $5,464/month — Ages 6 to 18, household of 3, published line

Covers: Hospital and clinic care · Chemotherapy and prescriptions · Medically necessary under-21 services within federal Medicaid benefit categories, subject to applicable coverage and approval rules · Nursing and personal care at home when the plan approves it · Rides, and meals and lodging on long trips · Dental and vision

Legal protection: Other insurance pays first and New Mexico Medicaid pays behind it

What it costs the family: The eligibility office and plan can confirm the current child category’s premium, fee, deductible and copay rules. A complete current cost-sharing schedule remains unresolved; the separate covered-service billing protections still apply.

The eligibility facts, as published

Age
under 19
Age max exclusive
19
Income
The outer children’s bases are 300% of poverty before age 6 and 240% at ages 6–18. The lower Medicaid-funded bases are 240% and 190%; actual other qualified coverage can bar the upper CHIP-funded band. The conditional five-percentage-point allowance and agency household/income calculation also apply.
Resources
none: resources are not an eligibility factor in this category
Insurance status condition
Other coverage is allowed in the lower Medicaid-funded band and pays first; actual other qualified coverage can bar the upper CHIP-funded band (8.295.400.11 and 8.302.3.10 NMAC).
Residency
New Mexico
Continuous eligibility
Approval before age 6 generally protects coverage through age 6 with at least 12 months from enrollment; ages 6–18 generally receive 12 months, subject to permitted exceptions.
Retroactive months
3 now; 2 for applications made on or after 2027-01-01
Processing standard
Generally 45 days for ordinary applications or 90 when disability must be determined, with permitted documented extensions; decision within three working days after complete verification under the posted rule.

Decisions this site cannot make: Health Care Authority income determination on yes.nm.gov · Hospital presumptive eligibility by a participating hospital

Expect friction on: Choosing a Turquoise Care plan the hospital and the oncology group take

The trap: New Mexico takes five percent of the poverty guideline off your income before it compares, and it publishes no dollar column for that step. A family a little over the printed cell can still get a yes, so apply and let the office do the arithmetic. Do not cancel private insurance to apply.

Where I read this

← Back to your options