MedicaidCoverageMedium impact
Supplement 25-10: Implementation of Community Health Worker (CHW) and Community Health Representatives (CHR) Updates Per Repeal and Replace Letter of Direction
New Mexico Medicaid·NM · Family Medicine, General Practice, Internal Medicine·Specialty Services
Effective date
Aug 25, 2025
We identified it
Jun 21, 2026
Summary
New Mexico Medicaid now covers Community Health Worker (CHW) and Community Health Representative (CHR) services starting August 25, 2025. CHWs/CHRs must enroll as Provider Type 462/Specialty 230, obtain DOH certification, and can bill CPT codes 98960-98962 for patient education services with physician orders or standing orders.
Action Required
By August 25, 2025: CHWs/CHRs must enroll with New Mexico Medicaid as Provider Type 462 and Provider Specialty 230 through YesNM portal. Upload DOH OCHW certification letter. Establish MCO participation agreements. Document all services with physician orders or complete New Mexico Statewide Standing Order Form. Submit prior authorization for services exceeding 16 units per 30-day period. Claims without proper documentation may be subject to recoupment.