reglab/statecodes huggingface dataset:
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 252 - MEDICAID ELIGIBILITY - BREAST AND CERVICAL CANCER PROGRAM (CATEGORY 052) › Part 600 - BENEFIT DESCRIPTION › Section 8.252.600.11 - INITIAL BENEFITS

Current through Register Vol. 35, No. 13, July 16, 2024
Eligibility is always prospective and begins the month of
				  application. When an eligibility determination is made, notice of the approval
				  or denial is sent to the applicant. If the application is denied, the notice
				  shall include reason(s) for denial and the applicant's right to request a fair
				  hearing.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 252 - MEDICAID ELIGIBILITY - BREAST AND CERVICAL CANCER PROGRAM (CATEGORY 052) › Part 600 - BENEFIT DESCRIPTION › Section 8.252.600.12 - ONGOING BENEFITS

Current through Register Vol. 35, No. 13, July 16, 2024
An eligible recipient is responsible to report changes
				  affecting eligibility within 10 calendar days from the date on which the change
				  took place. Changes in eligibility status will be effective the first day of
				  the following month. A redetermination of eligibility is made every 12
				  months.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 252 - MEDICAID ELIGIBILITY - BREAST AND CERVICAL CANCER PROGRAM (CATEGORY 052) › Part 600 - BENEFIT DESCRIPTION › Section 8.252.600.13 - RETROACTIVE BENEFIT COVERAGE

Current through Register Vol. 35, No. 13, July 16, 2024
Retroactive medicaid coverage is provided in accordance with
				  8.200.400.14
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 252 - MEDICAID ELIGIBILITY - BREAST AND CERVICAL CANCER PROGRAM (CATEGORY 052) › Part 600 - BENEFIT DESCRIPTION › Section 8.252.600.14 - CHANGES IN ELIGIBILITY

Current through Register Vol. 35, No. 13, July 16, 2024
A recipient's eligibility ends when medical assistance
				  division (MAD) receives information from the treating physician or from the
				  recipient that her course of treatment is completed. A case is closed, with
				  provision of advance notice, when the recipient becomes ineligible. The case is
				  closed the month following the death of an eligible
				  recipient.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 259 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEES WITH SPEND DOWN PROVISION › Part 400 - RECIPIENT REQUIREMENTS › Section 8.259.400.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
The New Mexico medicaid program and other health care
				  programs are administered pursuant to regulations promulgated by the federal
				  department of health and human services under Title XIX of the Social Security
				  Act as amended or by state statute. See, Section 27-1-12 et seq. NMSA 1978.
				  Section 9-8-1 et seq. NMSA 1978 establishes the health care authority (HCA) as
				  a single, unified department to administer laws and exercise functions relating
				  to health care facility licensure and health care purchasing and
				  regulation.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 259 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEES WITH SPEND DOWN PROVISION › Part 400 - RECIPIENT REQUIREMENTS › Section 8.259.400.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
January 1, 2014, unless a later date is cited at the end of a
				  section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 259 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEES WITH SPEND DOWN PROVISION › Part 400 - RECIPIENT REQUIREMENTS › Section 8.259.400.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of this rule is to provide specific
				  instructions when determining eligibility for the medicaid program and other
				  health care programs. Generally, applicable eligibility rules are detailed in
				  the medical assistance division (MAD) eligibility policy manual, specifically
				  8.200.400 NMAC,
General Medicaid Eligibility
. Processes for
				  establishing and maintaining MAD eligibility are detailed in the income support
				  division (ISD) general provisions 8.100 NMAC,
General Provisions for
				  Public Assistance Programs
.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 259 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEES WITH SPEND DOWN PROVISION › Part 400 - RECIPIENT REQUIREMENTS › Section 8.259.400.8 - MISSION

Current through Register Vol. 35, No. 13, July 16, 2024
To reduce the impact of poverty on people living in New
				  Mexico by providing support services that help families break the cycle of
				  dependency on public assistance.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 259 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEES WITH SPEND DOWN PROVISION › Part 400 - RECIPIENT REQUIREMENTS › Section 8.259.400.9 - REFUGEE MEDICAL ASSISTANCE SPEND DOWN ONLY - CATEGORY 059

Current through Register Vol. 35, No. 13, July 16, 2024
Refer to 8.249.400 NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 259 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEES WITH SPEND DOWN PROVISION › Part 400 - RECIPIENT REQUIREMENTS › Section 8.259.400.10 - BASIS FOR DEFINING THE GROUP

Current through Register Vol. 35, No. 13, July 16, 2024
Refer to 8.249.400 NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 259 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEES WITH SPEND DOWN PROVISION › Part 400 - RECIPIENT REQUIREMENTS › Section 8.259.400.11 - GENERAL RECIPIENT REQUIREMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
Refer to 8.249.400 NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 259 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEES WITH SPEND DOWN PROVISION › Part 400 - RECIPIENT REQUIREMENTS › Section 8.259.400.15 - SPECIAL RECIPIENT REQUIREMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
Refer to 8.249.400 NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 259 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEES WITH SPEND DOWN PROVISION › Part 400 - RECIPIENT REQUIREMENTS › Section 8.259.400.17 - RECIPIENT RIGHTS AND RESPONSIBILITIES

Current through Register Vol. 35, No. 13, July 16, 2024
Refer to 8.249.400 NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 259 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEES WITH SPEND DOWN PROVISION › Part 400 - RECIPIENT REQUIREMENTS › Section 8.259.400.18 - ASSIGNMENTS OF MEDICAL SUPPORT

Current through Register Vol. 35, No. 13, July 16, 2024
Refer to 8.249.400 NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 259 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEES WITH SPEND DOWN PROVISION › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.259.500.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
The New Mexico medicaid program and other health care
				  programs are administered pursuant to regulations promulgated by the federal
				  department of health and human services under Title XIX of the Social Security
				  Act as amended or by state statute. See Section 27-1-12 et seq. NMSA 1978.
				  Section 9-8-1 et seq. NMSA 1978 establishes the health care authority (HCA) as
				  a single, unified department to administer laws and exercise functions relating
				  to health care facility licensure and health care purchasing and regulation.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 259 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEES WITH SPEND DOWN PROVISION › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.259.500.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
January 1, 2014, unless a later date is cited at the end of a
				  section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 259 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEES WITH SPEND DOWN PROVISION › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.259.500.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of this rule is to provide specific
				  instructions when determining eligibility for the medicaid program and other
				  health care programs. Generally, applicable eligibility rules are detailed in
				  the medical assistance division (MAD) eligibility policy manual, specifically
				  8.200.400 NMAC,
General Medicaid Eligibility
. Processes for
				  establishing and maintaining MAD eligibility are detailed in the income support
				  division (ISD) general provisions 8.100 NMAC,
General Provisions for
				  Public Assistance Programs
.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 259 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEES WITH SPEND DOWN PROVISION › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.259.500.8 - MISSION

Current through Register Vol. 35, No. 13, July 16, 2024
To reduce the impact of poverty on people living in New
				  Mexico by providing support services that help families break the cycle of
				  dependency on public assistance.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 259 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEES WITH SPEND DOWN PROVISION › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.259.500.9 - NEED DETERMINATION

Current through Register Vol. 35, No. 13, July 16, 2024
Refer to 8.249.500 NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 259 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEES WITH SPEND DOWN PROVISION › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.259.500.10 - RESOURCE STANDARDS

Current through Register Vol. 35, No. 13, July 16, 2024
Refer to 8.249.500 NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 259 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEES WITH SPEND DOWN PROVISION › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.259.500.11 - INCOME STANDARDS

Current through Register Vol. 35, No. 13, July 16, 2024
Refer to 8.249.500 NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 259 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEES WITH SPEND DOWN PROVISION › Part 600 - BENEFIT DESCRIPTION › Section 8.259.600.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
The New Mexico medicaid program and other health care
				  programs are administered pursuant to regulations promulgated by the federal
				  department of health and human services under Title XIX of the Social Security
				  Act as amended or by state statute. See Section 27-1-12 et seq. NMSA 1978.
				  Section 9-8-1 et seq. NMSA 1978 establishes the health care authority (HCA) as
				  a single, unified department to administer laws and exercise functions relating
				  to health care facility licensure and health care purchasing and regulation.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 259 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEES WITH SPEND DOWN PROVISION › Part 600 - BENEFIT DESCRIPTION › Section 8.259.600.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
January 1, 2014, unless a later date is cited at the end of a
				  section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 259 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEES WITH SPEND DOWN PROVISION › Part 600 - BENEFIT DESCRIPTION › Section 8.259.600.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of this rule is to provide specific
				  instructions when determining eligibility for the medicaid program and other
				  health care programs. Generally, applicable eligibility rules are detailed in
				  the medical assistance division (MAD) eligibility policy manual, specifically
				  8.200.400 NMAC,
General Medicaid Eligibility
. Processes for
				  establishing and maintaining MAD eligibility are detailed in the income support
				  division (ISD) general provisions 8.100 NMAC,
General Provisions for
				  Public Assistance Programs
.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 259 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEES WITH SPEND DOWN PROVISION › Part 600 - BENEFIT DESCRIPTION › Section 8.259.600.8 - MISSION

Current through Register Vol. 35, No. 13, July 16, 2024
To reduce the impact of poverty on people living in New
				  Mexico by providing support services that help families break the cycle of
				  dependency on public assistance.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 400 - RECIPIENT POLICIES › Section 8.280.400.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
The New Mexico medicaid program is administered pursuant to
				  regulations promulgated by the federal department of health and human services
				  under Title XIX of the Social Security Act, as amended and by the state health
				  care authority pursuant to state statute. See Section 27-2-12
et
				  seq
., NMSA 1978 (Repl. Pamp. 1991). Section 9-8-1 et seq. NMSA 1978
				  establishes the health care authority (HCA) as a single, unified department to
				  administer laws and exercise functions relating to health care facility
				  licensure and health care purchasing and regulation.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 400 - RECIPIENT POLICIES › Section 8.280.400.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
January 1, 2019, or upon a later approval date by the federal
				  centers for medicare and medicaid services (CMS), unless a later date is cited
				  at the end of the section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 400 - RECIPIENT POLICIES › Section 8.280.400.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of these regulations is to provide eligibility
				  policy and procedures for the medicaid program.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 400 - RECIPIENT POLICIES › Section 8.280.400.8 - MISSION STATEMENT

Current through Register Vol. 35, No. 13, July 16, 2024
To transform lives. Working with our partners, we design and
				  deliver innovative, high quality health and human services that improve the
				  security and promote independence for New Mexicans in their
				  communities.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 400 - RECIPIENT POLICIES › Section 8.280.400.9 - PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) - CATEGORIES 081, 083, AND 084

Current through Register Vol. 35, No. 13, July 16, 2024
Certain populations meeting financial, non-financial, and
				  medical criteria can receive acute and long-term care services in the
				  community. These services are funded by medicaid on a capitated
				  basis.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 400 - RECIPIENT POLICIES › Section 8.280.400.10 - BASIS FOR DEFINING THE GROUP

Current through Register Vol. 35, No. 13, July 16, 2024
Recipients and eligible applicants must live in certain
				  designated zip codes within New Mexico. A PACE recipient cannot concurrently
				  receive other medicaid home and community-based services. A PACE recipient may
				  be placed in a qualifying nursing facility upon a medical doctor's orders and
				  continue to participate in PACE. Upon disenrollment from PACE, a former PACE
				  recipient may receive institutional care (IC) medicaid services as long as the
				  individual meets all IC medicaid eligibility requirements. PACE recipients can
				  concurrently receive the qualified medicare beneficiaries program (QMB), the
				  specified low income medicare beneficiaries program (SLIMB), or supplemental
				  security income (SSI). For PACE applicants/recipients who receive SSI benefits
				  no further verification of income, resources, citizenship, age, disability, or
				  blindness is required.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 400 - RECIPIENT POLICIES › Section 8.280.400.11 - APPLICANT AND RECIPIENT REQUIREMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
Applicants must live within the designated PACE service area
				  and meet all of the criteria listed below at the time of application and
				  enrollment.
A. Applicants must be 55
				years of age or older. Applicants/recipients must be determined blind or
				disabled if under the age of 65 years.
(1) To
				be considered blind, an applicant/recipient must have central visual acuity of
				20/200 or less with corrective lenses or must be considered blind for practical
				purposes.
(2) To be considered
				disabled, an applicant/recipient must be unable to engage in any substantial
				gainful activity, because of any medically determinable physical,
				developmental, or mental impairment which has lasted, or is expected to last,
				for a continuous period of at least 12 months.
(3) If a determination of blindness or
				disability has not been made, the income support division worker will submit
				medical reports to the disability determination unit.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 400 - RECIPIENT POLICIES › Section 8.280.400.12 - RECIPIENT RIGHTS AND RESPONSIBILITIES

Current through Register Vol. 35, No. 13, July 16, 2024
Applicants and recipients are responsible for establishing
				  eligibility for medicaid. As part of this responsibility, the applicant or
				  recipient must provide required information and documents or take the actions
				  necessary to establish eligibility. Failure to do so must result in a decision
				  that eligibility does not exist.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 400 - RECIPIENT POLICIES › Section 8.280.400.13 - REPORTING REQUIREMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
All changes that may affect eligibility must be reported
				  within 10 calendar days of the date of the change in accordance with
				  8.200.430.18
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.280.500.1 - ISSUING AGENCY

Current through Register Vol. 35, No. 13, July 16, 2024
New Mexico Health Care Authority.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.280.500.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
The New Mexico medicaid program is administered pursuant to
				  regulations promulgated by the federal department of health and human services
				  under Title XIX of the Social Security Act, as amended, and by the state health
				  care authority pursuant to state statute. See Section 27-2-12 et seq. NMSA 1978
				  (Repl. Pamp. 1991). Section 9-8-1 et seq. NMSA 1978 establishes the health care
				  authority (HCA) as a single, unified department to administer laws and exercise
				  functions relating to health care facility licensure and health care purchasing
				  and regulation.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.280.500.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
July 1, 2024, unless a later date is cited at the end of a
				  section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.280.500.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of these regulations is to provide eligibility
				  policy and procedures for the medicaid program.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.280.500.8 - MISSION STATEMENT

Current through Register Vol. 35, No. 13, July 16, 2024
To transform lives. Working with our partners, we design and
				  deliver innovative, high quality health and human services that improve the
				  security and promote independence for New Mexicans in their
				  communities.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.280.500.9 - NEED DETERMINATION

Current through Register Vol. 35, No. 13, July 16, 2024
Eligibility for PACE is determined prospectively.
Applicants/recipients must meet, or expect to meet, all
				  financial eligibility criteria in the month for which a determination of
				  eligibility is made. Applicants for and recipients of medicaid through PACE
				  must apply for, and take all necessary steps to obtain, any income or resources
				  to which they may be entitled. Such steps must be taken within 30 days of the
				  date the HCA (HCA) furnishes notice of the potential entitlement. Failure or
				  refusal to apply for and take all necessary steps to determine eligibility for
				  other benefits after notice is received results in an applicant/recipient
				  becoming ineligible for medicaid.
A.
				Applicants/ recipients who have elected a lower veterans affairs (VA) payment
				do not need to reapply for veteran's administration improved pension (VAIP)
				benefits.
B. Crime victims are not
				required to accept victim's compensation payments from a state-administered
				fund as a condition of medicaid eligibility.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.280.500.10 - RESOURCE STANDARDS

Current through Register Vol. 35, No. 13, July 16, 2024
See
				  8.281.500.10 NMAC and all following
				  subsections.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.280.500.11 - APPLICABLE RESOURCE STANDARDS

Current through Register Vol. 35, No. 13, July 16, 2024
An applicant/recipient is eligible for medicaid on the factor
				  of resources if countable resources do not exceed $2,000. See
				  8.281.500.11
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.280.500.12 - COUNTABLE RESOURCES

Current through Register Vol. 35, No. 13, July 16, 2024
See
				  8.281.500.12
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.280.500.13 - RESOURCE EXCLUSIONS

Current through Register Vol. 35, No. 13, July 16, 2024
See
				  8.281.500.13
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.280.500.14 - ASSET TRANSFERS

Current through Register Vol. 35, No. 13, July 16, 2024
See
				  8.281.500.14 NMAC for regulations
				  governing transfers of assets. All provisions pertaining to transfers under
				  institutional care medicaid apply to transfers under PACE with the exception of
				  the penalty for transfers without fair return. The penalty for transfers of
				  assets without fair return for PACE applicants/recipients is ineligibility for
				  medicaid under PACE.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.280.500.15 - TRUSTS

Current through Register Vol. 35, No. 13, July 16, 2024
See
				  8.281.500.15
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.280.500.16 - RESOURCE STANDARDS FOR MARRIED COUPLES

Current through Register Vol. 35, No. 13, July 16, 2024
See
				  8.281.500.16 NMAC for spousal
				  impoverishment methodology used in the determination of eligibility for married
				  applicants/recipients with a spouse in the home who began receiving PACE
				  services on or after September 30, 1989. A resource assessment is completed as
				  of the first moment of the first day of the month in which the level of care is
				  approved.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.280.500.17 - DEEMING RESOURCES

Current through Register Vol. 35, No. 13, July 16, 2024
Not applicable to PACE.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.280.500.18 - INCOME

Current through Register Vol. 35, No. 13, July 16, 2024
An applicant/recipient's gross countable monthly income must
				  be less than the maximum allowable monthly income standard. See
				  8.281.500.18
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.280.500.19 - INCOME STANDARDS

Current through Register Vol. 35, No. 13, July 16, 2024
See
				  8.281.500.19
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.280.500.20 - UNEARNED INCOME

Current through Register Vol. 35, No. 13, July 16, 2024
See
				  8.281.500.20
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.280.500.21 - DEEMED INCOME

Current through Register Vol. 35, No. 13, July 16, 2024
See
				  8.281.500.21
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.280.500.22 - DISREGARDS

Current through Register Vol. 35, No. 13, July 16, 2024
See
				  8.281.500.22
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.280.500.23 - MEDICAL CARE CREDIT

Current through Register Vol. 35, No. 13, July 16, 2024
There are medical care credits in PACE only when a PACE
				  recipient enters a nursing facility. See
				  8.281.500.22
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 600 - BENEFIT DESCRIPTION › Section 8.280.600.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
The New Mexico medicaid program is administered pursuant to
				  regulations promulgated by the federal department of health and human services
				  under Title XIX of the Social Security Act, as amended and by the state health
				  care authority pursuant to state statute. See Section 27-2-12
et
				  seq
., NMSA 1978 (Repl. Pamp. 1991). Section 9-8-1 et seq. NMSA 1978
				  establishes the health care authority (HCA) as a single, unified department to
				  administer laws and exercise functions relating to health care facility
				  licensure and health care purchasing and regulation.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 600 - BENEFIT DESCRIPTION › Section 8.280.600.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
January 1, 2019, or upon a later approval date by the federal
				  centers for medicare and medicaid services (CMS), unless a later date is cited
				  at the end of the section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 600 - BENEFIT DESCRIPTION › Section 8.280.600.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of these regulations is to provide eligibility
				  policy and procedures for the medicaid program.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 600 - BENEFIT DESCRIPTION › Section 8.280.600.9 - BENEFIT DESCRIPTION

Current through Register Vol. 35, No. 13, July 16, 2024
An applicant/recipient who is eligible for PACE is eligible
				  for specified services available under the program. See specific program policy
				  sections for covered services.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 600 - BENEFIT DESCRIPTION › Section 8.280.600.10 - BENEFIT DETERMINATION

Current through Register Vol. 35, No. 13, July 16, 2024
Application for PACE is made using the HSD 100 application.
				  Applications must be acted upon and notice of approval, denial, or delay sent
				  out within 45 days of the date of application. The applicant/recipient may
				  complete the form himself, or receive help from a relative, friend, guardian,
				  or other designated representative. To avoid a conflict of interest, a PACE
				  provider must not complete the application nor be a designated
				  representative.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 600 - BENEFIT DESCRIPTION › Section 8.280.600.11 - INITIAL BENEFITS

Current through Register Vol. 35, No. 13, July 16, 2024
An application for PACE can be approved when all factors of
				  eligibility have been met and the individual is enrolled in the program. The
				  effective date for PACE enrollment is the first day of the calendar month
				  following the signing of the enrollment agreement (if all financial,
				  non-financial, and medical eligibility criteria are met and an approved level
				  of care (LOC) is in place). Applicants determined to be ineligible for PACE are
				  notified of the reason for the denial and provided with an explanation of
				  appeal rights. Applicants determined to be eligible for PACE are notified of
				  the approval.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 600 - BENEFIT DESCRIPTION › Section 8.280.600.12 - ONGOING BENEFITS

Current through Register Vol. 35, No. 13, July 16, 2024
A. A
				complete redetermination of eligibility must be performed annually by the
				income support division worker for each open case.
B. Level of care reviews are required to be
				completed at least annually. Level of care determinations for PACE are made by
				the utilization review contractor.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 280 - MEDICAID ELIGIBILITY - PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) › Part 600 - BENEFIT DESCRIPTION › Section 8.280.600.13 - RETROACTIVE BENEFITS

Current through Register Vol. 35, No. 13, July 16, 2024
Retroactive coverage is not available in the PACE
				  program.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 400 - RECIPIENT POLICIES › Section 8.281.400.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
The New Mexico medicaid program is administered pursuant to
				  regulations promulgated by the federal department of health and human services
				  under Title XIX of the Social Security Act, as amended and by the state health
				  care authority pursuant to state statute. See, Section 27-2-12
et
				  seq
., NMSA 1978 (Repl. Pamp. 1991). Section 9-8-1 et seq. NMSA 1978
				  establishes the health care authority (HCA) as a single, unified department to
				  administer laws and exercise functions relating to health care facility
				  licensure and health care purchasing and regulation.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 400 - RECIPIENT POLICIES › Section 8.281.400.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
January 1, 2019, unless a later date is cited at the end of a
				  section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 400 - RECIPIENT POLICIES › Section 8.281.400.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of these regulations is to provide eligibility
				  policy and procedures for the medicaid program.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 400 - RECIPIENT POLICIES › Section 8.281.400.8 - MISSION STATEMENT

Current through Register Vol. 35, No. 13, July 16, 2024
To transform lives. Working with our partners, we design and
				  deliver innovative, high quality health and human services that improve the
				  security and promote independence for New Mexicans in their
				  communities.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 400 - RECIPIENT POLICIES › Section 8.281.400.9 - INSTITUTIONAL CARE MEDICAID CATEGORIES 081, 083 AND 084

Current through Register Vol. 35, No. 13, July 16, 2024
The New Mexico medicaid program (medicaid) pays for services
				  furnished to individuals who require institutional care and who meet all
				  supplemental security income (SSI) eligibility criteria and whose monthly gross
				  countable income is less than the maximum allowed amount for institutional
				  care.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 400 - RECIPIENT POLICIES › Section 8.281.400.10 - BASIS FOR DEFINING THE GROUP

Current through Register Vol. 35, No. 13, July 16, 2024
An applicant or recipient must require institutional care as
				  certified by a physician licensed to practice medicine or osteopathy. The
				  applicant or recipient must be institutionalized in a medicaid qualifying bed
				  in a New Mexico medicaid approved institution or in a hospital administered
				  under the authority of the US department of veterans affairs (VA). Medicaid
				  approved "Institutions" are defined as acute care hospitals (ACHs), nursing
				  facilities (NFs) and intermediate care facilities for individuals with
				  intellectual disabilities (ICF/IID), swing beds and certified instate inpatient
				  rehabilitation centers. Level of care (LOC) determinations for institutional
				  care medicaid eligibility are made by the MAD utilization review (UR)
				  contractor or a member's selected or assigned Managed Care Organization (MCO).
				  Documentation of these determinations is provided to the institution by the UR
				  contractor or MCO. For applicants or recipients in a hospital awaiting
				  placement in NFs, confirmation letters are furnished by the MAD UR contractor
				  for use by hospital staff. A level of care (LOC) is not required for acute care
				  hospitals. Documentation of acute care hospitalization must be provided by the
				  hospital to determine the eligibility period.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 400 - RECIPIENT POLICIES › Section 8.281.400.11 - INTERVIEW REQUIREMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
An interview is not required for institutional care medicaid.
				  An applicant or recipient can request an interview from the income support
				  division (ISD).
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 400 - RECIPIENT POLICIES › Section 8.281.400.12 - ENUMERATION

Current through Register Vol. 35, No. 13, July 16, 2024
An applicant or recipient must furnish their social security
				  number in accordance with
				  8.200.410.10
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 400 - RECIPIENT POLICIES › Section 8.281.400.13 - CITIZENSHIP

Current through Register Vol. 35, No. 13, July 16, 2024
Refer to medical assistance program manual Section
				  8.200.410.11
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 400 - RECIPIENT POLICIES › Section 8.281.400.14 - RESIDENCE

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Residence
				in the United States:
An applicant or recipient must be residing in the
				United States at the time of approval. An applicant or recipient who leaves the
				United States for an entire calendar month loses eligibility. The applicant or
				recipient must re-establish their residence in the United States for at least
				30 consecutive days before becoming eligible for any SSI-related medicaid
				program.
B.
Residence in New
				Mexico:
To be eligible for institutional care medicaid, an applicant or
				recipient must be physically present in New Mexico on the date of application
				or final determination of eligibility and must have demonstrated intent to
				remain in the state. If the individual does not have the present mental
				capacity to declare intent, the parent, guardian or adult child may assume
				responsibility for a declaration of intent. If the individual does not have the
				present mental capacity to declare intent and there is no guardian or relative
				to assume responsibility for a declaration of intent, the state where the
				person is living is recognized as the state of residence. A temporary absence
				from the state does not preclude eligibility. A temporary absence exists if the
				applicant or recipient leaves the state for a specific purpose with a
				time-limited goal and intends to return to New Mexico when the goal is
				accomplished.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 400 - RECIPIENT POLICIES › Section 8.281.400.15 - SPECIAL RECIPIENT REQUIREMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Institutional care medicaid:
To be eligible for institutional care medicaid an applicant or recipient must
				be aged, blind, or disabled as defined by the social security administration
				(SSA). Recipients of institutional care medicaid in New Mexico are terminated
				from assistance if they are transferred to, or choose to move to, a long term
				care facility out-of-state. New Mexico medicaid does not cover NF services
				furnished to applicants or recipients in out-of-state facilities with the
				exception of out-of-state long-term care facilities that are not available in
				the state of New Mexico in accordance with Subsection F of
				8.302.4.12
				NMAC.
B.
Intermediate care
				facilities for individuals with intellectual disabilities (ICF/IID):
To
				be eligible for an ICF/IID, applicants or recipients must obtain a match letter
				from the department of health to confirm that they meet the definition of an
				individual with a developmental disability as determined by the department of
				health/developmental disabilities supports division, in accordance with
				8.290.400.10
				NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 400 - RECIPIENT POLICIES › Section 8.281.400.16 - AGED

Current through Register Vol. 35, No. 13, July 16, 2024
To be considered aged, an applicant or recipient must be 65
				  years of age or older. Age is verified by the following:
A. decision from SSA regarding age;
B. acceptable documentary evidence including:
(1) birth certificate or delayed birth
				certificate;
(2) World War II
				ration books;
(3) baptismal
				records;
(4) marriage license or
				certificate;
(5) military discharge
				papers;
(6) insurance
				policies;
(7) Indian census
				records;
(8) dated newspaper
				clippings;
(9) voting
				registration;
(10) World War I
				registration;
(11) veterans
				administration records; or
(12)
				school census.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 400 - RECIPIENT POLICIES › Section 8.281.400.17 - BLIND

Current through Register Vol. 35, No. 13, July 16, 2024
To be considered blind, an applicant or recipient must have
				  central visual acuity of 20/200 or less with corrective lenses.
A.
Documentation of blindness:
An applicant or recipient must meet the SSA's definition of blindness. If the
				applicant or recipient is receiving social security or supplemental security
				income (SSI) benefits based on the condition of blindness, verification of this
				factor can be accomplished through documents, such as award letters or benefit
				checks.
B.
Status of SSA
				determination:
If it has not been determined whether an applicant or
				recipient meets SSA's definition of blindness or if only a temporary
				determination was made, the ISD worker must request a determination from the
				disability determination unit (DDU). Eligibility based on blindness cannot be
				considered to exist without a DDS determination.
C.
Redetermination of blindness:
A redetermination of blindness by the DDU is not required on a re-application
				following an applicant or recipient's termination from SSI/SSA or medicaid, if
				a permanent condition of blindness was previously established or the
				termination was based on a condition unrelated to blindness and there was no
				indication of possible improvement in an applicant or recipient's
				vision.
D.
Remedial
				treatment:
If the DDU recommends remedial medical treatment that carries
				no more than the usual risk or a reasonable plan for vocational training, an
				applicant or recipient must comply with the recommendation unless good cause
				for not doing so exists.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 400 - RECIPIENT POLICIES › Section 8.281.400.18 - DISABILITY

Current through Register Vol. 35, No. 13, July 16, 2024
To be considered disabled, an applicant or recipient under
				  65 years of age is considered to have a qualifying disability if they are
				  unable to engage in any substantial gainful activity because of any medically
				  determinable physical, developmental, or mental impairment which has lasted, or
				  is expected to last, for a continuous period of at least 12 months.
A.
Documentation of disability:
An applicant or recipient must meet the social security administration (SSA)'s
				definition of disability. If the applicant or recipient is receiving social
				security or supplemental security income (SSI) benefits based on the condition
				of disability, verification of this factor can be accomplished through
				documents, such as award letters or benefit checks.
B.
Status of SSA determination:
If it has not been determined whether an applicant or recipient meets the SSA's
				definition of disability or if only a temporary determination was made, the ISS
				must request a determination from the DDU. Eligibility based on disability
				cannot be considered to exist without a DDS determination.
C.
Redetermination of
				disability:
A redetermination of disability by the DDU is not required
				on a re-application following an applicant or recipient's termination from
				SSI/SSA or medicaid, if a permanent condition of disability was previously
				established or the termination was based on a condition unrelated to disability
				and there was no indication of possible improvement in an applicant/recipient's
				physical condition.
D.
Remedial treatment:
If the DDU recommends remedial medical
				treatment that carries no more than the usual risk or a reasonable plan for
				vocational training, an applicant or recipient must comply with the
				recommendation unless good cause for not doing so exists.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 400 - RECIPIENT POLICIES › Section 8.281.400.19 - SSI STATUS

Current through Register Vol. 35, No. 13, July 16, 2024
The ISD worker determines whether an applicant or
				  recipient's SSI eligibility will continue while they are
				  institutionalized.
A.
Applicant/recipient currently eligible for SSI:
If an applicant or
				recipient will not continue to be eligible for SSI while institutionalized, the
				ISD worker processes the application regardless of the fact that SSA will not
				terminate SSI benefits until the month following the month the applicant or
				recipient enters an institution.
B.
Applicant not currently receiving SSI:
If an applicant or
				recipient is not receiving SSI or has not applied for SSI before applying for
				medicaid and their gross income is less than $50, the ISD worker processes the
				application and refers the applicant to the SSA for determination of
				eligibility for SSI benefits. If an applicant's gross monthly income is $50 or
				more but not in excess of the maximum allowable income standard, the ISD worker
				determines eligibility for institutional care medicaid based on remaining
				financial and nonfinancial criteria.