New Mexico - Housing Stabilization — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The New Mexico Health Care Authority (HCA) Medical Assistance Division (MAD) does not offer a standalone "Housing Stabilization" service, but instead funds tenancy support, housing search, and retention planning through "Community Transition Services" under the Turquoise Care 1115 Demonstration Waiver's Agency-Based Community Benefit (ABCB). Providers seeking to deliver these housing supports must first secure a Program Approval Letter from the Long-Term Services and Supports Bureau (LTSSB) before they can submit a MAD 335 application to obtain a Provider Type 363 (Community Benefit Provider) Medicaid ID.

Approval requires submitting an ABCB application packet to the HCA, passing an HCBS Settings Final Rule attestation, and subsequently securing network contracts with the four Turquoise Care Managed Care Organizations (MCOs). The state explicitly warns that obtaining a Program Approval Letter guarantees neither an MCO contract nor client referrals, making MCO network inclusion the definitive operational gate for this service.

1. Service Definition and Scope

In New Mexico, housing stabilization activities are absorbed into Community Transition Services and Care Coordination under the Turquoise Care ABCB program. These services assist individuals transitioning from institutional settings or facing housing instability to locate, secure, and maintain community-based housing.

The scope includes landlord mediation, housing application assistance, and retention planning, but strictly prohibits the use of Medicaid funds for ongoing rent or mortgage payments.

• Service Name: Community Transition Services (under Agency-Based Community Benefit).
• Covered Activities: Housing search, application assistance, tenant rights education, and landlord mediation.
• Excluded Costs: Monthly rental payments, mortgage payments, and ongoing utility charges.
• Target Population: Medicaid beneficiaries meeting Nursing Facility Level of Care (NF LOC) enrolled in Turquoise Care.
• Delivery Setting: Community-based settings compliant with the CMS HCBS Final Settings Rule.

2. Regulatory and Oversight Agencies

The New Mexico Health Care Authority (HCA) oversees the Medicaid program and the Turquoise Care 1115 waiver. Within the HCA, the Medical Assistance Division (MAD) and its Long-Term Services and Supports Bureau (LTSSB) manage provider program approvals.

The Department of Health (DOH) Division of Health Improvement (DHI) conducts quality surveys and incident management oversight for HCBS providers.

• New Mexico Health Care Authority (HCA): Administers Turquoise Care and Medicaid policy (https://www.hca.nm.gov/).
• Medical Assistance Division (MAD): Manages Medicaid provider enrollment and rules (https://www.hca.nm.gov/about-us/medical-assistance-division/).
• Long-Term Services and Supports Bureau (LTSSB): Issues the required Program Approval Letter for ABCB providers (https://www.hca.nm.gov/providers/agency-based-community-benefits-abcb-program/).
• Department of Health Division of Health Improvement (DOH/DHI): Conducts provider surveys and quality monitoring (https://www.nmhealth.org/about/dhi/).
• Turquoise Care MCOs: Manage authorizations and provider contracting (https://www.hca.nm.gov/turquoise-care/).

3. Gatekeeping Prerequisites: Who Can Even Apply

New Mexico utilizes a strict sequential gatekeeping process for ABCB providers. An applicant cannot simply enroll in Medicaid; they must first pass a programmatic review by the LTSSB to receive a Program Approval Letter.

Furthermore, because Turquoise Care is a managed care delivery system, holding an active Medicaid ID does not guarantee the ability to bill. Providers must successfully negotiate and execute contracts with the individual MCOs, which may close their networks if adequacy is met.

• LTSSB Program Approval Letter: Required precondition before the MAD 335 Medicaid application can be submitted.
• MCO Network Contracting: Providers must secure contracts with Turquoise Care MCOs (e.g., Presbyterian, Blue Cross Blue Shield) to receive authorizations and payment.
• HCBS Settings Attestation: Providers must sign the Centennial Care ABCB Provider Attestation Form confirming compliance with 42 C.F.R. § 441.301 before approval.
• Provider Type Designation: Must be approved specifically as Provider Type 363 (Community Benefit Provider).

4. Licensure and Certification Requirements

Unlike Adult Day Health or Assisted Living services under the ABCB program, Community Transition Services do not require a specific facility license from the New Mexico Department of Health (DOH).

Providers must instead maintain standard business licensure and certify compliance with federal HCBS regulations through the state's attestation process.

• DOH Facility License: Not required for Community Transition Services.
• Business Licensure: Must hold a valid New Mexico state business license and applicable local municipal licenses.
• HCBS Final Rule Attestation: Mandatory submission of the state-specific attestation form verifying community integration standards.
• Tax Identification: Must possess a valid Federal Employer Identification Number (FEIN) or SSN.

5. Medicaid Provider Enrollment

Once the LTSSB Program Approval Letter is obtained, providers must enroll through the New Mexico Medicaid Portal operated by Conduent. The application requires uploading the approval letter and completing the MAD 335 form online.

Incomplete applications submitted to the LTSSB or the Medicaid portal are rejected without review.

• Enrollment Portal: New Mexico Medicaid Portal via Conduent (https://nmmedicaid.portal.conduent.com/static/ProviderInformation.htm).
• Application Form: Online MAD 335 Medicaid provider application.
• Provider Type: Must enroll as Provider Type 363 (Community Benefit Provider).
• Required Upload: The LTSSB Program Approval Letter must be attached to the portal application.
• Application Fee: Subject to the standard CMS institutional provider application fee unless waived by Medicare enrollment.

6. Staffing, Training and Background Checks

Agencies providing ABCB services must ensure all staff interacting with waiver participants pass the New Mexico DOH Caregivers Criminal History Screening (CCHS).

Staff must also complete mandatory training on the HCBS Final Settings Rule, person-centered planning, and critical incident reporting.

• Background Checks: Mandatory clearance through the DOH Caregivers Criminal History Screening Program.
• Fingerprinting: Required for all direct support personnel prior to client contact.
• HCBS Training: Staff must be trained on the CMS HCBS Final Settings Rule requirements.
• Incident Management: Mandatory training on DOH/DHI critical incident reporting protocols.

7. Documentation, Policies and Records

Providers must maintain comprehensive records aligning with the participant's Service and Support Plan (SSP) developed by the MCO Care Coordinator.

Documentation must prove that services are delivered in integrated settings and that the provider is actively assisting the member in achieving housing stability goals.

• Service and Support Plan (SSP): All billed activities must be explicitly authorized in the member's MCO-approved SSP.
• Progress Notes: Must detail the specific housing search or tenancy support activities performed, date, time, and duration.
• Attestation Form: The Centennial Care ABCB Provider Attestation Form must be kept on file and updated annually.
• Critical Incident Reports: Must be submitted to the DOH/DHI portal within 24 hours of any reportable event.

8. Billing, Rates and Claims

Because Turquoise Care is a managed care program, the HCA does not publish a fixed fee schedule for ABCB services. Rates are negotiated directly between the provider and each MCO.

Claims must be submitted directly to the authorizing MCO's clearinghouse, not to the state MMIS, and require prior authorization.

• Rate Setting: Negotiated individually with Turquoise Care MCOs; no state-mandated fee schedule exists for this service.
• Prior Authorization: 100% of ABCB services require prior authorization from the member's MCO.
• Claims Submission: Routed through the specific MCO's designated claims portal or clearinghouse.
• Billing Codes: Specified in the MCO contract and authorization letter (typically HCPCS codes mapped to Community Transition Services).

9. Approval Sequence and Timeline

The approval process is sequential and cannot be expedited. Providers must complete the programmatic review before touching the Medicaid enrollment system.

The entire process, from LTSSB submission to active MCO contracts, typically takes 4 to 6 months depending on MCO credentialing timelines.

• Step 1: Submit the ABCB application checklist and required forms to [email protected].
• Step 2: Receive the Program Approval Letter from LTSSB (typically 30-60 days).
• Step 3: Submit the MAD 335 application via the New Mexico Medicaid Portal with the approval letter attached.
• Step 4: Receive active Provider Type 363 Medicaid ID.
• Step 5: Initiate credentialing and contracting with Turquoise Care MCOs (90-120 days).

10. Common Denials and Survey Findings

The LTSSB explicitly states that all incomplete applications will be rejected and not considered for review until a complete packet is submitted.

During DHI surveys, providers frequently face citations for failing to document how their services comply with the HCBS Final Settings Rule or failing to follow the exact parameters of the MCO-approved SSP.

• Incomplete ABCB Checklist: Missing documents in the initial LTSSB email submission result in immediate rejection.
• Missing Attestation: Failure to include the signed HCBS Final Rule Attestation Form.
• MCO Closed Networks: Providers may gain state approval but be denied MCO contracts if the MCO determines its network is adequate.
• Settings Rule Non-Compliance: DHI survey findings indicating the provider is isolating participants or failing to optimize autonomy.

11. Key Contacts and Resources

Providers should rely on the HCA Medical Assistance Division and the specific Turquoise Care MCOs for authoritative guidance.

The Managed Care Policy Manual is the primary regulatory document defining ABCB service requirements.

• LTSSB Provider Enrollment Email: [email protected]
• New Mexico Medicaid Portal: https://nmmedicaid.portal.conduent.com/
• Managed Care Policy Manual: https://www.hca.nm.gov/providers/managed-care-policy-manual/
• Turquoise Care Information: https://www.hca.nm.gov/turquoise-care/
• DOH Health Facility Licensing: 1-505-476-9098 (for general facility inquiries, though not required for this specific service).

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