New Mexico Medicaid Definition
In New Mexico, Medicaid is called Centennial Care and is administered by New Mexico’s Human Services Department (HSD).
Medicaid is a wide-ranging, jointly funded state and federal health care program for low-income individuals of all ages. While the Medicaid program has many different eligibility groups, this page is focused on Medicaid eligibility for New Mexico elderly residents, aged 65 and over, and specifically for long term care, whether that be at home, in a nursing home, or in an assisted living facility.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which New Mexico seniors may be eligible. These programs have slightly different financial and medical eligibility requirements, as well as varying benefits. Further complicating eligibility are the facts that the requirements vary with marital status and that New Mexico offers multiple pathways towards Medicaid eligibility.
1) Institutional / Nursing Home Medicaid – this is an entitlement program, meaning anyone who is eligible will receive assistance. It is provided only in nursing home facilities.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – these programs limit the number of participants. Therefore, wait lists may exist. Services are provided at home, adult day care, or in assisted living.
3) Regular Medicaid / Aged Blind and Disabled – this is an entitlement program, which means anyone who is eligible will receive assistance. It is provided at home or adult day care.
The table below provides a quick reference to allow seniors to determine if they are immediately eligible for long term care from an New Mexico Medicaid program. Alternatively, take the Medicaid Eligibility Test. IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible. More.
|2018 New Mexico Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||$2,250 / month||$2,000||Nursing Home||$4,500/ month (Each spouse is allowed up to $2,250)||$4,000 (Each spouse is allowed up to $2,000)||Nursing Home||$2,250 / month for applicant||$2,000 for applicant & $123,600 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,250 / month||$2,000||Nursing Home||$4,500/ month (Each spouse is allowed up to $2,250)||$4,000 (Each spouse is allowed up to $2,000)||Nursing Home||$2,250 / month for applicant||$2,000 for applicant & $123,600 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$750 / month||$2,000||None||$1,125/ month||$3,000||None||$750 / month||$2,000||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, this income can come from any source. Examples include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. However, when only one spouse of a married couple is applying for Medicaid, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded. For married couples, with non-applicant spouses’ with insufficient income in which to live, there is what is called a Minimum Monthly Maintenance Needs Allowance (MMMNA). This is the minimum amount of monthly income to which the non-applicant spouse is entitled. This provision allows applicant spouses to transfer a portion of their income to their non-applicant spouses. As of 2018, this figure falls between $2,057.50 / month (this figure changes 7/1 of each year) and $3,090 / month (this figure changes 1/1 of each year). This rule prevents non-applicant spouses from becoming impoverished.
What Defines “Assets”
Countable assets include cash, stocks, bonds, investments, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility, there are many assets that are considered exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, burial accounts (up to $1,500, or up to any amount if it is prepaid and irrevocable) and one’s primary home, given the Medicaid applicant or their spouse lives in the home and the equity value is under $858,000 (in 2018). For married couples, as of 2018, the community spouse (the non-applicant spouse) can retain up to half of the couple’s joint assets, up to a maximum of $123,600, as the chart indicates above. This, in Medicaid terminology, is referred to as the Community Spouse Resource Allowance (CSRA). There is also a minimum CSRA, and if a couples’ joint assets are $31,290 or less, the community spouse is entitled to 100% of it.
It’s important to note that New Mexico has a Medicaid Look-Back Period. This is a period of 60 months (5 years) that dates back from one’s Medicaid application date. During this time frame, Medicaid checks to ensure no assets were sold or given away for less than they are worth. If a Medicaid applicant, or even their non-applicant spouse, is found to be in violation of the look-back period, there will be a period of Medicaid ineligibility for the applicant.
Qualifying When Over the Limits
For New Mexico elderly residents, aged 65 and over, who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Qualified Income Trusts (QIT’s) – QIT’s, also referred to as Miller Trusts, are for Medicaid applicants who are over the income limit, but still cannot afford to pay for their long-term care. (For New Mexico Medicaid purposes, a Miller Trust is often called an Income Diversion Trust.) This type of trust offers a way for individuals over the Medicaid income limit to still qualify for long-term care Medicaid, as money deposited into a QIT does not count towards Medicaid’s income limit. In basic terms, one’s excess income (over the Medicaid limit) is directly deposited into a trust, in which a trustee is named, giving that individual legal control of the money. The money in the account can only be used for very specific purposes, such as paying a spousal allowance and contributing towards the cost of nursing home care, HCBS long term care, and medical expenses accrued by the Medicaid enrollee. As previously stated, the income in this account is exempt from Medicaid’s income limit. The account must be irreversible, meaning once it has been established, it cannot be changed or canceled, and upon death of the Medicaid participant or in the event of Medicaid disenrollment, the remainder of the funds must be paid to the state of New Mexico.
Unfortunately, Income Diversion Trusts do not assist one in spending down extra assets to qualify for Medicaid. Said another way, if one meets the income requirement for Medicaid eligibility, but not the asset requirement, the above option cannot assist one in reducing their assets that are over the limit. However, one can “spend down” assets by spending excess assets on non-countable assets, such as home improvements (replacing a leaky roof, updating the heating/plumbing), home modifications (wheelchair ramps, roll-in showers, and stair lifts), vehicle modifications (wheelchair lifts, adaptive control devices, and floor modifications to allow one to drive from a wheelchair), prepaying funeral and burial expenses, and paying off debt.
2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.
Specific New Mexico Medicaid Programs
New Mexico Centennial Care Community Benefit – Intended to encourage independent living at home or in the community, a variety of supportive services are provided. These include assisted living, adult day health, home health aides, personal care assistance, and home modifications. Program participants have the choice of self-directing their own care, including hiring a relative to provide care assistance, or going through a provider agency.