Nursing Homes in New Mexico
Many seniors have chronic health conditions that make it more difficult to live alone. Although New Mexico has many options for assisted living, adult day health care and home health services, some seniors require a much higher level of care. Nursing homes fill this need by offering around-the-clock medical care, ensuring that residents are as safe and comfortable as possible.
In New Mexico, 18.5% of the population consists of adults aged 65 and older. As of 2022, just under 4,800 of those seniors were residing in nursing homes. The state has a total of 68 certified nursing facilities, giving older residents from Albuquerque to Las Cruces and everywhere in between the opportunity to access high-quality care.
This guide provides detailed information about using Medicaid and Medicare benefits to pay for nursing home care in New Mexico, including what type of coverage is available and instructions for applying. It also provides an overview of the regulations nursing homes must follow to ensure the safety and well-being of their residents.
Cost of New Mexico Nursing Homes
The average cost of nursing homes in New Mexico is $205 per day. This is higher than the national average which is $228 per day.
Can You Use Medicaid to Pay for Nursing Home Care in New Mexico?
New Mexico Medicaid covers the cost of skilled nursing and other services provided in nursing homes. Also known as Centennial Health, this program assigns enrollees to one of several approved Medicaid plans offered by private insurance companies. As of 2023, three organizations offer these plans: Western Sky Community Care, Presbyterian Health Plan and Blue Cross Blue Shield of New Mexico.
By the end of December 2022, New Mexico had 884,416 Medicaid enrollees. The program covers a variety of medical services, including skilled nursing and other long-term supports offered by nursing homes. Enrollees have access to nursing care, physical therapy, occupational therapy, dietitian services and assistance with activities of daily living, enabling them to preserve as much of their physical functioning as possible. Medicaid also covers mental health services, including psychiatric care and counseling.
Eligibility for Medicaid in New Mexico
Single Centennial Care applicants have an income limit of $32,904 per year and an asset limit of $2,000. For married couples, the limits depend on who needs coverage. If only one spouse applies, the applicant is allowed to have $2,000 in assets and up to $32,904 per year in income. The asset limit for the non-applicant spouse is $148,620. If both spouses apply, the limits increase to $65,808 per year for income and $4,000 for assets.
|Income Limits*||Asset Limits|
|Two-Person Household||$65,808||$4,000 ($2,000 per spouse)|
* Per year
To qualify for Centennial Care benefits, applicants must also meet the following eligibility requirements:
- At least 65 years old, blind or disabled
- Demonstrated need for health insurance
- New Mexico residency
- U.S. citizenship or qualifying immigrant status
Applying for Medicaid in New Mexico
The easiest way to apply for Centennial Care is to use the YesNM portal, which uses a single application to determine eligibility for all benefits administered by NMHSD, such as Medicaid, energy assistance and food stamps. To apply via YesNM, an individual must create an account and follow the on-screen prompts.
Centennial Care also offers in-person, telephone and mail application options. To apply by telephone, call (888) 997-2583 to speak with an agent from the New Mexico Medicaid Call Center. Individuals who prefer to apply in person should visit their nearest Income and Support Division Field Office. NMHSD maintains a list of field offices and their hours of operation on its website.
To apply via mail, an applicant should follow these steps:
- Fill out all required sections of the form.
- Make a copy of the completed application for their records.
- Mail the paperwork to Central ASPEN Scanning Area, P.O. Box 830, Bernalillo, New Mexico 87004.
What Information You Will Need
Applicants should be prepared to submit documentation related to their eligibility. The New Mexico Human Services Department may ask for the following:
- Pay stubs
- Tax returns
- W-2 or 1099 forms
- Social Security statements
- Employment verification letters
- Statements for checking, savings and investment accounts
- Appraisal documents to confirm the value of jewelry and other assets
- Receipts or other sales documents for vehicles
Additional Medicaid Support & Resources in New Mexico
|New Mexico Legal Aid||(833) 545-4357||New Mexico residents have the right to appeal if they're denied for Medicaid benefits or don't receive a response within 45 days of applying. New Mexico Legal Aid has volunteer attorneys available to guide applicants through the appeals process.|
|New Mexico Medicaid Call Center||(888) 997-2583||The New Mexico Medicaid Call Center has trained agents available to answer questions about Medicaid coverage and accept applications over the telephone.|
|New Mexico State Health Insurance Assistance Program||(800) 432-2080||New Mexico SHIP has trained counselors available to answer questions about Medicaid, Medicare and other types of health insurance coverage.|
Can You Use Medicare to Pay for Nursing Home Care in New Mexico?
Medicare provides limited coverage for short-term stays in a skilled nursing facility following a hospital stay, but seniors must meet a number of specific requirements. This benefit is available to beneficiaries who have been hospitalized for at least three days, excluding the date of discharge, so it's most valuable for those who are recovering from an injury, illness, or surgery.
Once seniors meet the hospitalization requirement, Medicare will pay for up to 100 days of skilled nursing per benefit period. The first 20 days are covered in full. Starting on day 21, beneficiaries must pay a daily coinsurance rate. After day 100, seniors are responsible for the entire cost.
What Does Medicare Cover?
Medicare covers a number of specific services, including:
- A semiprivate room
- Skilled nursing
- Physical therapy
- Occupational therapy
- Speech therapy
- Audiologist care
- Medical supplies
- Medical social services
- Nutritional counseling
- Ambulance transportation
What Isn't Covered by Medicare?
Medicare does not cover long-term custodial care that addresses seniors' day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.
For more information about Medicare and when it covers Nursing Home Care, read our Guide to Nursing Homes.
Medicare Support & Resources in New Mexico
New Mexico has several resources available to help seniors determine if they're eligible for Medicare, fill out the Medicare application or get help with any Medicare-related problems they may have. Seniors can contact these organizations for personalized assistance.
|Area Agencies on Aging||Contact the nearest Area Agency on Aging||Area Agencies on Aging exist to help older adults achieve the highest possible quality of life. Each of New Mexico's four agencies has staff members available to answer questions about Medicare and other benefits available to seniors.|
|New Mexico Aging and Disability Resource Center||(800) 432-2080||ADRC offers a wide variety of services to help older adults and adults with disabilities access care. It also operates the state's Senior Medicare Patrol program, which helps Medicare enrollees understand how to detect and report fraud.|
|New Mexico Department of Health||(888) 493-0092||New Mexico's Department protects seniors by issuing licenses to medical facilities and offering a variety of other health services. DOH also provides referrals to other agencies, which is helpful for seniors with questions about Medicare.|
Other Financial Assistance Options for Nursing Home Care in New Mexico
While Medicaid and Medicare are two of the most common programs used to pay for Nursing Home Care, there are other financial assistance options available, depending on your unique situation.
|How to Apply||How It Works|
|Aid and Attendance||Learn more and apply online at va.gov.||Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for skilled nursing care.|
|Reverse Mortgages||Learn more about your options and how to apply at ftc.gov.||If you own a home, you may be able to use a reverse mortgage to help pay for nursing care. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. This type of funding can be especially useful for married couples when only one partner needs nursing care, as the other residents of the home may continue living there. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan.|
|Long-Term Care (LTC) Insurance||Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov.||Seniors who already have long-term care insurance may be covered for skilled nursing care. Most policies cover at least a portion of the cost of nursing home care, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not be eligible to sign up for a LTC insurance policy.|
Nursing Home Laws and Regulations in New Mexico
|Licensing Requirements||Every nursing home in New Mexico must obtain a license from the Department of Health's Health Facility Licensing & Certification division.|
|Staffing Requirements||Skilled nursing facilities must offer at least 2.5 hours of direct care per day, and intermediate care facilities must offer 2.3 hours daily. All nursing homes must have a director of nursing and ensure that a qualified charge nurse is available during every shift.|
|Staff Training Requirements||All nursing homes must provide continuing education and quarterly in-service training to staff members who have direct contact with residents. Certified nursing assistants must complete 75 hours of training before working in New Mexico nursing homes.|
|Admission Restrictions||Nursing homes aren't permitted to admit residents who have or are suspected to have infectious illnesses. A nursing home must also deny admission to individuals who have serious mental illnesses or have shown a tendency to be destructive or abusive.|
|Care Planning Requirements||Nursing home staff must conduct a brief assessment within 48 hours of a resident's admission and a more comprehensive assessment within 30 days. Physicians must review care plans every 30 to 60 days, depending on whether the resident needs skilled nursing or intermediate care.|
|Dietary and Nutritional Services Requirements||Nursing homes in New Mexico must provide three meals per day according to established dietary guidelines. Residents must also have access to drinking water and snacks. All nursing homes must make a reasonable effort to adjust meals according to residents' personal preferences and medical needs.|
|Specialized Rehabilitative Services||Nursing homes must provide physical therapy, occupational therapy and other rehabilitative services as ordered by a physician. Staff members must develop a personalized plan for each resident and keep detailed records.|
|Medication and Pharmaceutical Services||Under New Mexico law, every nursing home must have a qualified pharmacist conduct monthly reviews of resident medication plans. This pharmacist is also responsible for keeping records related to medication administration. All prescription medications must be obtained from a licensed pharmacy.|
|Activities Requirements||Facilities must employ an activities coordinator who has relevant education, on-the-job training or work experience in planning recreational activities for older adults. Nursing homes are also required to provide a combination of individual and group activities that are well-suited to each resident's needs and preferences.|
|Infection Control Requirements||New Mexico law requires nursing homes to have detailed laundry and housekeeping policies to prevent the spread of communicable diseases. Every nursing home must also have its own set of written procedures for infection control.|
|Medicaid Coverage||New Mexico uses a managed-care model to administer its Medicaid program. Under this model, Centennial Health is responsible for enrolling eligible seniors in one of the state's approved Medicaid managed care plans. These plans cover skilled nursing and other types of long-term care.|
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