Lightly coat a 5- to 6-quart slow cooker with nonstick spray and set it to LOW to preheat.
Make the cheese base: In a medium saucepan over medium heat, whisk together the condensed cheddar soup, milk, and cream cheese until smooth and steamy, 3 to 4 minutes. Stir in 1 1/2 cups of the shredded cheddar until just melted. Remove from heat.
Brown the beef: Heat a large skillet over medium-high. Add olive oil if needed, then the ground beef and onion. Cook, breaking up the meat, until no pink remains, 5 to 6 minutes; drain excess fat. Stir in the minced garlic for 30 seconds. Sprinkle in the taco seasoning and add 1/4 cup water; cook 1 minute to bloom the spices. Pour in the RoTel and simmer 2 minutes to slightly thicken.
Parboil pasta: Boil the macaroni in well-salted water for 5 minutes (it should be very firm). Drain and rinse briefly under cool water to halt cooking.
Assemble: Add the beef mixture and macaroni to the slow cooker. Pour the warm cheese base over the top, then season with the salt and pepper. Stir until all the noodles are coated.
Slow cook on LOW for 1 hour 45 minutes to 2 hours, stirring once halfway through. If the sauce looks tight at the midpoint, splash in 2 to 4 tablespoons milk and stir.
Finish and serve: Stir in the sour cream and lime juice. Sprinkle the remaining 1/2 cup cheddar over the top, cover, and let stand 5 to 10 minutes until melty. Garnish with cilantro or green onion, if using, and serve hot.