New Mexico Medicaid for Seniors & Long-Term Care

Mi Via is a self-directed HCBS program, but per HCA and the current CMS waiver record, it now serves individuals with intellectual or developmental disabilities (I/DD), autism, or medically fragile conditions who meet an ICF/IID level of care — not seniors qualifying solely on the basis of age-related nursing facility needs. An earlier version of Mi Via for people 65 and older and adults with other physical disabilities (the Mi Via NF Waiver) was terminated in 2014; seniors today use the Turquoise Care Community Benefit's self-directed option instead (see below).

Where it applies, Mi Via gives the participant control over a personal care budget — the participant decides what services they need, hires their own workers (including certain family members), and manages their care schedule with help from a consultant. Contact HCA at 1-800-283-4465 for Mi Via eligibility information and to request a functional needs assessment.

The Turquoise Care Community Benefit is the main HCBS pathway for seniors and adults with physical disabilities who meet a nursing facility level of care but want to stay at home. It is delivered through your Turquoise Care managed care organization (Blue Cross Blue Shield, Presbyterian, Molina, or United Healthcare) rather than as a stand-alone 1915(c) waiver. Members choose between the Agency-Based Community Benefit, where a contracted agency provides services under a care coordinator's plan, and the Self-Directed Community Benefit, where the member (or a designated employer of record) hires and manages their own workers with help from a support broker. New enrollees must start with the Agency-Based model for at least 120 days before they can switch to Self-Directed.

New Mexico Medicaid also covers skilled nursing facility care for seniors who meet clinical and financial criteria. Once approved, Medicaid pays the nursing home directly, and the resident contributes most of their monthly income toward the cost of care — typically all income minus a personal needs allowance of $97/month — with Medicaid covering the gap.

New Mexico follows federal Spousal Impoverishment rules (42 USC 1396r-5). The community spouse retains up to $162,660 in countable assets (2026 CSRA, federal maximum), a Minimum Monthly Maintenance Needs Allowance of approximately $2,643.75/month minimum (2026 federal floor), and the primary home, exempt while the community spouse lives in it.

New Mexico operates a Medicaid Estate Recovery Program (MERP) required by 42 USC 1396p. After a Medicaid recipient who was 55 or older and received nursing facility or HCBS waiver services passes away, HCA may file a claim against the estate. Recovery is deferred while a surviving spouse or dependent minor or disabled child lives in the home. New Mexico allows hardship exemptions. The 5-year asset look-back period applies — asset transfers within 5 years before applying may trigger a penalty period of ineligibility.

HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Contact New Mexico Medicaid to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.