In January 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 available through a program entitled Community Benefit. Community Benefit’s suite of services has 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 (with the exception of a spouse) 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!, and CoLTs waivers, and the state’s Medicaid Personal Care Options (PCO) program.
The state now has selected three managed care organizations (MCOs) to provide services, currently Blue Cross Blue Shield of New Mexico, Presbyterian, and Western Sky Community Care. 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.
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. Requiring assistance with a minimum of two activities of daily living, such as eating, bathing, and mobility, is indication that an individual requires a nursing home level of care.
Income Requirements – Income criteria vary with marital status and if both spouses are applying for Medicaid assistance. In 2022, a single (widowed or divorced) applicant can have up to $2,523 per month in income. A married couple, with both spouses as applicants, is permitted twice that amount. With a married couple with only one spouse applying, the non-applicant spouse is allowed to retain a portion of his or her spouse’s income to prevent impoverishment. A common scenario is for a couple’s income to be all 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 $3,435 per month of the applicant’s income to be allocated to his or her non-applicant spouse.
Asset Requirements – Like income, the asset limit changes based on marital status and whether or not both spouses are applying. Single, elderly applicants are limited to a countable asset value of $2,000. This excludes the value of the home, given the home equity is valued under $955,000 and the applicant or his or her spouse lives in the home. Other personal items, household items, a single vehicle, and a very low value life insurance policy are also exempt assets. A married couple with two applicants is permitted $4,000. However, a married couple with a single applicant allows a non-applying spouse to keep up to $137,400 of the couple’s joint assets. This is a rule called the Community Spouse Resource Allowance.
Services provided under the Centennial Care’s Community Benefit can be agency-directed or self-directed. However, not every service is available to self-direction. Those that can be are indicated with an asterisk (*) in the list below.
If already on Medicaid, a beneficiary can talk to his or 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 Medicaid Expansion Hotline at 855-637-6574 to apply. For questions, one can call the customer service hotline at the state’s Medicaid Call Center at (888) 997-2583. A list of local HSD offices can be found here.
Persons uncertain regarding their Medicaid eligibility, should consult with a Medicaid planner in advance of their application. Read more.
While ideally NM switching to Medicaid managed care should have eliminated wait lists for community based services, some press reports indicate this is not yet the case. That said, approximately 30,000 New Mexican residents are receiving help in their homes through this program.