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. Specifically, long term care is covered, whether that be at home or outside the home (i.e., adult day care center, nursing home, 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 varying financial and medical / functional criteria, as well as 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; Anyone who is eligible will receive assistance. Benefits are provided only in nursing home facilities.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – This is not an entitlement program; The number of participants is limited and wait lists may exist. Services are meant to delay / prevent the need for nursing home care and may be provided at home, adult day care, or in assisted living. More on waivers.
3) Regular Medicaid / Aged Blind and Disabled – This is an entitlement program; Anyone who is eligible will receive assistance. Long-term care benefits, such as personal care assistance or adult day care, may be available.
The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from a New Mexico Medicaid program. Alternatively, seniors may take the Medicaid Eligibility Test. IMPORTANT: Not meeting all the criteria does not mean one is ineligible or cannot become eligible for NM Medicaid. More.
|2022 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||$2,523 / month*||$2,000||Nursing Home||$5,046 / month ($2,523 per spouse)*||$4,000 ($2,000 per spouse)||Nursing Home||$2,523 / month for applicant*||$2,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,523 / month||$2,000||Nursing Home||$5,046 / month ($2,523 per spouse)||$4,000 ($2,000 per spouse)||Nursing Home||$2,523 / month for applicant||$2,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$841 / month||$2,000||Help with ADLs||$1,261 / month||$3,000||Help with ADLs||$1,261 / month||$3,000||Help with ADLs|
What Defines “Income”
Any income that a Medicaid applicant receives is counted towards Medicaid’s income limit. This means the 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. An exception exists for Holocaust restitution payments and Covid-19 stimulus checks. They do not count as income and do not impact Medicaid eligibility.
When only one spouse of a married couple is applying for nursing home Medicaid or a HCBS Medicaid Waiver, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded. However, the non-applicant spouse may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their applicant spouse to prevent spousal impoverishment. The MMMNA is said to be the minimum amount of monthly income a non-applicant requires to avoid poverty. The MMMNA in NM is $2,177.50 / month (effective 7/1/21 – 6/30/22). If a non-applicant spouse has monthly income under $2,177.50, income can be transferred from their applicant spouse to bring their monthly income up to this level.
In New Mexico, a non-applicant spouse can further increase their spousal income allowance if their housing and utility costs exceed a “shelter standard” of $653 / month (effective 7/1/21 – 6/30/22). However, in 2022, in no case can a spousal income allowance put a non-applicant’s monthly income over $3,435.This is the Maximum Monthly Maintenance Needs Allowance. Learn more about calculating the spousal allowance.
Income is counted differently when only one spouse applies for regular Medicaid / Aged Blind and Disabled; The income of both the applicant spouse and the non-applicant spouse is calculated towards the applicant’s income eligibility. For additional information on how Medicaid calculates income, click here.
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. There are also many assets that Medicaid considers exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, and burial accounts (limited to $1,500 if not prepaid and irrevocable). One’s primary home is also exempt if the Medicaid applicant lives in it or has intent to return and their home equity interest is not more than $636,000 (in 2022). Equity interest is the home’s value, minus any debt against the home, in which the applicant owns. The home is also exempt, regardless of any other circumstances, if the applicant has a spouse living in it.
All assets of a married couple are considered jointly owned regardless of the long-term care Medicaid program for which one is an applicant. This means that assets in the non-applicant spouse’s name are counted towards the applicant spouse’s asset eligibility. However, the non-applicant spouse of a nursing home or Waiver applicant is permitted a Community Spouse Resource Allowance (CSRA). In 2022, the community spouse (the non-applicant spouse) can retain 50% of the couple’s joint assets, up to a maximum of $137,400, as the chart indicates above. If the non-applicant’s share falls below $31,290, 100% of the assets, up to $31,290 can be retained by the non-applicant spouse.
New Mexico has a 60-month (5 year) Medicaid Look-Back Period that immediately precedes one’s Medicaid application date. During this time frame, Medicaid checks to ensure no assets were sold or gifted for less than fair market value. If a Medicaid applicant, or even their non-applicant spouse, violates 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) – Also called Miller Trusts, or specific to New Mexico, Income Diversion Trusts, these trusts enable Medicaid applicants who are over the income limit to still qualify for nursing home Medicaid or a Medicaid Waiver. In basic terms, one’s excess income (over the Medicaid limit) is directly deposited into the irreversible trust, no longer counting towards Medicaid’s income limit. Irreversible means that once the trust has been established, it cannot be changed or canceled. A trustee manages the trust and has legal control of the money. The funds can only be used for very specific purposes, such as paying a non-applicant spousal income allowance and contributing towards the cost of long-term care and medical expenses accrued by the Medicaid enrollee. Following the 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.
2) Asset Spend Down – Persons with assets over the limit can spend down extra assets to qualify for Medicaid. This can be done by spending excess assets on non-countable ones, 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. When “spending down”, it is best to keep documentation of how the assets were spent as evidence Medicaid’s look back period was not violated.
3) 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 these persons, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible, as well as to protect their home from Medicaid’s estate recovery program. Read more or connect with a Medicaid planner.
Specific New Mexico Medicaid Programs
1) 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 care, 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.
2) Program of All-Inclusive Care for the Elderly (PACE) – Combines the benefits of Medicaid, including long-term care, and Medicare into a single program.
How to Apply for New Mexico Medicaid
There are several ways for seniors to apply for Centennial Care in New Mexico. Persons can apply online at Yes New Mexico, over the phone at 1-855-637-6574, or download an application. Completed applications can be faxed to 1-855-804-8960, mailed to Central ASPEN Scanning Area (CASA), PO Box 830, Bernalillo, NM 87004, or dropped off at one’s local Human Services Department (HSD) Income Support Division (ISD) office. For additional program information or for assistance, ISD Customer Service Center can be reached at 1-800-283-4465.
Persons wishing to qualify for NM long-term care Medicaid should not apply without being certain that they meet all eligibility requirements (discussed above). Seniors who are uncertain, or have income and / or assets over the limit(s), should consider Medicaid planning for the best chance of acceptance into the Medicaid program. Applying for Centennial Care can be a complicated, confusing, and lengthy process. To learn more about applying for long-term care Medicaid, click here.