Centennial Care Community Benefit: NM Medicaid Services and Supports for the Aged and Disabled

Last updated: May 31, 2022

 

Overview of the Centennial Care Community Benefit Program

New Mexico’s Community Benefit Program, often simply called Community Benefit (CB), provides home and community based services for elderly and disabled state residents of any age. Intended to prevent and delay the need for institutionalization (nursing home admission), a variety of long-term benefits are available to assist persons in living in their homes and community. This includes assistance with daily living activities, adult day health care, home modifications for safety and accessibility, and respite care. Furthermore, the program assists persons currently residing in nursing home facilities in transitioning back home.

Program participants can reside in one’s home or the home of a loved one. The CB Program also provides assisted living services, allowing program participants to live in assisted living facilities. It is thought that persons cannot reside in adult foster care homes.

In addition to long-term care, Community Benefit program participants receive medical, vision, dental, and behavioral health benefits via a single Medicaid plan provided by a managed care organization (MCO). An MCO is essentially a private healthcare company. The MCO has a network of care providers and program participants receive services via these providers. Currently, there are three healthcare plans from which a program participant can choose.

There is some flexibility of providers for persons receiving Community Benefit. In addition to the agency-directed community benefit (ADCB), program participants have the option of self-directed community benefit (SDCB). This means that rather than receive services by the MCO’s network of licensed care providers, a program participant can direct and control their own services. This includes the ability to hire their own caregiver, including relatives such as an adult child and even a spouse with the approval of the MCO. A financial management services agency handles the financial aspects of employment responsibilities such as tax withholding and caregiver payments. Community Benefit program participants must initially enroll in ADCB, but can switch to SDCB after 120 days.

Community Benefit is not necessarily an entitlement; meeting the eligibility criteria does not mean one will immediately receive program benefits. Instead, the number of participant slots may be limited, and when these slots are full, a waiting list called the Central Registry forms.

New Mexico previously had a 1915(c) Home and Community Based Services (HCBS) Medicaid waiver called CoLTS (Coordinated Long Term Services), initially called the Disabled and Elderly Waiver, through which home and community based services were provided for seniors and disabled state residents. In January of 2014, the CoLTS program ended, as did the state’s Personal Care Options (PCO) program. However, the available services and supports were absorbed into the state’s managed care program as the Community Benefit (In-Home and Community Based Supports), which operates via an 1115 Demonstration Waiver called Centennial Care 2.0. New Mexico’s Medicaid program is called Centennial Care.

 What is Medicaid Managed Care? Medicaid pays doctors, hospitals, and other providers in one of two ways, either “Fee-For-Service” or “Managed Care”. Under Fee-For-Service, Medicaid pays providers directly for each service they provide. Beneficiaries can receive services from any Medicaid-certified provider. Under Managed Care, Medicaid contracts with a Managed Care Organization (MCO). Medicaid pays the MCO a set amount for each beneficiary, rather than for each service provided. The MCO has a network of doctors, hospitals, and other providers and the MCO pays them. Beneficiaries must use providers within the network.

 

Benefits of the Community Benefit Program

Follows is a list of potential home and community based services available via Community Benefit. An individualized service plan determines which services and supports a program participant receives. An asterisk indicates the benefits that can be self-directed.

– Adult Day Health Care
– Assisted Living Services
– Behavior Support Consultation*
– Community Transition Services – assists persons with transitioning from a nursing home to a private home
– Customized Community Supports* – limited to persons self-directing their care
– Emergency Response Services*
– Employment Supports*
– Home Health Aide*
– Home Modifications / Environmental Modifications*
– Non-Medical Transportation* – limited to persons self-directing their care
– Nutritional Counseling*
– Personal Care Assistance*
– Private Duty Nursing*
– Related Goods* – limited to persons self-directing their care
– Respite Care* – includes nursing respite to give a primary caregiver a break
– Skilled Maintenance Therapies* – occupational, speech and language, and physical
– Specialized Therapies* – limited to persons self-directing their care (i.e., acupuncture, chiropractic, cognitive rehabilitation therapy, massage)

While services and supports can be provided in assisted living residences, the cost of room and board is not covered by NM Medicaid / Centennial Care.

 

Eligibility Requirements for Centennial Care Community Benefit Program

The CB Program is for New Mexico residents who are elderly (65+) or disabled and between the ages of 0 and 64. Disabled persons who are over age 64 can receive program benefits under the aged (65+) category. Additional eligibility criteria relevant to seniors are below.

 The American Council on Aging provides a quick and easy Medicaid eligibility test for New Mexico seniors. Start here
Financial Criteria: Income, Assets & Home Ownership

Income
There are two pathways through which an applicant can be financially eligible for the CB Program. The first is through “full coverage” Medicaid, which is state plan Medicaid. In 2022, a single senior applicant can have income up to $841 / month, and a married senior couple, regardless of if one or both spouses are applicants, can have up to $1,261 / month.

If an applicant’s income is too high to qualify for “full coverage” Medicaid, they can potentially qualify instead through the “waiver” program. The applicant income limit via this pathway is equivalent to 300% of the Federal Benefit Rate (FBR), which increases on an annual basis in January. In 2022, an applicant, regardless of marital status, can have a monthly income up to $2,523. When both spouses are applicants, each spouse is considered individually, with each spouse allowed income up to $2,523 / month. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of their spouse. Furthermore, monthly income from the applicant spouse can be transferred to the non-applicant spouse as a spousal income allowance, also called a monthly maintenance needs allowance.

New Mexico has set a minimum spousal income allowance of $2,288.75 / month (effective July 2022 – June 2023). This allows an applicant spouse to supplement their non-applicant spouse’s monthly income, bringing their income up to this amount. The state also sets a maximum income allowance of $3,435 / month (effective January 2022 – December 2022). While this potentially allows a non-applicant spouse a higher income allowance, the exact amount one can receive is dependent on their shelter and utility costs. However, a spousal income allowance can never push a non-applicant’s total monthly income over $3,435.

Assets
For “full coverage” Medicaid, the asset limit for a single senior in 2022 is $2,000, and for a married couple, regardless of if one or both spouses are applicants, is $3,000. Medicaid considers the assets of a married couple to be jointly owned.

For the Medicaid “waiver” program, the asset limit in 2022 is $2,000 for a single applicant. For married couples, with both spouses as applicants, the asset limit is $4,000. When only one spouse is an applicant, the applicant spouse is allowed up to $2,000 in assets and the non-applicant spouse is allocated a larger portion of the couple’s assets as a community spouse resource allowance (CSRA) to prevent spousal impoverishment.

In 2022, the CSRA allows the non-applicant spouse to keep 50% of the couple’s assets, up to $137,400. If 50% of the couple’s assets falls under $31,290, the non-applicant spouse can keep all of the couple’s assets, up to $31,290.

Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.

Assets should not be given away or sold under fair market value within 60-months of long-term care Medicaid application. This is because Medicaid has a look back rule and violating it results in a penalty period of Medicaid ineligibility.

 To determine if you might have assets over Medicaid’s countable limit, and if so, receive an estimate of the amount, use our spend down calculator.  

Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. Fortunately, for eligibility purposes, New Mexico Medicaid considers the home exempt (non-countable) in the following circumstances.

– The applicant lives in the home or has intent to return, and their home equity interest is no greater than $636,000 (in 2022). Home equity interest is the current value of the home minus any outstanding mortgage.
– The applicant has a spouse living in the home.
– The applicant has a minor child living in the home.
– The applicant has a disabled adult child living in the home.

To learn more about the potential of Medicaid taking the home, click here.

 

Medical Criteria: Functional Need

An applicant must require a nursing facility level of care (NFLOC) to be eligible for the Community Benefit Program. A functional assessment is completed and one must be determined as needing assistance with 2 or more activities of daily living (ADLs). ADLs include bathing, dressing, eating, toileting, mobility, and transitioning. While persons with Alzheimer’s disease, Lewy Body, Multi-Infarct, and other types of dementia may warrant a NFLOC, a diagnosis of dementia in and of itself does not mean one will automatically meet a NFLOC.

 For more information about long-term care Medicaid in New Mexico, click here.

 

Qualifying When Over the Limits

Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for Medicaid. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.

When persons have income over the limits, Miller Trusts, specifically called income diversion trusts in NM, can help. “Excess” income is deposited into the trust, no longer counting as income.

When persons have assets over the limits, one option is to “spend down” assets. Examples include paying off debt, making home modifications, and purchasing pre-paid funeral and burial expense trusts called Irrevocable Funeral Trusts. Another option are annuities that turn countable assets into a stream of income. There are many other options when the applicant has assets exceeding the limit.

Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid planners are educated in the planning strategies available in the state of New Mexico to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Furthermore, there are additional planning strategies that not only help one meet Medicaid’s financial criteria but can also protect assets from Medicaid’s estate recovery program. These strategies often violate Medicaid’s 60-month look back rule, and therefore, should be implemented well in advance of the need for long-term care. However, there are some workarounds, and Medicaid planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid planner.

 

How to Apply for the Centennial Care Community Benefit Program

Before You Apply

Prior to applying for the CB Program, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a free Medicaid eligibility test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid eligibility test.

As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, bank statements up to 60-months prior to application, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, a common reason applications are delayed is required documentation is missing or not submitted in a timely manner.

Since the Community Benefit Program is not necessarily an entitlement program, there may be a waiting list (Central Registry) for program participation. This waitlist is only for persons who qualify financially for CB through the “waiver” pathway. Currently, approximately 5,789 persons per year can be served via the “waiver” portion of this program. In the case of a Central Registry, priority is given to some individuals, such as those currently residing in a nursing home who wish to return home and those who have high medical needs.

 

Application Process

To apply for the Community Benefit Program, one must be eligible for NM Medicaid / Centennial Care. Persons can apply online at YesNM or over the phone by calling the Consolidated Customer Service Center at 800-283-4465. Alternatively, a Medicaid Application can be found and downloaded towards the bottom of this page or one can get an application from their Income Support Division (ISD) field office. Contact information can be found here.

Persons who are already enrolled in Medicaid and receive their benefits via a Managed Care Organization (MCO) should contact their care coordinator or current MCO to request a functional needs assessment and begin the process of applying for Community Benefit. Medicaid-enrolled persons who do not currently receive their benefits via a MCO, should call 800-283-4465 to first enroll in a MCO. Additionally, contact information for Centennial Care MCOs can be found here.

More information about the Community Benefit can be found here. Persons can also call the Aging & Disability Resource Center at 800-432-2080.

The New Mexico Human Services Department (HSD) administers the Community Benefit Program. Financial eligibility is determined by the HSD’s Income Support Division (ISD). Functional eligibility is determined by one’s Managed Care Organization (MCO).

 

Approval Process & Timing

The Medicaid application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed even further. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). However, despite the law, applications are sometimes delayed even further. Furthermore, as a Central Registry (waiting list) may exist, approved applicants may spend many months waiting to receive benefits.

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