Community Benefit from NM Centennial Care: Services to Assist the Elderly Remain at Home

Program Description

As of January 1, 2014, New Mexico’s state Medicaid program was renamed Centennial Care. As part of Centennial Care, long-term care services for the elderly that are provided outside of nursing homes are provided through a program entitled Community Benefit. Community Benefit's suite of services have been specifically chosen to help the elderly remain living in their homes or "in the community".

Services include adult day health, respite care, and personal care services, including assistance with daily tasks such as hygiene, meals, and mobility. The program supports both Agency-Based Community Benefit (ABCB) care, as well as Self-Directed Community Benefit (SDCB) care. The difference between these two options is with Agency-Based the administering organization chooses the care providers. With Self-Directed, the program participant has the flexibility to choose their care providers. For personal care or other unskilled services, participants can elect to hire a family member or friend to provide care. Having said that, the managed care organization (MCO) will make the final decision on whether the person is qualified and capable of providing the needed care.

When New Mexico accepted federal support for Medicaid expansion under the Affordable Care Act, several of the state’s Medicaid programs merged into the single comprehensive, Centennial Care managed care network. These include, most relevantly, the Mi Via, Salud!, CoLTs waivers and the state’s Medicaid Personal Care Options (PCO) program.

The state now has selected four managed care organizations (MCOs) to provide services, currently Molina Health Care of New Mexico, Blue Cross Blue Shield of New Mexico, Presbyterian Healthcare Services, and United Healthcare. The number of providers is smaller than before the Medicaid expansion, a limit designed to cut overhead costs. Additional MCOs will be added to the list over time.

 

Eligibility Guidelines

Residence – In order to be eligible for Community Benefit, an applicant must be a resident of New Mexico.

Functional Ability - to receive Community Benefit services under Centennial Care, candidates must require the level of care typically provided in a nursing home.

Income Requirements - New Mexico uses the federal income threshold to determine eligibility. What this means is non-married persons, aged 65 and older, cannot have income exceeding 300% of the Supplemental Security Income limit, also know as the Federal Benefit Rate. In 2017, an individual’s monthly income cannot exceed $2,205. Married applicants have different limits. This is most relevant when one spouse is applying for Medicaid long term care services and the other spouse is not. The non-applicant spouse is allowed to retain a portion of their spouse’s income to prevent impoverishment. A common scenario is for a couple’s income to all be in the husband’s name. Should he require nursing home care, all his income would go to pay for that care leaving his spouse without any money. A rule called the Maximum Monthly Maintenance Needs Allowance allows for up to $3,022.50 month of the applicant’s income to be allocated to their non-applicant spouse.

Asset Requirements - Single, elderly applicants are limited to a countable asset value of $2,000. This excludes the value of the home, given their home equity is valued under $840,000 and the applicant lives in the home. Other personal items, household items, a single vehicle and a very low value life insurance policy are also exempt assets. As with income, a married couple has different criteria. A rule called the Community Spouse Resource Allowance allows a non-applying spouse to have up to $120,900 of the couple’s joint assets reserved.

Over the Eligibility Limits?
Families who do need meet the financial eligibility criteria for Medicaid in New Mexico might still gain access to the program by working with a Medicaid planning professional. There are strategies, technique and approaches that can help in this situation. Learn more.

Benefits and Services

Services provided under the Centennial Care's Community Benefit can be agency-directed or self-directed.  Although not every service is available to self-direction.  Those, that can be are indicated with an asterisk (*) in the list below.

  • Assisted living – Assistance with activities of activities of daily living (ADL), such as bathing, eating, dressing, etc., as well as instrumental activities of daily living (IADL), such as light housekeeping, laundry, etc. 
  • Adult day health care / Adult day care
  • Behavior support consultation*
  • Community transition services 
  • Personal emergency response services (PERS)* - Installation, monitoring, monthly checks
  • Employment supports
  • Environmental modifications* - Roll in showers, modified switches, ramps, lifts, etc. 
  • Home health aide* - Assistance with transferring, toileting, bathing, etc. 
  • Homemaker*
  • Non-medical transportation*
  • Nutritional counseling*
  • Personal Care – Assistance with ADLs and IADLs
  • Private duty nursing* - Temporary and long term
  • Respite* / Nursing respite
  • Skilled maintenance therapy* - Physical, speech and language, and occupational therapy

 

How to Apply / Learn More

If already on Medicaid, a beneficiary can talk to his/her managed care organization about receiving services under the Community Benefit.

If Medicaid eligibility has not yet been determined, the Human Services Department (HSD) eligibility office will serve applicants. The quickest route is to create a login account at the state’s health care web portal, Yes New Mexico.  Alternately, potential applicants can call the HSD Customer Service number at (800) 283-4465 or the customer service hotline at the state’s Medicaid Call Center is (888) 997-2583.  A list of local HSD offices can be found here.

If one is uncertain regarding their Medicaid eligibility, they should consult with a Medicaid planner in advance of their application.  Read more.

While ideally NM switch to Medicaid managed care should have eliminated wait lists for community based services, some press reports indicate this is not yet the case.