New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.291.410.24 - USE OF INFORMATION AND REQUESTS OF ADDITIONAL INFORMATION FROM INDIVIDUALS (42 CFR 435.952)

Current through Register Vol. 35, No. 13, July 16, 2024
A. HSD
				will promptly evaluate information received or obtained by it in accordance
				with regulations per
				42 CFR 435.940
				through
				435.960
				to determine whether such information may affect the eligibility of an
				individual or the benefits to which he or she is entitled.
B. If information provided by or on behalf of
				an individual (on the application or renewal form or otherwise) is reasonably
				compatible with information obtained by HSD in accordance with 42. CFR 435.948,
				435.949 or 435.956 HSD will determine or renew eligibility based on such
				information.
C. An individual must
				not be required to provide additional information or documentation unless
				information needed by the agency HSD in accordance with
				42 CFR
				435.948,
				435.949
				or
				435.956
				cannot be obtained electronically or the information obtained electronically is
				not reasonably compatible, as provided in the verification plan described in
				8.291.410.24 NMAC with information provided by or on behalf of the individual.
(1) Income information obtained through an
				electronic data match shall be considered reasonably compatible with income
				information provided by or on behalf of an individual if both are either above
				or at or below the applicable income standard or other relevant income
				threshold.
(2) If information
				provided by or on behalf of an individual is not reasonably compatible with
				information obtained through an electronic data match, HSD must seek additional
				information from the individual including:
(a)
				A statement which reasonably explains the discrepancy; or
(b) Other information (which may include
				documentation), provided that documentation from the individual is permitted
				only to the extent electronic data are not available and establishing a data
				match would not be effective, considering such factors as the administrative
				costs associated with establishing and using the data match compared with the
				administrative costs associated with relying on paper documentation, and the
				impact on program integrity in terms of the potential for ineligible
				individuals to be approved as well as for eligible individuals to be denied
				coverage.
(c) HSD must provide the
				individual a reasonable period, defined as 10 calendar days, to furnish any
				additional information required under Subsection C of 8.291.410.24
				NMAC.
(3) Exception for
				special circumstances. HSD must establish an exception to permit, on a
				case-by-case basis, self-attestation of individuals for all eligibility
				criteria when documentation does not exist at the time of application or
				renewal, or is not reasonably available, such as in the case of individuals who
				are homeless or have experienced domestic violence or a natural disaster. This
				exception does not apply if documentation is specifically required under title
				XI or XIX, such as requirements for verifying citizenship and immigration
				status.