Paul Sanchez
Medicaid is a federal program that provides free or low-cost health care to low-income individuals and families who meet certain eligibility requirements. Each state has its own eligibility criteria and application process for Medicaid, and New Mexico is no exception. In this state, Medicaid offers long-term care programs for seniors, Native Americans, and children in state custody, among other groups. The application process for New Mexico Medicaid is open year-round, and there are several ways to submit an application. This article will explore the specifics of New Mexico's Medicaid program, including eligibility criteria, application procedures, and the types of services covered.
| Characteristics | Values |
|---|---|
| Medicaid Enrollment Window | Year-round |
| Medicaid Application Channels | Online, Phone, Mail, In-person |
| Medicaid Coverage | Nursing Home Care, Home and Community-Based Services, Personal Care, Long-Term Nursing Facility Care |
| Medicaid Eligibility | Low-income individuals, Children, Elderly Residents |
| Medicaid Income Count | Employment Wages, Alimony Payments, Pension Payments, Social Security Disability Income, Social Security Income, IRA Withdrawals, Stock Dividends |
| Medicaid Non-Income Count | Holocaust Restitution Payments, VA Aid & Attendance |
| Medicaid Spending | Home Improvements, Vehicle Modifications, Funeral and Burial Expenses, Debt Repayment |
| Medicaid Planning | For "Over-Income" and/or "Over-Asset" Individuals |
| Medicaid Buy-In Program | Not Passed in 2019 |
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What You'll Learn
Medicaid eligibility in New Mexico
Medicaid is a health care program for low-income individuals of all ages. In New Mexico, Medicaid is available to low-income adults under the age of 65, with coverage extending to children and pregnant women with higher incomes. Those aged 65 or older, blind, or disabled can also be eligible, but there are income and asset limits for these groups.
The following populations are eligible for Medicaid in New Mexico:
- Adults under 65 with household incomes up to 138% of poverty.
- Children aged 0-5 with household incomes up to 305% of poverty.
- Children aged 6-18 with household incomes up to 245% of poverty.
- Pregnant women with household incomes up to 255% of poverty.
Postpartum coverage has recently been extended for a year after birth, instead of ending after 60 days. Additionally, New Mexico Medicaid covers long-term care for seniors, including nursing home care and services to support independent living.
There are three categories of Medicaid long-term care programs:
- Institutional/Nursing Home Medicaid: An entitlement, meaning anyone eligible will receive assistance, but benefits are only provided in nursing home facilities.
- Medicaid Waivers/Home and Community-Based Services (HCBS): This is not an entitlement, and the number of participants is limited with potential wait lists. These services are designed to delay or prevent the need for nursing home care and may be provided at home, adult day care, or assisted living.
- Medicaid Planning: For those who are "over-income" or "over-asset" but still cannot afford long-term care costs. By working with a Medicaid Planning Professional, families can employ strategies to become eligible.
In New Mexico, individuals deemed eligible for SSI are automatically approved for Regular Medicaid. Additionally, New Mexico's Medicaid Managed Care program, Turquoise Care, began on July 1, 2024, offering four health plans to choose from. Under Turquoise Care, enrollees receive additional services such as expanded care coordination, community benefits, and value-added benefits that each MCO (Managed Care Organization) offers its members.
Medicaid enrollment in New Mexico is year-round, with no open enrollment window. Applications can be submitted online, by phone, by mail, or in person at a NM Human Services Department field office.
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Medicaid enrolment process
Medicaid is a health care program for low-income individuals of all ages. The enrolment process for Medicaid depends on the state in which the applicant is a resident. Here is a general overview of the Medicaid enrolment process, with specific reference to New Mexico.
Firstly, it is important to note that not all US states have expanded Medicaid, and each state has different eligibility criteria. In New Mexico, there are three categories of long-term care programs for which residents may be eligible:
- Institutional/Nursing Home Medicaid: An entitlement; anyone who is eligible will receive assistance. Benefits are provided only in nursing home facilities.
- Medicaid Waivers/Home and Community-Based Services (HCBS): This is not an entitlement; the number of participants is limited, and waitlists may exist. Services are provided at home, adult daycare, or assisted living to delay/prevent the need for nursing home care.
- Medicaid Planning: This is for individuals who are "over-income" or "over-asset" but still cannot afford their long-term care costs. By working with a Medicaid Planning Professional, families can employ strategies to become eligible for Medicaid.
To enrol in Medicaid, individuals must meet certain financial and non-financial eligibility criteria. The Affordable Care Act established a new methodology for determining income eligibility, based on Modified Adjusted Gross Income (MAGI). MAGI considers taxable income and tax filing relationships to determine financial eligibility. Non-financial eligibility criteria include US citizenship or qualified non-citizen status, and some groups are limited by age, pregnancy, or parenting status.
There are several options for submitting a Medicaid application:
- Apply online through the Centennial Care website or HealthCare.gov (for those under 65 without Medicare).
- Apply by phone.
- Download a paper application, complete it, and mail it to the specified address.
- Visit a Human Services Department field office for in-person assistance with the application.
Additionally, states employ various strategies to facilitate the enrolment process, such as presumptive eligibility, where "qualified entities" like healthcare providers or community-based organizations can screen and immediately enrol eligible individuals. States may also use Express Lane agency programs, including Supplemental Nutrition Assistance Programs (SNAP) and School Lunch programs, to streamline enrolment and renewal.
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Medicaid long-term care programs
Medicaid is a health care program for low-income individuals of all ages. While there are varying coverage groups, it also provides long-term care services and supports to eligible individuals. The rules, benefits, and names of Medicaid programs vary by state. This text will focus on Medicaid long-term care programs, specifically in New Mexico (NM), and discuss the options available to seniors and individuals requiring long-term care.
In New Mexico, there are three categories of Medicaid long-term care programs for seniors aged 65 and over:
- Institutional / Nursing Home Medicaid: This is an entitlement, meaning anyone who is eligible will receive assistance. Benefits are provided only in nursing homes that are licensed and certified by the state survey agency as a Medicaid Nursing Facility (NF). These facilities provide various services, and individuals may be eligible for Medicaid under higher income limits.
- Medicaid Waivers / Home and Community-Based Services (HCBS): This is not an entitlement, and there are limited spots available with potential wait lists. These services are meant to delay or prevent the need for nursing home care and may be provided at home, adult day care, or assisted living facilities.
- Medicaid Planning: This option is for individuals who are "over-income" or "over-asset" but still cannot afford their long-term care costs. By working with a Medicaid Planning Professional, families can develop a plan to become eligible for Medicaid while protecting their assets.
It is important to note that not meeting all the criteria does not mean one is ineligible for NM Medicaid. Seniors can take the Medicaid Eligibility Test to determine their eligibility. Additionally, in New Mexico, individuals determined eligible for Supplemental Security Income (SSI) are automatically approved for Regular Medicaid.
While the above information focuses on New Mexico, it is worth mentioning that other states have similar programs. For example, Texas offers the STAR+PLUS Waiver program, which provides long-term care services to eligible residents requiring a Nursing Facility Level of Care but living in the community. Texas also has the Medicaid for the Elderly and People with Disabilities (MEPD) program, which provides long-term care benefits to seniors (65+) or disabled individuals living in the community.
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Medicaid for children
Medicaid is a health care program for low-income individuals of all ages. In New Mexico, Medicaid ensures continuous health coverage for children from birth up to age six. This federal approval, which started in January 2024, eliminates the need for annual Medicaid renewals for this age group, ensuring uninterrupted access to essential health care services.
The EPSDT benefit covers a wide range of services for children with special needs. To access these additional services, HSD offers additional wraparound benefit programs. The New Mexico Department of Health also provides early intervention services to over 14,000 children from birth to age three who have or are at risk of developmental delays.
The state of New Mexico has also implemented the Vaccines for Children (VFC) program, which is federally funded and provides free vaccines to children who otherwise could not be vaccinated due to financial constraints. The Centers for Medicare and Medicaid Services (CMS) require that all children enrolled in Medicaid have a Blood Lead Level (BLL) screening test at 12 and 24 months of age.
In New Mexico, persons who are determined eligible for SSI are automatically approved for Regular Medicaid. Enrollment is year-round, and there are several options for submitting an application. Applications can be submitted online, by phone, by mail, or in person at a New Mexico Human Services Department field office.
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Medicaid for Native Americans
Medicaid is a health care program for low-income individuals of all ages. In New Mexico, there are no open enrollment windows, meaning enrollment is open year-round. There are several options for submitting an application for Medicaid in New Mexico. Applications can be submitted online through the Centennial Care website, HealthCare.gov, or by phone. Paper applications can also be downloaded, completed, and mailed to the Central ASPEN Scanning Area, PO Box 830, Bernalillo, NM, 87004. Additionally, applicants can visit a New Mexico Human Services Department field office for in-person assistance with their application.
Medicaid and the Children's Health Insurance Program (CHIP) are available to qualifying federally recognized Native Americans. These programs provide better access to services that a local Indian health clinic might not be able to provide. Applicants can apply for Medicaid or CHIP even if they have filed for an exemption from the shared responsibility payment. If eligible for services from the Indian Health Service, tribal health programs, or urban Indian programs (known as I/T/Us), including Contract Health Services, applicants are not required to pay Medicaid premiums or enrollment fees. Certain Indian resources and payments are not counted for Medicaid and CHIP eligibility, making it easier for some people to qualify. Applicants may need to provide documentation of US citizenship, such as a document issued by a federally recognized tribe indicating tribal membership.
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Frequently asked questions
Medicaid is a health care program for low-income individuals of all ages.
You can apply online through the Centennial Care website, HealthCare.gov, or by phone at 1-800-318-2596. You can also download a paper application or visit a NM Human Services Department field office for in-person assistance.
The income requirements for Medicaid in New Mexico vary depending on the specific program and the applicant's circumstances. In general, Medicaid is designed for individuals with low incomes.
Yes, there are several types of Medicaid programs in New Mexico, including Institutional/Nursing Home Medicaid, Medicaid Waivers/Home and Community-Based Services (HCBS), and Turquoise Care for Native Americans.
No, New Mexico does not have a Medicaid buy-in program. However, the state has created a Health Care Affordability Fund to make private health insurance more affordable for people with mid-range incomes.
