New Mexico Assisted Living and In Home Care Medicaid Waiver Information and Rules for 2017

Introduction

New Mexico provides long-term care resources to seniors through the New Mexico Aging and Long Term Services Department and New Mexico Human Services Department. The Aging and Long Term Services Department provides services to senior through New Mexico’s four Area Agencies on Aging, or AAA’s, administer, plan and support community based services for individuals 60 and older, or age 55 and older in tribal programs. Most of the services coordinated through the AAA’s are provided at the local level. Specific services offered by each AAA vary throughout the state, but each AAA offers a wide array of programs to help older New Mexicans and their families get the help and information they need. Some services provided through the AAAs include: adult day care, case management, caregiver support, transportation, respite care, chore services, home-delivered meals, legal services, and health promotion and disease prevention.

The New Mexico Human Services Department oversees the home-and-community based waiver services for seniors looking for long-term care resources outside of a nursing home facility.

Medicaid Waiver Program for Assisted Living and In-Home Care

New Mexico Centennial Care Medicaid Waiver for Home & Community-Based Services

In July 2013, the Centers for Medicare & Medicaid Services (CMS) approved the New Mexico Human Services Department (HSD) request for Centennial Care, a new Medicaid Section 1115 demonstration waiver. Centennial Care will consolidate nine waiver programs into a single, comprehensive managed care delivery system with four managed care organizations (MCOs). The mission for Centennial Care is to educate Medicaid participants to become more savvy healthcare consumers, promote more integrated care, deliver proper care coordination for participants, involve participants in their own wellness, and pay providers for outcomes. This waiver is a consolidated program that encompasses all of the Medicaid waiver programs available to New Mexico residents.

Under the Centennial Care program there is a specific program for seniors over 65, under theHCBS category of Disabled & Elderly.

Services

Services include: A full range of services including physical health, behavioral health and long term care and supports (home and community based services and institutional care) are covered. Also included is the Community Benefit which is a set of services that help keep people in their homes and communities. Some of these community benefits include: adult day health, respite care and personal care services.

Eligibility

Recipients of Centennial Care services who qualify through the Disabled & Elderly pathway must meet both the healthcare and financial criteria required for institutional carebut choose to remain in the community.

  1. Health: An applicant must require a Nursing Home Level of Care.
  2. Financial: An applicant must meet certain income and asset limits to qualify for institutional Medicaid benefits under the Centennial Care program. The criteria for institutional (nursing facility) Medicaid benefits are the same as for the Disabled & Elderly category. For 2017, an individual must not have more than $2,205 in income per month. The asset, or resource limit, is $2,000 (or $3,000 for a married couple if both are applying. For married applicants, special income and resource rules apply. An amount up to $120,900 of the couple’s resources can be protected for the non-institutionalized spouse (or, “community spouse”) when one member of the couple begins institutionalization for a continuous period of at least 30 days on or after January 1, 2017. Applicants can also qualify under the SSI income and resource limits, which are $735 a month for an individual and $1,103 for a couple; the resource limits are the same as for the Disabled & Elderly Category.

Practical Considerations

New Mexico’s restructuring of its state Medicaid program into one entity called Centennial Care makes distinguishing the Medicaid waiver service for seniors over 65 difficult. However, the asset and income limits are the same. It is unclear whether a trust instrument, such as a Qualified Income Trust (or, Miller Trust) is available to help lower your income for financial eligibility purposes.

Conclusion

The new Centennial Care Medicaid program is a confusing Section 1115 Demonstration Waiver that combines all the state waiver programs under one roof. However, the same Elderly & Disabled Waiver that was previously available is still available through the program and eligibility is the same as if it were an HCBS waiver.