New Mexico Medicaid Long Term Care Eligibility

New Mexico Long Term Care

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New Mexico is an income cap state, meaning that in order to be eligible for Medicaid long term care benefits there is a hard income limit. Non income cap states allow applicants to spend down money for their care, whereas income cap states require the amount to be no higher than their limit at time of application. Income in excess of the cap must be transferred into a Qualified Income Trust (QIT).

Eligibility:

1. Residency and Citizenship – the applicant must be a New Mexico resident and a U.S. citizen or have proper immigration status.

2. Age/Disability – the applicant must be age 65 or older, or blind, or disabled. The applicant must meet certain medical requirements consistent with the level of care requested. Persons must need care for thirty (30) consecutive days.

3. Income Limitations – if single, the applicant’s income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.) must be no higher than $2,205 per month ($3,000/month limit if both spouses need care).

4. Asset Limitations (Exempt vs. Available) – Medicaid divides assets into two categories: Exempt and Available. Exempt assets are specifically designated under the rules, and ownership of an exempt asset by the applicant will not result in a denial of benefits. If an asset is not listed as exempt then it needs to be liquidated and applied toward the costs of nursing home care before the applicant can receive Medicaid benefits. The state has a look back period of 5 years with a penalty for people who sell assets below fair market price, transfer assets to others, or give money and property away.

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Exempt Assets for an applicant in New Mexico include:

i. $2,000 or less in cash/non-exempt assets if single. If the assets exceed the limit on the first of the month the applicant is ineligible for the entire month.

ii. One home is exempt (equity limit $828,000) if planning to return, a spouse, a child under 21, or a disabled person resides in it. Whenever an institutionalized person sells a previously exempted residence, the money from the sale becomes a countable asset. The recipient may then lose eligibility for Medicaid until he/she has spent down the money and their countable resources are once again less than the maximum.

iii. One car, no equity amount specified.

iv. An irrevocable funeral trust, no amount specified.

v. Life insurance policy if the face value of said policy is $1,500 or less.

Spousal Rules:

Amount of assets community spouse may retain: The community spouse can keep non-exempt resources owned by one or both spouses with a maximum of $120,900. If the community spouse’s assets do not equal the minimum of $31,290, the community spouse is able to retain assets from the institutionalized spouse until the minimum is reached.

Community spouse impoverishment protection: The community spouse can keep part of the institutionalized spouse’s income if the community spouse has an income of less than $2,002.00 per month. Depending on living expenses, the community spouse may keep up to a maximum of $3,023.00 per month. New Mexico is an “income first” state, meaning the state limits the right to petition for an increased community spouse resource amount (CSRA) to couples whose combined income fails to meet the community spouse’s income needs. Basically, this means a community spouse can petition for an increased CSRA where there’s an income gap only after factoring in the nursing home spouse’s income first.

Further Contact Information:

New Mexico Aging & LTC Services Department
2550 Cerrillos Road, Santa Fe, NM 87505
Phone: (505) 476-4799
Fax: (505) 476-4836