New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 290 - MEDICAID ELIGIBILITY - HOME AND COMMUNITY-BASED SERVICES WAIVER (CATEGORIES 090, 091, 092, 093, 094, 095 AND 096) › Part 400 - RECIPIENT POLICIES › Section 8.290.400.11 - GENERAL RECIPIENT REQUIREMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
Eligibility for the waiver programs is always prospective
				  per
				  8.290.600.11
				  NMAC. Applicants/recipients must meet, or expect to meet, all non-financial
				  eligibility criteria in the month for which determination of eligibility is
				  made including any mandatory income or resources deemed to a minor child per
				  8.290.500.17
				  and
				  8.290.500.21
				  NMAC.
A.
Enumeration:
An
				applicant/recipient must furnish his social security number in accordance with
				8.200.410.10
				NMAC.
B.
Citizenship:
Refer to
				8.200.410.11 NMAC for
				citizenship requirements.
C.
Residence:
To be eligible for medicaid, an applicant/recipient
				must be physically present in New Mexico on the date of application or final
				determination of eligibility and must have declared an intent to remain in the
				state. If the applicant/recipient does not have the present mental capacity to
				declare intent, the applicant's/recipient's representative may assume
				responsibility for the declaration of intent. If the applicant/recipient does
				not have the mental capacity to declare intent and there is no representative
				to assume this responsibility, the state where the applicant/recipient is
				living will be recognized as the state of residence. If waiver services are
				suspended because the recipient is temporarily absent from the state but is
				expected to return within 90 consecutive days at which time waiver services
				will resume, the medicaid case remains open. If waiver services are suspended
				for any other reason for 90 consecutive days, the medicaid case is closed after
				appropriate notice is provided to the recipient.
D.
Non-concurrent receipt of
				assistance:
HCBS waiver services furnish medicaid benefits to an
				applicant/recipient who qualifies both financially and medically for
				institutional care but who, with provision of waiver services, can receive the
				care he needs in the community at less cost to the medicaid program than the
				appropriate level of institutional care. Individuals receiving services under a
				HCBS waiver may not receive concurrent services under nursing facility (NF),
				ICF/IID, personal care or any other HCBS waiver.
(1)
SSI recipients:
Applicants
				receiving supplemental security income (SSI) benefits are categorically
				eligible for waiver services. No further verification of income, resources,
				citizenship, age, disability, or blindness is required. The applicant must,
				however, meet the level of care requirement. (An SSI recipient must meet the
				assignment of rights and TPL requirements and not be ineligible because of a
				trust).
(2)
Married SSI
				couples:
All married SSI couples where neither member is
				institutionalized in a medicaid-certified facility are treated as separate
				individuals for purposes of determining eligibility and benefit amounts
				beginning the month after the month they began living apart. See Section 8012
				of the Omnibus Budget Reconciliation Act of 1989. In the case of an initial
				application, or reinstatement following a period of ineligibility, when members
				of a married couple are not living together on the date of application or date
				of request for reinstatement, each member of the couple is considered
				separately as of the date of application or request, regardless of how recently
				the separation occurred.