Long-Term Care and Community Benefit

Long-Term Care

Blue Cross Community Centennial covers long-term care services. These services help you meet health or personal needs. This type of care can help you stay independent.

  • Includes medical and non-medical care for those who are disabled or have long-term illness
  • Can help with daily needs like dressing, bathing, and using the bathroom
  • Can be given at home, in the community, in assisted living or nursing homes

People can need long-term care at any age. If you need nursing care, the Community Benefit may provide options.

Community Benefit

You may be eligible for the Community Benefit:

  • If you meet certain Medicaid requirements
  • Based on medical need for programs that are available through Human Services Department/Medical Assistance Division (HSD/MAD)

To find out if you are eligible, a Care Coordinator will assess your level of care. You will be eligible if the assessment shows you need a certain level of care. If you need care from a nursing facility, you are eligible.

Those who are eligible for the Community Benefit have options. They can choose either the Agency-Based or the Self-Directed Community Benefit.

Agency-Based Community Benefit
This option means an agency handles your personal care. For example, a Personal Care Agency will work with you – they will help find caregivers who can best meet your needs. The agency will hire the caregivers and do background checks. You will need to work with your Care Coordinator to coordinate your care. The type of care is based on your comprehensive needs assessment.

What is covered?What is not covered?
Here are just a few of the covered services for eligible members:
  • Adult day health
  • Assisted living
  • Behavior support
  • Community transition services
  • Emergency response
  • Employment supports
  • Home health aide
  • Personal care services
  • Private duty nursing for adults
  • Respite
  • Skilled maintenance therapy services
  • Changes to your home (ramps, grab bars in the bathroom, etc.)
Centennial Care does not cover:
  • Room and board as a community benefit service or as ancillary services

Self-Directed Community Benefit
This option includes home and community-based services. Self-direction gives you choices. It also gives you control over how the services are provided. You can choose who provides the services.

What is covered?What is not covered?
Here are some of the covered services for eligible members:
  • Behavior support consultation
  • Emergency response
  • Employment supports
  • Changes to your home (ramps, grab bars in the bathroom, etc.)
  • Home health aide
  • Homemaker/personal care
  • Nutritional counseling
  • Customized community supports
  • Private duty nursing for adults
  • Respite
  • Related goods
  • Skilled maintenance therapy services
  • Specialized therapies
  • Transportation (non-medical)
Here are some things that Centennial Care does not cover:
  • Services covered by the Medicaid state plan (including EPSDT), MAD school-based services, Medicare and other third-parties
  • Food and shelter expenses, including property-related costs
  • Gas cards and gift cards
  • Purchase of a vehicle
  • Firearms, ammunition, or other weapons
  • Gambling, games of chance, alcohol, tobacco, or similar items
  • Vacation expenses (airline tickets, hotels, cruises, meals, etc.)
  • Clothing and accessories

If you choose the Self-Directed Community Benefit and are eligible, you will need:

  • An Employer of Record (EOR)
  • A Care Coordinator
  • A Support Broker
  • An Authorized Agent (optional). You can assign someone to help. The agent you choose will have access to your medical and financial information. This is so the agent can help you to understand waiver services.

All these people will work together. They will make sure you meet all requirements. They will help with filling out forms, hiring providers, training, planning and more.

You can be the EOR or choose someone to be EOR for you. The EOR will recruit, hire and fire all employees. The EOR will make all work schedules and assign tasks. The EOR will supervise and train all employees.

Members must work with their Care Coordinator to plan care. The type of care is based on the needs assessment.

If you want to move between the Agency-Based Community Benefit and the Self-Directed Community Benefit, please be aware of the following: :

  • If you do not get services under Mi Via, you must wait 120 days before you can choose to move to the Self-Directed Community Benefit.
  • If you are involuntarily removed from the Self-Directed Community Benefit, being reinstated is up to Blue Cross and Blue Shield of New Mexico (BCBSNM).
  • If you go over your budget or if BCBSNM has given repeated technical assistance, you will need HSD approval to move back to the Self-Directed Community Benefit.

See the Member Handbook pdf to learn more about Community Benefit options. You will find more details on what is and what isn't covered by your health plan.

 
 

Contact Us

If you have questions about Blue Cross Community Centennial, call 866-689-1523. Members with hearing or speech loss can call the TTY/TDD line at 711. You can also email us.