New Mexico Medicaid / Centennial Care Long Term Care Programs, Benefits & Eligibility Requirements
Summary
Medicaid is a joint federal and state program, so its rules, coverage plans and even its name all vary by state. This article focuses on New Mexico Medicaid Long Term Care for seniors. This is different from regular Medicaid, which is for low-income people of all ages. In New Mexico, Medicaid is called Centennial Care and it is administered by the state’s Human Services Department. New Mexico residents can receive long term care benefits through Centennial Care in a nursing home, in their home, the home of a loved one or an assisted living residence through one of three programs – Nursing Home / Institutional Medicaid, Home and Community Based Service (HCBS) Waivers or Aged Blind and Disabled (ABD).
New Mexico Medicaid Long Term Care Programs
Nursing Home / Institutional Medicaid
New Mexico Medicaid, which is called Centennial Care, will cover the cost of long term care in a nursing home for eligible New Mexico residents who require a Nursing Facility Level of Care. Nursing home coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services. These can include skilled nursing care, physician’s visits, prescription medication, medication management, mental health counseling, social activities and assistance with the Activities of Daily Living (eating, bathing, moving, dressing, toileting).
Some of the things Centennial Care (New Mexico Medicaid) won’t cover in a nursing home are a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example), personal reading items, plants, flowers, and any care services not considered medically necessary.
Nursing Home Medicaid is an entitlement. This means that eligible New Mexico residents who apply are guaranteed by law, aka “entitled,” to receive Nursing Home Medicaid benefits once their application has been approved.
Any Centennial Care beneficiary who receives nursing home coverage must give most of their income to the state to help pay for the cost of the nursing home. They are only allowed to keep a “personal needs allowance” of $83 / month, as of 2023. This can be spent on personal items such as clothes, snacks, books, etc.
Home and Community Based Service (HCBS) Waivers
Home and Community Based Service (HCBS) Waivers will pay for long term care services and supports that help Centennial Care (New Mexico Medicaid) recipients who require a Nursing Facility Level of Care remain living in the community instead of residing in a nursing home. In New Mexico, needing assistance with two or more Activities of Daily Living (mobility, bathing, dressing, eating, toileting) is the criteria for a Nursing Facility of Level of Care designation.
The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long term care services for New Mexico residents who live in the home of a loved one, group residential facilities or an assisted living residence. While New Mexico’s HCBS Waivers will cover some long term care services and supports in those settings, it will not cover room and board costs.
New Mexico’s HCBS Waiver program that provides long term care benefits to seniors is the Centennial Care Community Benefit.
Centennial Care Community Benefit
New Mexico residents who are eligible for HCBS Waivers can receive long term care benefits through the state’s Centennial Care Community Benefit program, which is often just called Community Benefit. Program participants can live in their own home, the home of a loved one or an assisted living facility. While Community Benefit will pay for some services and supports in those settings, it will not pay for room and board. Community Benefit will also help cover transition expenses for Centennial Care beneficiaries who reside in a nursing home but want to return to living in the community.
Community Benefit program long term care benefits include adult day care, nursing visits, home modifications, Emergency Personal Response Systems and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). These benefits will be made available depending on each individual’s need and circumstances. For Medicaid recipients who reside in a nursing home but wish to return to living in the community, the Community Benefit will help pay for transitional expenses like moving costs, security deposits and essential furnishings. It will also cover long term care services and supports in the new residence, which can be the beneficiary’s home, the home of a loved one or an assisted living residence. The beneficiary must also be moving from a Medicaid-approved nursing home.
A state agency can provide licensed caregivers to deliver some of the long term care benefits available through Community Benefit. Program participants also have the option to self-direct their care. This means they can hire caregivers of their choice, including friends and family members, even spouses. However, Community Benefit recipients can only self direct their care after at least 120 days of care from a licensed, state-provided caregiver.
The Community Benefit program will also coordinate the beneficiary’s medical, vision, dental and behavioral health benefits, along with long term care services and supports, into one managed care plan.
For individuals who qualify for the Community Benefit program through New Mexico’s HCBS Waivers, the Community Benefit is not an entitlement. Instead, there are a limited number of enrollment spots (5,789 per year as of 2022), and once those spots are full, additional eligible applicants will be placed on a waiting list called the Central Registry. New Mexico residents can also qualify for Community Benefit through the state’s Aged Blind and Disabled (ABD) Medicaid program. The financial requirements are more strict (detailed below), but qualifying through ABD Medicaid means that Community Benefit is an entitlement, so all eligible applicants are guaranteed by law to receive benefits, and there is no waiting list.
Aged Blind and Disabled Medicaid
New Mexico’s Aged, Blind and Disabled (ABD) Medicaid provides healthcare and person service benefits to low-income New Mexico residents who are aged (age 65+) or disabled and live “in the community.” Living “in the community” can mean living in their home, the home of a loved one or an assisted living residence. While ABD Medicaid will cover services in all of those settings, it will not cover room and board costs. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for low-income people of all ages.
Receiving ABD Medicaid through Centennial Care (New Mexico Medicaid) is an entitlement, which means all eligible applicants are guaranteed by law to receive benefits without any wait.
Centennial Care beneficiaries can receive long term care services and supports through the Centennial Care Community Benefit and the Program of All-Inclusive Care for the Elderly (PACE).
1) Centennial Care Community Benefit
New Mexico’s Centennial Care Community Benefit program will provide long term care benefits to ABD Medicaid recipients who live in their own home, the home of a loved one or an assisted living residence. Program participants must also require assistance with at least two Activities of Daily Living (mobility, bathing, dressing, toileting).
Long term care services and supports available through the Community Benefit program include adult day care, nursing visits, skilled therapies, home modifications, Emergency Personal Response Systems and personal care assistance with the Activities of Daily Living. These benefits are made available depending on each individual’s need and circumstances. Program participants will receive their long term care benefits, as well as their medical, vision, dental and behavioral health benefits, all through one managed care plan via Community Benefit.
A state agency can provide licensed caregivers to deliver the Community Benefit long term care services, but program participants also have the option to self-direct their care. This means they can hire caregivers of their choice, including friends and family members, even spouses. However, Community Benefit recipients can only self-direct their care after at least 120 days of care from a licensed, state-provided caregiver.
For New Mexico residents who qualify for the Community Benefit program through ABD Medicaid, the program is an entitlement. That means that all eligible applicants are guaranteed by law to receive the program’s benefits.
2) Program of All-Inclusive Care for the Elderly (PACE)
New Mexico residents who are age 55 or older and have Aged Blind and Disabled Medicaid through Centennial Care (New Mexico Medicaid) can coordinate their medical, social service and non-medical personal needs into one comprehensive plan and delivery system using the Program of All-Inclusive Care for the Elderly (PACE). PACE program participants are required to need a Nursing Facility Level of Care, but they must live in their own home, the home of a loved one or assisted living residence instead of living in a nursing home, and a PACE program must be available in that community. New Mexico’s PACE programs can be used by people who are “dual eligible” for Medicaid and Medicare, and it will coordinate the care and benefits from those two programs into one plan. PACE also administers vision and dental care, and PACE day centers provide meals, social activities, exercise programs and regular health checkups and services to program participants. New Mexico’s PACE program is called InnovAge New Mexico PACE and is located in Albuquerque. More on PACE.
Eligibility Criteria For New Mexico Medicaid’s Long Term Care Programs
To be eligible for Centennial Care (New Mexico Medicaid), a person has to meet certain financial and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home / Institutional Medicaid, Home and Community Based Service (HCBS) Waivers or Aged Blind and Disabled (ABD) Medicaid.
New Mexico Nursing Home Medicaid Eligibility Criteria
Financial Requirements
New Mexico residents have to meet an asset limit and an income limit in order to be financially eligible for nursing home coverage through Centennial Care (New Mexico Medicaid). For a single applicant in 2023, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the red box below for more details), and there are other non-countable assets like funeral trusts and Medicaid-approved annuities. The 2023 income limit for a single applicant is $2,742 / month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, Centennial Care beneficiaries who reside in nursing homes are only allowed to keep $83 / month of their income as a “personal needs allowance” and must give the state the rest to help offset nursing home costs.
For married applicants with both spouses applying, the 2023 asset limit for nursing home coverage through Centennial Care is $2,000 per spouse, and the income limit is $2,742 / month per spouse. For a married applicant with just one spouse applying, the 2023 asset limit is $2,000 for the applicant spouse and $148,620 for the non-applicant spouse, and the income limit is $2,742 / month for the applicant. The income of the non-applicant spouse is not counted.
Centennial Care Nursing Home Medicaid applicants are not allowed to give away their assets in order to get under the asset limit. To make sure they don’t, New Mexico has a “look-back” period of five years. This means the state will look back into the previous five years of the applicant’s financial records to make sure they have not given away assets.
Functional Requirements
The functional, or medical, criteria for nursing home coverage through Centennial Care is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that can only be provided in a nursing home. For New Mexico’s Centennial Care, the criteria for a Nursing Facility Level of Care is needing assistance with at least two of the Activities of Daily Living (mobility, bathing, dressing, eating, toileting).
New Mexico Medicaid Home and Community Based Service (HCBS) Waivers Eligibility Criteria
Financial Requirements
New Mexico residents have to meet an asset limit and an income limit in order to be financially eligible for Home and Community Based Service (HCBS) Waivers. For a single applicant in 2023, the asset limit for HCBS Waivers in New Mexico is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the red box below for more details), and there are other non-countable assets like funeral trusts and Medicaid-approved annuities. The 2023 income limit for a single applicant is $2,742 / month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.
For married applicants with both spouses applying, the 2023 asset limit for HCBS Waivers in New Mexico is $2,000 per spouse, and the income limit is $2,742 / month per spouse. For a married applicant with just one spouse applying, the 2023 asset limit is $2,000 for the applicant spouse and $148,620 for the non-applicant spouse, and the income limit is $2,742 / month for the applicant. The income of the non-applicant spouse is not counted.
New Mexico HCBS Waiver applicants are not allowed to give away their assets in order to get under the asset limit. To make sure they don’t, New Mexico has a “look-back” period of five years. This means the state will look back into the previous five years of the applicant’s financial records to make sure they have not given away assets.
Functional Requirements
The functional, or medical, criteria for Home and Community Based Service (HCBS) Waivers through Centennial Care (New Mexico Medicaid) is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that can only be provided in a nursing home. For New Mexico’s Centennial Care, the criteria for a Nursing Facility Level of Care is needing assistance with at least two of the Activities of Daily Living (mobility, bathing, dressing, eating, toileting).
New Mexico Aged Blind and Disabled Medicaid Eligibility Criteria
Financial Requirements
New Mexico residents have to meet an asset limit and an income limit in order to be financially eligible for Aged Blind and Disabled (ABD) Medicaid. For a single applicant in 2023, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the red box below for more details), and there are other non-countable assets like funeral trusts and Medicaid-approved annuities. The 2023 income limit for a single applicant is $914 / month. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments.
For married applicants, the 2023 asset limit for ABD Medicaid through Centennial Care (New Mexico Medicaid) is $3,000 combined, and the income limit is $1,371 / month combined. This applies to married couples with both spouses applying or with just one spouse applying.
While New Mexico has a “look-back” period of five years for Nursing Home Medicaid and Home and Community Based Service Waivers applicants to make sure they don’t give away their assets to get under the limit, there is no “look-back” period for ABD Medicaid applicants. However, ABD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid, or an HCBS Waiver, and those programs will deny or penalize the applicant for giving away assets.
Functional Requirements
The functional requirements for Aged Blind and Disabled (ABD) Medicaid through Centennial Care are being disabled, blind or aged (65 or over). For ABD Medicaid applicants who require in-home services and supports, New Mexico will administer an assessment of ABD applicants and their ability to perform Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and Instrumental Activities of Daily Living (which include shopping, cooking, housekeeping and medication management) to determine the kind of long term care services the beneficiary needs and the state will cover.
One’s home is often their most valuable asset, and if counted toward the asset limit, it would likely cause them to be over the limit for eligibility. However, in some situations the home is not counted against the asset limit. If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage / debt) is less than $688,000 (as of 2023) then the home is exempt. If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives. If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $688,000. These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. More on Medicaid & Homeownership.
Applying For New Mexico Medicaid Long Term Care Programs
The first step in applying for Centennial Care (New Mexico Medicaid) Long Term Care coverage is deciding which of the three Medicaid programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Home and Community Based Service (HCBS) Waivers or Aged Blind and Disabled (ABD) Medicaid.
The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for Centennial Care when not financially eligible will result in the application, and benefits, being denied.
During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Centennial Care applicant. These documents will be needed for the official Medicaid application. Necessary documents include five years of quarterly bank statements from all accounts; the most recent monthly or quarterly statements from all investments, IRAs, 401Ks, annuities and any other financial accounts; a letter from the Social Security Administration showing the applicant’s gross Social security income and deductions; tax forms to verify income streams including wages, pensions, royalties and interest; lists of items of any trusts; proof life insurance (if the applicant has any) and a list of beneficiaries; Power of Attorney documentation.
After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, New Mexico residents can apply online at Yes New Mexico. They can also download an application and fax the completed version to 855-804-8960, drop it off at their local Human Services Department Income Support Division office, or mail it to Central ASPEN Scanning Area, PO Box 830, Bernalillo, NM 87004. New Mexico residents can also apply over the phone by calling 855-637-6574.
Choosing a New Mexico Medicaid Nursing Home
After an applicant has been approved for nursing home coverage through Centennial Care (New Mexico Medicaid), they need to choose which Medicaid-approved nursing home they will live in. Even though Centennial Care nursing home coverage is an entitlement, Medicaid will only cover stays and care in approved nursing homes. New Mexico residents can use Nursing Home Compare, which is a federal government website that has information about more than 15,000 nursing homes across the country, to help them find a nursing home. All of the nursing homes on this site are either Medicaid- or Medicare-approved.