Home and Community-Based Waiver FAQs

The home and community-based waiver program allows individuals who would benefit from a caregiver in their home access to full Centennial Care Medicaid Benefits. This program is intended to help New Mexicans who might otherwise be forced to enter Long Term Nursing Facilities stay in their own homes or Assisted Living Facilities.

To qualify, an individual must meet both income and health related requirements. The Aging and Disability Resource Center assists with the intake process for this program which begins with registration to the registry waiting list.

If you or someone you know would benefit from this program, here are some important steps to be aware of:

1. Set up a phone appointment to complete an intake assessment with an Options Counselor at 1-800-432-2080
2. Once funding is available and the individual’s name reaches the top of the list an allocation packet is mailed by Medical Assistance Division’s Long-Term Services and Supports Bureau (aka Allocations Unit)
   • This packet contains a Medicaid Application
   • A Primary Freedom of Choice form (PFOC)
   • A withdrawal form
   • A self-addressed stamped envelope to return the documents
   • The individual will be asked to select from one of three health insurance companies (MCOs) who will manage their services if/when individual qualifies
3. The individual receives and completes the application and must return the packet contents within 45 days from when the packet was mailed or risk losing allocation
   • If you need assistance, request a SHIP referral and a counselor will help you complete the packet
4. The allocation unit receives the packet and sends a letter back to the individual acknowledging receipt with a letter explaining the next steps
   • The contents of the packet are then scanned to the Income Support Division’s (ISD) Waiver unit and the MCO selected in the application
   • If the individual does not select an MCO, they are automatically assigned to one
5. The MCO reaches out to complete a more in-depth assessment of the individual’s needs to ensure they meet the criteria for the program which is referred to as Nursing Facility Level of Care (NFLOC)
6. ISD Waiver Unit reaches out to perform an interview and request any documentation needed to qualify the individual financially
7. Once both eligibility requirements are fulfilled, the individual’s MCO is notified, and the individual can begin receiving services

Important Notes:

• The process may take many months to complete
• It is based on individual circumstances and hardships
• If approved, eligibility will not be back dated
• If the individual is wishing to enter into an Assisted Living Facility, not all costs are paid by this program and the benefit likely won’t begin until the month following the start of initial eligibility