New Mexico Medicaid Eligibility for Long Term Care: Income & Asset Limits

Last updated: May 31, 2024

 

New Mexico Medicaid Long-Term Care Definition

Medicaid is a health care program for low-income individuals of all ages. While there are many different coverage groups, this page is focused on long-term care Medicaid eligibility for New Mexico elderly residents, aged 65 and over. In addition to nursing home care and assisted living services, benefits are available to help this population to remain living at home. There are three categories of Medicaid long-term care programs for which NM seniors may be eligible.

1) Institutional / Nursing Home Medicaid – An entitlement; anyone who is eligible will receive assistance. Benefits are provided only in nursing home facilities.

2) Medicaid Waivers / Home and Community Based Services (HCBS) – Not an entitlement; 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 – An entitlement; anyone who is eligible will receive assistance. Long-term care benefits, such as personal care assistance or adult day care, may be available.

In New Mexico, Medicaid is called Centennial Care. While this program is jointly funded by the state and federal government, the state administers the program under federally set parameters. New Mexico’s Human Services Department (HSD) is the administering agency.

  The American Council on Aging now offers a free, quick and easy Medicaid Eligibility Test for seniors.

 

Income & Asset Limits for Eligibility

The three categories of long-term care Medicaid programs have varying financial and medical criteria. Further complicating eligibility is that the financial requirements change annually, vary with marital status, and that New Mexico offers multiple pathways towards Medicaid eligibility.

 Simplified Eligibility Criteria: Single Nursing Home Applicant
New Mexico seniors must have limited income and assets, and a medical need to qualify for Medicaid long-term care. In 2024, a single Nursing Home Medicaid applicant must meet the following criteria: 1) Income under $2,829 / month 2) Assets under $2,000 3) Require a Nursing Home Level of Care.

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 TestIMPORTANT: Not meeting all the criteria does not mean one is ineligible or cannot become eligible for NM Medicaid. More.

2024 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 $2,829 / month* $2,000 Nursing Home $5,658 / month ($2,829 per spouse)* $4,000 ($2,000 per spouse) Nursing Home $2,829 / month for applicant* $2,000 for applicant & $154,140 for non-applicant Nursing Home
Medicaid Waivers / Home and Community Based Services $2,829 / month† $2,000 Nursing Home $5,658 / month ($2,829 per spouse)† $4,000 ($2,000 per spouse) Nursing Home $2,829 / month for applicant† $2,000 for applicant & $154,140 for non-applicant Nursing Home
Regular Medicaid / Aged Blind and Disabled $943 / month $2,000 Help with ADLs $1,415 / month $3,000 Help with ADLs $1,415 / month $3,000 Help with ADLs
*All of a beneficiary’s monthly income, with the exception of a Personal Needs Allowance of $91 / month, Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse, must be paid to the nursing home. This is called a Patient Liability.
†Based on one’s living setting, a program beneficiary may not be able keep monthly income up to this level.

 

Income Definition & Exceptions

Countable vs. Non-Countable Income
Nearly all income that a Medicaid applicant receives is counted towards Medicaid’s income limit. This includes employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. Nationally, Holocaust restitution payments are not counted as income. Furthermore, in NM, the VA Aid & Attendance, which is above and beyond the Basic VA Pension, does not count as income.

Treatment of Income for a Couple
When only one spouse of a married couple applies for Nursing Home Medicaid or a HCBS Medicaid Waiver, only the applicant’s income is counted towards the income limit. Furthermore, 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 to which a non-applicant is entitled.

The MMMNA in NM is $2,555 / month (effective 7/1/24 – 6/30/25). If a non-applicant spouse has monthly income under $2,555, 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 $766.50 / month (effective 7/1/24 – 6/30/25). However, in 2024, a Spousal Income Allowance cannot put a non-applicant’s monthly income over $3,853.50. 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 and non-applicant spouse is calculated towards the applicant’s income eligibility. More on how Medicaid calculates income.

 

Asset Definition & Exceptions

Countable vs. Non-Countable Assets
Countable assets are counted towards Medicaid’s asset limit. This includes cash, stocks, bonds, investments, bank accounts (credit union, savings, and checking), and real estate in which one does not reside. In New Mexico, IRA’s / 401K’s are counted. There are also many non-countable (exempt) assets. Exemptions include personal belongings, household furnishings, an automobile, burial accounts (limited to $1,500 if not prepaid and irrevocable), and generally one’s primary home.

Treatment of Assets for a Couple
All assets of a married couple are considered jointly owned. This is true regardless of the long-term care Medicaid program for which one is an applicant and regardless of if one or both spouses are applicants. This means that assets in a non-applicant spouse’s name are counted towards their applicant spouse’s asset eligibility. There is, however, a Community Spouse Resource Allowance (CSRA) that protects a larger amount of a couple’s countable assets for a non-applicant spouse of a Nursing Home Medicaid or Medicaid Waiver applicant.

In 2024, the community spouse (the non-applicant spouse) can retain 50% of the couple’s joint assets, up to a maximum of $154,140. 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. There is no CSRA for Regular Medicaid.

Medicaid’s Look-Back Rule
New Mexico has a 60-month (5 year) Medicaid Look-Back Period for Nursing Home Medicaid and Medicaid Waivers that immediately precedes one’s application date. During the “look back”, Medicaid checks to ensure no assets were sold or gifted by the applicant and / or their spouse for less than fair market value. If the Look-Back Rule is violated, a Penalty Period of Medicaid ineligibility will be established. There is no Look-Back Rule for Regular Medicaid.

The U.S. Federal Gift Tax Rule does not extend to Medicaid eligibility. In 2024, the Gift Tax Rule allows one to gift up to $18,000 per recipient without filing a gift tax return. Gifting under this rule is a violation of Medicaid’s Look-Back Period.

 

New Mexico Medicaid Home Exemption Rules

For the home to be exempt, the Medicaid applicant or their spouse must live in it. If there is no spouse in the home, there is a home equity interest limit of $713,000 (in 2024). Home equity is the value of the home, minus any outstanding debt against it. Equity interest is the amount of the home’s equity that is owned by the applicant. Furthermore, if there is no spouse in the home, and the Medicaid applicant does not live there, the applicant must have Intent to Return. There is no home equity interest limit for Regular Medicaid. Other exemptions exist.

While one’s home is generally not counted towards Medicaid’s asset limit, it is not exempt from Medicaid’s Estate Recovery Program. Following a long-term care Medicaid beneficiary’s death, New Mexico’s Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains. This is often the home. Without proper planning strategies in place, the home will be used to reimburse Medicaid for providing care rather than going to family as inheritance.

 

Medical / Functional Need Requirements

An applicant must have a medical need for Medicaid long-term care. For Nursing Home Medicaid and Medicaid Waivers, a Nursing Home Level of Care (NFLOC) is required. Furthermore, some program benefits may have additional eligibility criteria specific to the particular benefit. For example, for a Waiver to cover home modifications, it may be required that a beneficiary be unable to safely live independently without modifying the home. For long-term care services via the Regular Medicaid program, a functional need with the Activities of Daily Living is required, but a NFLOC is not necessarily required.

 

Qualifying When Over the Limits

For New Mexico elderly residents, aged 65 and over, who do not meet the financial eligibility requirements 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 Nursing Home Medicaid and Medicaid Waiver applicants who are over the income limit to still become income-eligible. In basic terms, one’s “excess” income is directly deposited into the irreversible trust, no longer counting towards Medicaid’s income limit. Irreversible means that the terms of the trust 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 Medicaid’s limit can “spend down” extra assets to become asset-eligible. This is 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.

 Our Spend Down Calculator can assist persons in determining if they might have a Spend Down, and if so, provide an estimate of the amount.

3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” and / or “over-asset”, but they still cannot afford their long-term care costs. 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 ProgramConnect with a Medicaid Planner.

 

Specific New Mexico Medicaid Programs

In addition to paying for nursing home care, Medicaid in NM offers the following programs relevant to the elderly that helps them to continue to live at home or in the community.

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 and complete an application (HSD-100-Application for Assistance). 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. The application process may vary based on the program for which one is applying.

Persons wishing to qualify for NM long-term care Medicaid should not apply without being certain that they meet all eligibility requirements. 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. Familiarizing oneself with general information about the application process for long-term care Medicaid can be helpful.

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