New Mexico Medicaid (Centennial Care) Long Term Care Programs, Benefits & Eligibility Requirements

Summary
Medicaid’s rules, benefits and name can all vary by state. In New Mexico, Medicaid is called Centennial Care. This article focuses on New Mexico Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and in other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers or ABD Medicaid. This is different from regular Medicaid, which is for financially needy people of all ages.

 

New Mexico Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

New Mexico Nursing Home Medicaid will cover the cost of long-term care in a nursing home for financially limited New Mexico seniors who require a Nursing Facility Level of Care. This includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

  • Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
  • Skilled nursing care
  • Physician’s visits
  • Prescription medication
  • Medication management
  • Mental health counseling
  • Social activities

Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.

New Mexico Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover the nursing home expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $91/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.

New Mexico Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.

Home and Community Based Services (HCBS) Waivers

New Mexico Home and Community Based Services (HCBS) Waivers will pay for long-term care services and supports that help financially limited New Mexico seniors who require a Nursing Facility Level of Care remain living in the community instead of moving to 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.

The HCBS Waiver relevant to New Mexico 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 (about 5,800 per year as of 2022), and once those spots are full, additional eligible applicants will be placed on a waitlist 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 waitlist.

 

Aged, Blind, and Disabled Medicaid

New Mexico’s Aged, Blind and Disabled (ABD) Medicaid provides healthcare coverage and long-term care benefits to New Mexico residents with limited financial means who are aged (age 65+), blind or disabled and live in the community. 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 that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without wait. Access to long-term care benefits via ABD Medicaid depends on the availability of funds, programs and caregivers in the area where the beneficiary lives.

New Mexico ABD Medicaid beneficiaries who show a medical need 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 without wait.

2. Program of All-Inclusive Care for the Elderly (PACE)
New Mexico residents who are age 55 or older and have ABD Medicaid can coordinate their medical, social service and long-term care coverages 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. To learn more about PACE, click here.

 

Eligibility Criteria For New Mexico Medicaid 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 Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

 Just For You: The easiest way to find the most current Centennial Care (New Mexico Medicaid) eligibility criteria for your specific situation is to use our Medicaid Eligibility Requirements Finder tool.

 

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 2024, 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 How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for New Mexico Nursing Home Medicaid for a single applicant is $2,829/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, New Mexico Medicaid beneficiaries who reside in nursing homes must give most of their income to the state to help pay for the cost of care. They are only allowed to keep $91/month of their income as a “personal needs allowance,” and they are allowed to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.

For married applicants with both spouses applying, the 2024 asset limit for New Mexico Nursing Home Medicaid is a combined $4,000, and the income limit is a combined $5,856/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

  Plan Ahead: There are alternative pathways to eligibility for New Mexico Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply 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 Nursing Home Medicaid 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 is usually associated with 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 Services (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 2024, 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 How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for HCBS Waivers in New Mexico for a single applicants is $2,829/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 2024 asset limit for HCBS Waivers in New Mexico is a combined $4,000, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

  Plan Ahead: There are alternative pathways to eligibility for New Mexico HCBS Waivers applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply 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 Nursing Home Medicaid 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 Services (HCBS) Waivers through Centennial Care (New Mexico Medicaid) is needing a Nursing Facility Level of Care, which means the applicant requires the kind of full-time care that is usually associated with 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 2024, 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 How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for ABD Medicaid in New Mexico for a single applicant is $943/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 2024 asset limit for ABD Medicaid in New Mexico is a combined $3,000, and the income limit is a combined $1,415/month. This applies to married couples with both spouses applying or with just one spouse applying.

  Plan Ahead: There are alternative pathways to eligibility for ABD Medicaid applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While New Mexico has a Look-Back Period of five years for Nursing Home Medicaid and HCBS Waivers applicants to make sure they don’t give away their assets to get under the limit, the Look-Back Period does not apply to ABD Medicaid applicants. However, ABD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid or HCBS Waivers, and those programs will deny or penalize the applicant for giving away assets.

Functional Requirements
The only functional requirements for receiving basic healthcare coverage through New Mexico ABD Medicaid is being aged (65 or over), blind or disabled. For ABD Medicaid applicants who require long-term care services and supports, New Mexico will administer an assessment of their ability to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (which include shopping, cooking, housekeeping and medication management), as well as their cognitive ability, to determine the kind of long-term care benefits they need and they state will cover.

 

How New Mexico Medicaid Treats the Home for Eligibility Purposes

One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many 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 $713,000 (as of 2024) 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 $713,000.

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. To learn more about the impact of home ownership on Medicaid eligibility, click here.

New Mexico Medicaid applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in New Mexico and how you can protect your home from it, click here.

 

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 Services (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 may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.

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.

For step-by-step guides to applying for each of the 3 types of Medicaid Long Term Care, just click on the name: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.

 Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney. 

 

Choosing a New Mexico Medicaid Nursing Home

After being approved for nursing home coverage through Centennial Care (New Mexico Medicaid), seniors need to choose which Medicaid-accepting nursing home best meets their needs. Even though Centennial Care nursing home coverage is an entitlement, not all nursing homes accept Medicaid, and those that do might not have any available beds. Finding the right facility can be a challenge, especially if you’re looking in a specific area.

New Mexico has roughly 70 nursing homes that accept Medicaid. About 20 of them are in Albuquerque, and another three are in neighboring Rio Rancho. There are six nursing homes that accept Medicaid in Las Cruces. Otherwise, the facilities are spread throughout the state in the smaller cities and towns: there are three within 25 miles of Santa Fe, three more around Roswell and two in Gallup.

 TOOLS: To find and compare nursing homes, New Mexico residents can use Nursing Home Compare, which is a search tool administered by the Centers for Medicare & Medicaid Services (CMS) that has information on more than 15,000 nursing homes across the country.

When you’ve found nursing homes in your area that accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can be a good place to start. The healthcare professionals who work with you can also be a great source of information. And you can contact your local Area Agency on Aging to find out more information about nursing homes in the state.

After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: Does the residence offer social activities? Does it provide transportation? How does it handle dental and vision care? What is the food like? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.

CMS data reveals that nursing homes in New Mexico are subpar when it comes to health conditions. New Mexico nursing homes averaged 39.6 health deficiencies that led to citations during a three-year period from 2019-2022, and the national average was 25.7 during that same time frame. That doesn’t mean all New Mexico nursing homes have health standard issues, but it does mean you should research past health inspection reports for any facility before making your final decision. On the bright side, only 3.3% of residents in New Mexico nursing homes had depressive symptoms, which is much lower than the national average of 8.1%.