New Mexico Register / Volume
XXXVII, Issue 13 / July 14, 2026
TITLE 8 SOCIAL SERVICES
CHAPTER 310 HEALTH CARE PROFESSIONAL SERVICES
PART 14 JUST
HEALTH PLUS - JUSTICE REENTRY SERVICES PROGRAM
8.310.14.1 ISSUING AGENCY: New Mexico health care authority (HCA).
[8.310.14.1 NMAC - N, 8/1/2026]
8.310.14.2 SCOPE: The
rule governs the delivery of 90-day pre-release services to individuals in
correctional facilities that are medicaid eligible. This rule applies to all justice-involved
individuals eligible for medicaid benefits under the
JUST Health Plus program, to all providers delivering services under the
program, participating correctional facilities, and managed care organizations.
[8.310.14.2 NMAC -
N, 8/1/2026]
8.310.14.3 STATUTORY AUTHORITY: The
New Mexico medicaid program and other health care
programs are administered pursuant to regulations promulgated by the federal
department of health and human services under Title XIX of the Social Security
Act as amended or by state statute. See
Section 27-2-12 et seq., NMSA 1978. Section
9-8-1 et seq. NMSA 1978 establishes the health care authority (HCA) as a
single, unified department to administer laws and exercise functions relating
to health care facility licensure and health care purchasing and regulation. Section 27-2-12.22. NMSA 1978 establishes that
an individual’s incarceration shall not be used as a basis for denying or
terminating medicaid eligibility and authorizes HCA
to suspend rather than terminate medicaid during
incarceration and to accept and process applications for medicaid
from incarcerated individuals.
[8.310.14.3 NMAC -
N, 8/1/2026]
8.310.14.4 DURATION: The
JUST Health Plus program is authorized through a medicaid
section 1115 waiver authority. Continuation
of the program is contingent upon federal approval of the waiver renewal or the
availability of state budget appropriations. If the waiver is not renewed or funding is not
appropriated, the program may be modified or
terminated.
[8.310.14.4 NMAC -
N, 8/1/2026]
8.310.14.5 EFFECTIVE DATE: August 1, 2026, unless a later date is cited at the end of a section.
[8.310.14.5 NMAC -
N, 8/1/2026]
8.310.14.6 OBJECTIVE: The
objective of these regulations is to establish standards for eligibility,
benefits, provider participation, and reimbursement under the JUST Health Plus
program, which covers a limited set of pre-release services for medicaid-eligible justice-involved individuals during the 90-day
period prior to their release to the community.
[8.310.14.6 NMAC -
N, 8/1/2026]
A. Definitions beginning with “A”: [RESERVED]
B. Definitions beginning with “B”: [RESERVED]
C. Definitions beginning with “C”:
(1) “Case management” means services furnished
to assist individuals in gaining access to needed medical, social, educational,
and other services. Services include comprehensive
assessment and periodic reassessment of individual needs, development and
periodic revision of a specific care plan, referral and related activities, and
monitoring and follow-up activities.
(2) “Certified peer support worker
(CPSW)” means peer support workers who have successfully completed training
with the behavioral health service division’s office of peer recovery and
engagement (OPRE) and have obtained certification from the New Mexico
credentialing board of behavioral health professionals.
(3) “Children, youth, and families department
(CYFD)” means the state agency overseeing juvenile justice services.
(4) “Community health worker (CHW)” means frontline
public health workers who are trusted members of the community they serve. CHWs
function as a liaison/link/intermediary between health and social services and
communities to facilitate access to services and improve the quality and
cultural competence of service delivery.
(5) “Community provider” means an entity that provides health care
services in the community. Certain
community providers may provide JUST Health Plus services to individuals in
correctional facilities either in person or via telehealth and be reimbursed by
medicaid.
(6) “Correctional facility” means a state prison or county detention
facility, whether operated by a government or private contractor, that is used
for confinement of adult and youth persons.
(7) “County detention facilities” means detention
centers operated by local governments used for the confinement of adult and
youth persons.
D. Definitions beginning with “D”: [RESERVED]
E. Definitions beginning with “E”: [RESERVED]
F. Definitions beginning with “F”: [RESERVED]
G. Definitions beginning with “G”: [RESERVED]
H. Definitions beginning with “H”: [RESERVED]
I. Definitions beginning with “I”: [RESERVED]
J. Definitions beginning with “J”: [RESERVED]
K. Definitions beginning with “K”: [RESERVED]
L. Definitions beginning with “L”: [RESERVED]
M. Definitions beginning with “M”: “Medication assisted treatment” means the use of
FDA-approved medications for the treatment of substance use disorder (SUD).
N. Definitions beginning with “N”: “New Mexico corrections department (NMCD)” means the state
agency overseeing New Mexico prison facilities whether operated by state
government or a private contractor.
O. Definitions beginning with “O”: [RESERVED]
P. Definitions beginning with “P”: [RESERVED]
Q. Definitions beginning with “Q”: [RESERVED]
R. Definitions beginning with “R”: “Reentry services” means resources
offered that help individuals prepare for return to their communities after
incarceration. Reentry services aim to
reduce recidivism and improve public safety by supporting individuals toward
independent living skills. Services may
include psychological and financial counseling, education, skill development,
employment, housing, transportation and various types of supportive services.
S. Definitions beginning with “S”:
(1) “Screening and diagnostic
services” means the use of an evidence-based tool and process to identify diseases
or other health conditions through established criteria.
(2) “Substance use disorder (SUD)” means a pattern of
use of substances leading to clinical or functional impairment, in accordance
with the definition in the diagnostic and statistical manual of mental
disorders (DSM-5) of the American psychiatric association, or any subsequent
editions.
T. Definitions beginning with “T”: [RESERVED]
U. Definitions beginning with “U”: [RESERVED]
V. Definitions beginning with “V”: [RESERVED]
W. Definitions beginning with “W”: [RESERVED]
X. Definitions beginning with “X”: [RESERVED]
Y. Definitions beginning with “Y”: [RESERVED]
Z. Definitions beginning with “Z”: [RESERVED]
[8.310.14.7 NMAC - N, 8/1/2026]
8.310.14.8 MISSION: We ensure that New Mexicans attain their
highest level of health by providing whole-person, cost-effective, accessible,
and high-quality health care and safety-net services.
[8.310.14.8 NMAC - N, 8/1/2026]
8.310.14.9 GENERAL
PROGRAM DESCRIPTION: The New Mexico medicaid program (medicaid) pays
for medically necessary health services furnished to eligible recipients. To help individuals reentering the community
following incarceration, the New Mexico medical assistance division (MAD) has
1115 authority to pay for covered medical services provided to incarcerated medicaid eligible individuals up to 90 days before their
release. This part describes eligible
providers, covered services, service limitations, and general reimbursement
methodology. See the JUST Health Plus
Policy and Billing Manual for additional information.
[8.310.14.9 NMAC -
N, 8/1/2026]
8.310.14.10 ELIGIBLE
PROVIDERS:
A. The
following providers are eligible to be reimbursed for furnishing JUST Health
Plus services:
(1) state operated facilities including
NMCD facilities;
(2) county detention facilities;
(3) Tribal correctional facilities;
(4) CYFD juvenile justice facilities;
(5) community providers enrolled in medicaid;
(6) providers employed by facilities
noted in Paragraph (1)-(4) of Subsection A of 8.310.14.10 NMAC; and
(7) htird-party
health care vendors.
B. Correctional facilities listed in Paragraph (1)-(4) of
Subsection A of 8.310.14.10 NMAC must complete a readiness review process
conducted by MAD to participate in JUST Health Plus in order to begin provision
of services.
C. Correctional facilities who plan to bill medicaid for services must enroll as a medicaid provider with MAD. Once enrolled, providers receive a packet of
information, including medicaid program policies,
billing instructions, utilization review instructions, and other pertinent
material from MAD. Providers are
responsible for ensuring that they have received these materials and for
updating them as new materials are received from MAD. Providers must be enrolled as a medicaid provider before submitting claims. See 8.302.2 NMAC. billing for medicaid services.
[8.310.14.10 NMAC -
N, 8/1/2026]
8.310.14.11 PROVIDER
RESPONSIBILITES: Providers who
furnish services to medicaid recipients must comply
with all specified medicaid participation
requirements. See 8.302.1 NMAC, general
provider policies. Providers must
verify that individuals are eligible for medicaid at
the time services are furnished and determine if medicaid
recipients have other health insurance.
Providers must maintain records which are sufficient to fully disclose
the extent and nature of the services provided to recipients. See 8.302.1 NMAC, general provider policies.
[8.310.14.11 NMAC -
N, 8/1/2026]
8.310.14.12 COVERED
REENTRY SERVICES AND SERVICE LIMITATIONS:
All services provided must be furnished in accordance with applicable
federal, state, and local laws and regulations. Covered services must be furnished within the
90-day pre-release period.
A. The following are covered reentry services, organized by
service level. Correctional facilities
must be assessed as ready to provide either service level one, two, or three,
and may not offer a higher service level until additional readiness to provide
those services has been assessed:
(1) Service Level 1:
(a) Case management;
(b) Medication assisted treatment, see
8.325.12 NMAC, medication assisted treatment services in correctional settings;
(c) 30-day supply of medications upon
release; and
(d) Screening and diagnostic services for
eligible justice-involved juveniles.
(2) Service Level 2:
(a) All services in service level 1;
(b) Hepatitis C diagnosis and treatment;
(c) Community health worker services; and
(d) Certified peer support worker
services.
(3) Service Level 3:
(a) All services in service level 1 and
2;
(b) Diagnostic services, including
laboratory and radiology;
(c) Prescribed drugs and medication
administration;
(d) Medical equipment and supplies;
(e) Physical and behavioral health
clinical consultation services; and
(f) Family planning services and
supplies. (Additional information on
covered services, including service definitions, is detailed in the JUST Health
Plus Policy and Billing Manual.)
[8.310.14.12 NMAC -
N, 8/1/2026]
8.310.14.13 ELIGIBLE
RECIPIENTS: An individual shall be
eligible for services under JUST Health Plus if the individual meets all of the
following criteria:
A. is incarcerated in an eligible correctional facility, see
8.310.14.10.A NMAC;
B. is determined eligible for full medicaid
benefits;
C. is within 90 days of their projected release date; and
D. consents to participating in the JUST Health Plus program.
[8.310.14.13 NMAC - N, 8/1/2026]
8.310.14.14 PROVIDER
REIMBURSEMENT: Providers and
correctional facilities can receive medicaid
reimbursement for the provision of pre-release services through several payment
methodologies (see the JUST Health Plus Policy and Billing Manual for
additional information).
[8.310.14.14 NMAC -
N, 8/1/2026]
HISTORY OF
8.310.14 NMAC: [RESERVED]