New Mexico Personal Care Services Through Medicaid

What Personal Care Services Cover

Personal care services (PCS) in New Mexico cover hands-on assistance with Activities of Daily Living that a senior can no longer perform safely on their own. The scope includes:

• Bathing, grooming, and hygiene assistance
• Dressing and undressing
• Toileting and incontinence care
• Transfers (bed to wheelchair, wheelchair to toilet)
• Mobility assistance and repositioning
• Meal preparation and feeding assistance
• Medication reminders (not administration — that requires skilled nursing)
• Light housekeeping directly related to the member's health and safety

PCS does not include skilled medical tasks like wound care, catheter management, or injections. Those fall under private-duty nursing or Medicare home health, both separate benefit categories.

Agency-Based vs. Self-Directed: Two Ways to Receive PCS

Under the Turquoise Care Community Benefit, personal care services are delivered through one of two models:

Agency-Based Community Benefit (ABCB)

The member's MCO contracts with licensed home care agencies that employ the personal care aides. The agency handles scheduling, background checks, training, supervision, and substitute coverage when a regular aide is unavailable.

The advantage is less administrative burden on the family. The downside is less control — you cannot choose your specific aide, and turnover in agency-employed positions can mean a rotating cast of workers who do not know your parent's routines.

Self-Directed Community Benefit (SDCB)

The member (or their designated Employer of Record) hires personal care workers directly. This can include adult children and spouses — with MCO approval. Payroll runs through Palco, the state's Fiscal Management Agency.

SDCB gives the family control over who provides care, when shifts happen, and how the budget is allocated across different service categories. But the family takes on employer responsibilities: posting the role, interviewing, managing schedules, handling performance issues, and ensuring EVV compliance.

The 120-day rule: Every new Community Benefit member must start on ABCB for a minimum of 120 days before they can elect SDCB. This mandatory agency period gives the MCO time to assess care needs and establish a baseline. On day 121, the member can request the switch.

How Authorized Hours Are Determined

The number of weekly PCS hours your parent receives is not arbitrary — it comes directly from the Comprehensive Needs Assessment (CNA) performed by the MCO's care coordinator (typically an RN or licensed social worker).

The CNA evaluates roughly 200 data points covering ADL deficits, cognitive impairment, behavioral health needs, environmental safety, and available natural supports. A higher acuity score means more authorized hours.

One critical point: the assessment captures a snapshot. If your parent has good days and bad days, the assessment should reflect their worst-day functioning, not their best. Many families make the mistake of presenting their parent at their most capable during the assessment visit, which directly reduces the hours authorized.

If the authorized hours feel insufficient, the member has the right to appeal through the MCO's internal grievance process and, if that fails, through a Medicaid fair hearing with the HCA.

Electronic Visit Verification Requirements

Every personal care aide working under the Turquoise Care Community Benefit — whether agency-employed (ABCB) or family-hired (SDCB) — must clock in and out through New Mexico's Electronic Visit Verification (EVV) system.

EVV captures the date, start and end time, type of service performed, the individuals receiving and providing the service, and the location of service delivery. It was mandated by the federal 21st Century Cures Act and New Mexico has fully implemented it across all PCS delivery.

For SDCB family caregivers, this means using the EVV method designated by the MCO or Palco and recording every shift. Missed or incomplete EVV entries can delay Palco payroll processing or require a documented correction under program rules. If your family caregiver is not tech-comfortable, the Support Broker can walk them through setup and troubleshooting.

Finding and Keeping Good Aides

Caregiver retention is one of the biggest practical challenges in New Mexico home care. Agency aides earn relatively low wages, and rural areas outside Albuquerque and Santa Fe face acute staffing shortages.

If your parent is on ABCB and experiencing frequent aide turnover or no-shows, document every incident and escalate to the MCO care coordinator. Persistent staffing failures are a valid reason to request a different contracted agency — or to transition to SDCB, where you control hiring directly.

Our New Mexico home care guide includes a full section on navigating the ABCB-to-SDCB transition, setting up Palco payroll, and managing the Employer of Record responsibilities that come with self-directed care.

See more New Mexico guides →