Turquoise Medicaid Waiver Program for Assisted Living in New Mexico

The first step is for residents to be enrolled in Medicaid. To learn more about all your options, apply on the YES.NM.GOV portal by using the “Let Us Help You” form. Contact YES.NM.GOV  at https://yes.nm.gov/. You may also stop by a Human Services Department field office. You will need to provide documents proving your identity, citizenship or legal residency, New Mexico residency, and household income. 

To qualify for Medicaid, a senior can only have $2,000 or less in their bank account. Once on Medicaid, the next step is to apply for the Turquoise Care “Waiver Program” for Assisted Living. Turquoise Care is the New Mexico Medicaid Managed Care program that began on July 1, 2024. Most Medicaid members are enrolled in managed care, and there are four health plans from which to choose. Managed Care Organizations (MCOs) are health plans that are contracted by the State of New Mexico to provide health care services to Medicaid members. In New Mexico, you may enroll with one of four MCOs: Blue Cross Blue Shield (BCBS), Presbyterian, Molina and UHC.

Applying for the “Waiver” program for Assisted Living is a separate process after the senior is approved for Medicaid, and can be a lengthy process. If a senior has a health setback and is already in a nursing home, the on-site social worker can help them apply for the “waiver” program. Their application can be fast tracked if they are already residing in a skilled nursing facility (SNF) for 3-4 months. At some point, the senior may no longer meet nursing eligibility and will be discharged. While they might no longer meet nursing eligibility, they might not be safe to go home.

Assisted living can help seniors retain their independent lifestyle with a helping hand with various activities of daily living. While it might no longer be easy to pull the trash can to the curb, go grocery shopping or mow the lawn, assisted living permits maintenance, carefree living so seniors can remain independent. That’s when CJ or Maria can visit and assess if the senior is eligible to reside in assisted living. 

Assisted Living offers a more robust social environment and assistance with daily tasks such as getting dressed in the morning, medication management and stand assist showers. Meals, housekeeping, and laundry are included. Residents need to be assessed to make sure they qualify. Our Director will meet with the resident to see if they can ambulate to the bathroom, transfer out of bed or wheelchair and walk to the bathroom.

CJ and Maria work with SNF discharge planners and social workers as well as service coordinators at the MCOs to get their clients assessed and enrolled in Medicaid for assisted living. Camino and Westwind House are one of the few Assisted Living Facilities that accept Medicaid (Turquoise Care or Innovage) in New Mexico. Several smaller homes of 9 people or less accept Turquoise Care. 

Assisted Living monthly rates in Albuquerque range from $5,000 to $7,500/month, which is often not affordable for many New Mexico seniors. Camino and Westwind House are among the more affordable assisted living residences, with assisted living “all-inclusive” monthly rent ranging from $3,400 to $4,000/month for a private apartment. A common path for Camino and Westwind House residents that only have 1-2 years of resources, is to pay “private” rent for 6 months or a year, until they “spend down” their bank account to less than $2,000. Both CJ and Maria work with families and the four Managed Care Organizations to transition these residents from private pay to Turquoise Care.

State-supported residents at pay room and board ($500 to $1,600 at Camino and Westwind) to the assisted living community and the Turquoise program covers the “care” portion of the resident’s care. CJ Patterson and Maria Duarte have been at the helm of Camino and Westwind House respectfully, for 20+ years, and are fabulous resources. If you have questions on private pay Assisted Living or the Medicaid Waiver program for Assisted Living, please give CJ (505-573-2020) or Maria (505-831-0002). You’ll be glad you did!