reglab/statecodes huggingface dataset:
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 150 - LOW INCOME HOME ENERGY ASSISTANCE PROGRAM › Part 600 - DESCRIPTION OF PROGRAM/BENEFITS › Section 8.150.600.8 - BENEFITS - ISSUANCE AND USE AND VENDOR RESPONSIBILITIES

Current through Register Vol. 35, No. 13, July 16, 2024
A. Issuance of benefits: Benefits are issued
				in one of the following methods:
(1)
				recipient warrants: HCA issues benefits directly to recipients through
				recipient warrants when appropriate and only as a last resort;
(2) vendor payments: HCA issues benefits
				directly to the vendor;
(a) HCA will provide
				the account name and customer account number for the LIHEAP eligible household
				to the vendor specified by the household; the vendor will notify HCA of
				mismatches within a specified time frame;
(b) vendors who carry customer accounts will
				credit eligible households with the amount of the LIHEAP regular benefit no
				more than 30 days from the time of the payment; vendors who provide fuel on
				demand will provide fuel to eligible households equal to the amount of the
				LIHEAP regular benefit no more than 30 days from the date of the eligible
				household's contact with the vendor to make arrangements for the provision of
				such fuel;
(c) vendors shall return
				to the LIHEAP central office excess LIHEAP benefits from the account originally
				credited if that account is closed.
(d) vendors should transfer a LIHEAP benefit
				credit on an account that is closed after the credit is posted; the transfer
				must be to a new or existing account for the new residence of the recipient
				household; the vendor must document the transfer in a manner that meets
				generally accepted audit standards;
(e) vendors may refund LIHEAP benefit credit
				to a household under certain circumstances when the household moves or will not
				have service with the company at their residence; the vendor must document the
				transfer in a manner that meets generally accepted audit standards;
(f) vendors must refund LIHEAP benefit
				credits on closed accounts to HCA when the credit cannot be transferred to a
				new account or the household cannot be located.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 150 - LOW INCOME HOME ENERGY ASSISTANCE PROGRAM › Part 600 - DESCRIPTION OF PROGRAM/BENEFITS › Section 8.150.600.9 - STATE LIHEAP FUNDING

Current through Register Vol. 35, No. 13, July 16, 2024
A.
				Purpose: To reduce the home heating and cooling costs of low-income New
				Mexicans.
B. Benefits:
(1) payments that assist low-income
				households to reduce the costs of home heating/ cooling; or
(2) weatherization services for the homes of
				low-income households.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 150 - LOW INCOME HOME ENERGY ASSISTANCE PROGRAM › Part 600 - DESCRIPTION OF PROGRAM/BENEFITS › Section 8.150.600.10 - FUND USES

Current through Register Vol. 35, No. 13, July 16, 2024
Unless specified by the New Mexico state legislature, the
				  secretary of the HCA has the authority to specify the uses of the funding.
				  Funding will be used for purposes similar to those allowed under the federal
				  low income home energy assistance program.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 150 - LOW INCOME HOME ENERGY ASSISTANCE PROGRAM › Part 600 - DESCRIPTION OF PROGRAM/BENEFITS › Section 8.150.600.11 - WINTER MORATORIUM ON UTILITY DISCONNECTION

Current through Register Vol. 35, No. 13, July 16, 2024
No utility vendor regulated by the public regulation
				  commission shall discontinue or disconnect residential utility service for
				  heating from November 15 through March 15 of the subsequent year for certain
				  customers.
A. Administering authority:
				The HCA or a tribal entity that administers its own low income home energy
				assistance program are designated as the authorities to identify customers who
				meet the certain qualifications for the winter moratorium. The customer must
				also meet the New Mexico public regulation commission requirements to receive
				winter moratorium protection.
B.
				Qualification: Customers who qualify for the winter moratorium must meet the
				following income standards:
(1) the customer
				is a member of a household in which the total gross income is at or below one
				hundred fifty percent of the current federal poverty guidelines; or
(2) one or more of the household members:
(a) receive supplemental security income;
				or
(b) are eligible for any
				federally funded assistance program administered by ISD with income guidelines
				at or below one hundred fifty percent of the current federal poverty
				guidelines;
(3) the
				person in whose name a utility account is listed and the name of the public
				assistance recipient need not match in order for the customer to be entitled to
				protection under this section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 150 - LOW INCOME HOME ENERGY ASSISTANCE PROGRAM › Part 620 - BENEFIT DETERMINATION GENERAL › Section 8.150.620.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
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. It also provides for administration of public assistance
				  programs.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 150 - LOW INCOME HOME ENERGY ASSISTANCE PROGRAM › Part 620 - BENEFIT DETERMINATION GENERAL › Section 8.150.620.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
July 1, 2024, unless a different date is at the end of a
				  section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 150 - LOW INCOME HOME ENERGY ASSISTANCE PROGRAM › Part 620 - BENEFIT DETERMINATION GENERAL › Section 8.150.620.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of these regulations is to provide policy and
				  procedures for the administration of the low income home energy assistance
				  program (LIHEAP).
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 150 - LOW INCOME HOME ENERGY ASSISTANCE PROGRAM › Part 620 - BENEFIT DETERMINATION GENERAL › Section 8.150.620.8 - POINT SYSTEM

Current through Register Vol. 35, No. 13, July 16, 2024
A point allocation system is used to ensure that the highest
				  level of assistance is provided to those households with the highest energy
				  needs, lowest income and largest household member size while giving priority to
				  those households with vulnerable members.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 150 - LOW INCOME HOME ENERGY ASSISTANCE PROGRAM › Part 620 - BENEFIT DETERMINATION GENERAL › Section 8.150.620.9 - CALCULATING THE BENEFIT/ASSIGNMENT OF POINTS

Current through Register Vol. 35, No. 13, July 16, 2024
To determine the amount of the benefit for households with an
				  energy cost, HCA assigns points for each following factors.
A. Energy costs points: Points are assigned
				based on the energy burden at the household's current residence for households
				that have a direct cost for heating or cooling expenses.
(1) Energy burden: Energy burden is "the
				expenditures of the household for home energy divided by the income of the
				household." Points are assigned to the household by determining the households'
				percentage of energy burden. The point allocation for energy burden is:
(a) Zero points for zero to five percent
				energy burden;
(b) One point for
				six to ten percent energy burden;
(c) Two points for eleven to fifteen percent
				energy burden; or
(d) Three points
				for sixteen percent or more energy burden.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 150 - LOW INCOME HOME ENERGY ASSISTANCE PROGRAM › Part 620 - BENEFIT DETERMINATION GENERAL › Section 8.150.620.10 - CALCULATION OF BENEFIT AMOUNT

Current through Register Vol. 35, No. 13, July 16, 2024
A.
				Prior to the start of the application period projections will be made to
				determine point value. Anticipated grant of award, potential applicants and the
				current economy of the state of New Mexico will be used to determine the point
				value. Households eligible for a LIHEAP benefit will have their point total
				multiplied times the point value. The product is the amount of payment that is
				issued to the utility vendor for credit on the household's account or is sent
				to the household.
B. Based on the
				availability of funds, benefits are issued for eligible applications received
				through September 30.
C. At the
				direction of the HCA secretary, the point value for energy cost points, income
				points, vulnerable population points, additional energy burden points, or any
				of their parts, may be adjusted as necessary taking into consideration the
				factors described in Subsection A of
				8.150.620.10 NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 150 - LOW INCOME HOME ENERGY ASSISTANCE PROGRAM › Part 620 - BENEFIT DETERMINATION GENERAL › Section 8.150.620.12 - RETROACTIVE BENEFIT COVERAGE

Current through Register Vol. 35, No. 13, July 16, 2024
Households that were denied LIHEAP benefits or received a
				  lesser benefit than they were entitled to but prevail in an appeal through an
				  agency conference or fair hearing are entitled a retroactive
				  benefit.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 150 - LOW INCOME HOME ENERGY ASSISTANCE PROGRAM › Part 624 - RETROACTIVE BENEFIT COVERAGE › Section 8.150.624.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
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. It also provides for administration of public assistance
				  programs.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 150 - LOW INCOME HOME ENERGY ASSISTANCE PROGRAM › Part 624 - RETROACTIVE BENEFIT COVERAGE › Section 8.150.624.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
July1, 2024, unless a different date is at the end of a
				  section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 150 - LOW INCOME HOME ENERGY ASSISTANCE PROGRAM › Part 624 - RETROACTIVE BENEFIT COVERAGE › Section 8.150.624.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of these regulations is to provide policy and
				  procedures for the administration of the low income home energy assistance
				  program (LIHEAP).
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 150 - LOW INCOME HOME ENERGY ASSISTANCE PROGRAM › Part 624 - RETROACTIVE BENEFIT COVERAGE › Section 8.150.624.8 - RETROACTIVE BENEFIT COVERAGE

Current through Register Vol. 35, No. 13, July 16, 2024
Households that were denied LIHEAP benefits or received a
				  lesser benefit than they were entitled to but, as the result of an agency
				  conference or fair hearing, are determined to be entitled to a benefit will be
				  issued a retroactive benefit.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 400 - GENERAL MEDICAID ELIGIBILITY › Section 8.200.400.3 - 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.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 400 - GENERAL MEDICAID ELIGIBILITY › Section 8.200.400.5 - 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 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 400 - GENERAL MEDICAID ELIGIBILITY › Section 8.200.400.6 - 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 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 400 - GENERAL MEDICAID ELIGIBILITY › Section 8.200.400.8 - MISSION

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 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 400 - GENERAL MEDICAID ELIGIBILITY › Section 8.200.400.9 - GENERAL MEDICAID ELIGIBILITY

Current through Register Vol. 35, No. 13, July 16, 2024
Medicaid services are jointly financed by the federal
				  government and the state of New Mexico and are administered by medical
				  assistance division (MAD).
A. Within
				broad federal regulations, New Mexico determines categories of eligible
				recipients, eligibility requirements, types and range of services, levels of
				provider reimbursement and managed care capitation, and administrative and
				operating procedures.
B. New Mexico
				administers medical assistance programs using waivers of the Social Security
				Act for comparability of services, rules for income and resources and freedom
				of choice of provider.
C. Payments
				for medical and behavioral health services, durable equipment and supplies are
				made directly to service providers, not to the medicaid eligible
				recipient.
D. This chapter
				describes the New Mexico categories of medicaid and medical assistance programs
				eligibility. Each medicaid and medical assistance program includes detailed
				eligibility requirements which are organized into the following three chapter
				types:
(1) recipient requirements
				(.400);
(2) income and resources
				standards (.500); and
(3) benefit
				description (.600).
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 400 - GENERAL MEDICAID ELIGIBILITY › Section 8.200.400.10 - BASIS FOR DEFINING GROUP - MEDICAID CATEGORIES

Current through Register Vol. 35, No. 13, July 16, 2024
A. Except where
				noted, the HSD income support division (ISD) determines eligibility in the
				categories listed below:
(1) other adult
				(Category 100);
(2) parent
				caretaker (Category 200);
(3)
				pregnant women (Category 300);
(4)
				pregnancy-related services (Category 301);
(5) loss of parent caretaker due to earnings
				from employment or due to spousal support (Categories 027 and 028);
(6) newborn (Category 031);
(7) children under age 19 (Categories 400,
				401, 402, 403, 420, and 421);
(8)
				children, youth, and families department medicaid (Categories 017, 037, 046,
				04, 066, and 086); and
(9) family
				planning (Category 029).
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 400 - GENERAL MEDICAID ELIGIBILITY › Section 8.200.400.11 - PRESUMPTIVE ELIGIBILITY FOR BREAST AND CERVICAL CANCER

Current through Register Vol. 35, No. 13, July 16, 2024
PE provides immediate access to health services when an
				  individual appears to be eligible for Category 052.
A.
Breast and cervical cancer (BCC)
				(Category 052):
PE provides temporary medicaid coverage for an uninsured
				woman, under the age of 65 who has been screened and diagnosed by the DOH as
				having breast or cervical cancer to include pre-cancerous conditions. Only one
				PE period is allowed per calendar year.
B. PE is determined by a qualified entity
				certified by HSD. Qualified entities may include community and rural health
				centers, hospitals, physician offices, local health departments, family
				planning agencies and schools.
C.
				The PE period begins on the date the provider determines presumptive
				eligibility and terminates at the end of the following month.
D. Providers shall notify the MAD claims
				processing contractor of the determination within 24-hours of the PE
				determination.
E. For continued
				medicaid eligibility beyond the PE period, a completed and signed application
				for medicaid must be submitted to HSD/ISD. An eligible PE provider must submit
				the application to ISD within 10 calendar days from the receipt of the
				application.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 400 - GENERAL MEDICAID ELIGIBILITY › Section 8.200.400.12 - 12 MONTHS CONTINUOUS ELIGIBILITY FOR CHILDREN (42 CFR 435.926)

Current through Register Vol. 35, No. 13, July 16, 2024
A. HSD provides
				continuous eligibility for the period specified in Subsection B of
				8.200.400.14 NMAC for an
				individual who is:
(1) Under age 19
				and
(2) Eligible and enrolled for
				mandatory or optional coverage under the State plan.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 400 - GENERAL MEDICAID ELIGIBILITY › Section 8.200.400.13 - AUTHORIZED REPRESENTATIVE

Current through Register Vol. 35, No. 13, July 16, 2024
HSD must permit applicants and beneficiaries to designate an
				  individual or organization to act responsibly on their behalf in assisting with
				  the individual's application and renewal of eligibility and other ongoing
				  communications.
A. Such a designation
				must be in writing including the applicant's signature, and must be permitted
				at the time of application and at other times. Legal documentation of authority
				to act on behalf of an applicant or beneficiary under state law, such as a
				court order establishing legal guardianship or a power of attorney, shall serve
				in the place of written authorization by the applicant or
				beneficiary.
B. Representatives may
				be authorized to:
(1) sign an application on
				the applicant's behalf;
(2)
				complete and submit a renewal form;
(3) receive copies of the applicant or
				beneficiary's notices and other communications from the agency; and
(4) act on behalf of the applicant or
				beneficiary in all other matters with the agency.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 400 - GENERAL MEDICAID ELIGIBILITY › Section 8.200.400.14 - RETROACTIVE MEDICAID

Current through Register Vol. 35, No. 13, July 16, 2024
A. HSD must
				make eligibility for medicaid effective no later than the first or up to the
				third month before the month of application if the individual:
(1) Requested coverage for months prior to
				the application month;
(2) received
				medicaid services, at any time during that period, of a type covered under the
				plan and;
(3) would have been
				eligible for medicaid at the time he or she received the services, if he or she
				had applied (or an authorized representative has applied for him or her)
				regardless of whether the individual is alive when application for medicaid is
				made.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.200.410.3 - 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 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.200.410.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
October 1, 2017, unless a later date is cited at the end of a
				  section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.200.410.6 - 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 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.200.410.8 - MISSION

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 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.200.410.9 - GENERAL RECIPIENT REQUIREMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
To be eligible or continue eligibility for medicaid or other
				  medical assistance programs, an applicant or eligible recipient must meet
				  specific non-financial requirements. In addition to the rules in this chapter,
				  refer to 8.100.130 NMAC regarding the following requirements:
A. citizenship or non-citizen
				status;
B. enumeration;
C. residence;
D. non-concurrent receipt of
				assistance;
E. applications for
				other benefits; and
F. assignment
				of medical support rights.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.200.410.10 - USE OF SOCIAL SECURITY NUMBER (42 CFR 435.910)

Current through Register Vol. 35, No. 13, July 16, 2024
Federal law requires, as a condition of eligibility, that
				  each individual (including children) seeking medicaid furnish each of his or
				  her social security numbers (SSN).
A
				HSD will advise the applicant of:
(1) the
				statute or other authority under which the agency is requesting the applicant's
				SSN; and
(2) the uses HSD will make
				of each SSN, including its use for verifying income, eligibility, and amount of
				medical assistance payments per
				42 CFR 435.940
				through
				435.960.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.200.410.11 - CITIZENSHIP

Current through Register Vol. 35, No. 13, July 16, 2024
To be eligible for medicaid, an individual must be a citizen
				  of the United States; United States national or a non-citizen who meets the
				  requirements set forth in either Subsection A or B of 8.200.410.11 NMAC.
A.
Non-citizens who entered the United
				States prior to August 22, 1996:
Non-citizens who entered the United
				States prior to August 22, 1996, will not be subject to the five-year bar for
				purposes of medicaid eligibility. These classes of non-citizens are as follows.
(1) Qualified non-citizens who entered the
				United States prior to August 22, 1996, and obtained their qualified
				non-citizen status prior to that date, are eligible for medicaid without the
				five year waiting period.
(2)
				Non-citizens who entered the United States prior to August 22, 1996, and
				remained continuously present in the United States until the date they obtained
				qualified non-citizen status on or after August 22, 1996; any single absence
				from the United States of more than 30 days, or a total aggregate of absences
				of more than 90 days, is considered to interrupt "continuous
				presence".
(3) Lawful Permanent
				Residents (LPRs) are qualified non-citizens per
				8 USC
				1641.
(4) A non-qualified non-citizen who was
				permanently residing in the United States under color of law (PRUCOL) on or
				before August 22, 1996, does not lose medicaid eligibility provided all other
				factors of eligibility continue to be met. These non-citizens are
				"grandfathered". For these individuals, non-citizen eligibility may continue to
				be based on the PRUCOL standard. An individual eligible under the PRUCOL
				standard retains his or her grandfathering rights even if benefits
				terminate.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.200.410.12 - TYPES OF ACCEPTABLE DOCUMENTARY EVIDENCE OF CITIZENSHIP (42 CFR 435.407)

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Stand-alone
				evidence of citizenship:
The following must be accepted as sufficient
				documentary evidence of citizenship:
(1) A
				U.S. passport, including a U.S. passport card issued by the department of
				state, without regard to any expiration date as long as such passport or card
				was issued without limitation.
(2)
				A certificate of naturalization.
(3) A certificate of U.S.
				citizenship.
(4) A valid
				state-issued driver's license if the state issuing the license requires proof
				of U.S. citizenship, or obtains and verifies a SSN from the applicant who is a
				citizen before issuing such license.
(a) A
				real ID issued on or after November 14, 2016 is sufficient documentary evidence
				of citizenship.
(b) A driver
				authorization card (DAC) is not sufficient documentary evidence of
				citizenship.
(5)
				Documentary evidence issued by a federally recognized Indian tribe identified
				in the federal register by the bureau of Indian affairs within the U.S.
				department of the interior, and including tribes located in a state that has an
				international border, which;
(a) Identifies
				the federally recognized Indian tribe that issued the document;
(b) Identifies the individual by name;
				and
(c) Confirms the individual's
				membership, enrollment, or affiliation with the tribe.
(d) Documents described in Paragraph (5) of
				Subsection A of 8.200.410.12 NMAC include, but are not limited to:
(i) A tribal enrollment card;
(ii) A certificate of degree of Indian
				blood;
(iii) A tribal census
				document;
(iv) Documents on tribal
				letterhead, issued under the signature of the appropriate tribal official, that
				meet the requirements of Paragraph (5) of Subsection A of 8.200.410.12
				NMAC.
(6) A
				data match with the SSA.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.200.410.13 - REASONABLE OPPORTUNITY PERIOD (42 CFR 435.956(b))

Current through Register Vol. 35, No. 13, July 16, 2024
A. HSD provides a reasonable opportunity
				period to individuals who have made a declaration of citizenship or
				satisfactory immigration status in accordance with
				42 CFR
				435.406, and for whom the HSD is unable to
				verify citizenship or satisfactory immigration status. During the reasonable
				opportunity period, the HSD continues efforts to complete verification of the
				individual's citizenship or satisfactory immigration status, or request
				documentation if necessary. The HSD provides notice of such opportunity that is
				accessible to persons who have limited English proficiency and individuals with
				disabilities, consistent with
				42 CFR
				435.905(b). During such
				reasonable opportunity period, the HSD must, if relevant to verification of the
				individual's citizenship or satisfactory immigration status:
(1) in the case of individuals declaring
				citizenship who do not have an SSN at the time of such declaration, assist the
				individual in obtaining an SSN in accordance with
				42 CFR
				435.910 and Parargraph (2) of Subsection A of
				8.200.410.10
				NMAC, and attempt to verify the individual's citizenship once an SSN has been
				obtained and verified;
(2) provide
				the individual with information on how to contact the electronic data source so
				that he or she can attempt to resolve any inconsistencies defeating electronic
				verification directly with such source, and pursue verification of the
				individual's citizenship or satisfactory immigration status if the individual
				or source informs the HSD that the inconsistencies have been resolved;
				and
(3) provide the individual with
				an opportunity to provide other documentation of citizenship or satisfactory
				immigration status, in accordance with section 1137(d) of the Act and
				42 CFR
				435.406 or
				435.407
				and
				8.200.410.12
				NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.200.410.14 - RESIDENCE

Current through Register Vol. 35, No. 13, July 16, 2024
To be eligible for medicaid, an applicant or eligible
				  recipient must be living in New Mexico on the date of application and final
				  determination of eligibility and have demonstrated an intention to remain in
				  the state.
A.
Establishing
				residence:
Residence is established by living in the state and carrying
				out the types of activities associated with day-to-day living, such as
				occupying a home, enrolling a child in school or getting a state driver's
				license. An applicant or recipient who is homeless is considered to have met
				the residence requirements if he or she intends to remain in the
				state.
B.
Recipients
				receiving benefits out-of-state:
An applicant or an eligible recipient
				who receives financial or medical assistance in another state which makes
				residence in that state a condition of eligibility are considered residents of
				that state until the ISD office receives verification from the other state
				agency indicating that it has been notified by an applicant or eligible
				recipient of the abandonment of residence in that state.
C.
Individuals court ordered into full
				or partial responsibility of the state children youth and families department
				(CYFD):
When CYFD places a child in a new state of residence, the new
				state of residence is responsible for the provision of medicaid; however, the
				state must provide limited medicaid coverage for medicaid services that are
				part of the state medicaid benefit package and not available in the new state
				of residence.
D.
Abandonment:
Residence is not abandoned by temporary absences.
				Temporary absences occur when an eligible recipient leaves the state for
				specific purposes with time-limited goals. Residence is considered abandoned
				when the applicant or the eligible recipient leaves the state for any of the
				following reasons:
(1) intends to establish
				residence in another state;
(2) for
				no specific purpose with no clear intention of returning;
(3) applies for financial, food or medical
				assistance in another state which makes residence in that state a condition of
				eligibility; or
(4) for more than
				30 consecutive calendar days, without notifying HSD of his or her departure or
				intention of returning.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.200.410.15 - NON-CONCURRENT RECEIPT OF ASSISTANCE

Current through Register Vol. 35, No. 13, July 16, 2024
A. An applicant or an eligible recipient
				receiving medicaid in another state is not medical assistance program eligible
				in New Mexico except when:
(1) institutional
				care medicaid begins on a specific date within the month rather than
				automatically reverting to the first day of the month, if an applicant for
				institutional care medicaid (Category 081, 083 or 084) moves to New Mexico from
				another state and it can be verified that the other state will terminate the
				individual's medicaid eligibility under that state program prior to the initial
				eligibility date in New Mexico, the application may be approved even though the
				individual receives medicaid from the other state for part of the month;
				coverage in New Mexico begins after the end date of services from the other
				state;
(2) an individual is court
				ordered into full or partial responsibility CYFD; when CYFD places a child in a
				new state of residence, the new state of residence is responsible for the
				provision of medicaid; however, New Mexico must provide limited medicaid
				coverage for medicaid services that are part of New Mexico's medicaid benefit
				package and not available in the new state of residence.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.200.410.16 - APPLICATIONS FOR OTHER BENEFITS

Current through Register Vol. 35, No. 13, July 16, 2024
As a condition of eligibility, a medicaid applicant or an
				  eligible recipient must take all necessary steps to obtain any annuities,
				  pensions, retirement, and disability benefits to which they are entitled,
				  within 30 calendar days from the date HSD furnishes notice of the potential
				  benefit, unless they can show good cause for not doing so.
A.
Benefit types:
Annuities,
				pensions, retirement and disability benefits include, but are not limited to,
				veterans' compensation and pensions, old age survivors and disability insurance
				(OASDI) benefits, railroad retirement benefits, and unemployment
				compensation.
B.
Exceptions
				to general requirement/good cause:
An individual may request a good
				cause waiver to this requirement by presenting ISD with corroborating evidence
				that:
(1) applying for other benefits is
				against the best interest of the individual, child or others, including
				physical or emotional harm to a child, parent or caregiver relative, adoption
				proceedings, and potential for emotional impairment; or
(2) exceptions applicable to institutional
				care medicaid, the SSI-related categories and the home and community based
				waivers are pursuant to Subsection B of
				8.215.500.9
				NMAC, Subsection B of
				8.281.500.9
				NMAC, and Subsection B of
				8.290.500.9
				NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.200.410.17 - INMATE IN A PUBLIC INSTITUTION

Current through Register Vol. 35, No. 13, July 16, 2024
A.
				A public institution is a:
(1) state and
				private correctional facility;
(2)
				county and privately operated jail;
(3) department of health behavioral health
				facility forensic unit;
(4)
				detention facility operated under the authority of CYFD; or
(5) facility that is operated under the
				authority of CYFD that provides for the care and rehabilitation of an
				individual who is under 18 years of age and who has committed an act that would
				be designated as a crime under the law if committed by an individual who is 18
				years of age or older.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.200.410.18 - AUTOMATIC ENROLLMENT INTO MEDICARE PART B COVERAGE

Current through Register Vol. 35, No. 13, July 16, 2024
A.  Beginning August 1, 2019, HSD
				automatically enrolls into medicare part B individuals:
(1)  who are active on a full medicaid or medicare savings program
				category of eligibility with the exception of the following categories:
(a)  other adults (COE 100);
(b)  newborn (COE 031);
(c)  children, youth and families department
				medicaid categories (COEs 017, 037, 046, 047, 066, and 086);
(d) family planning (COE 029);
(e)  pregnancy services (COE 301);
(f)  refugee (COE 049 and 059);
(g)  qualified disabled working individuals
				(COE 050);
(h)  breast and
				cervical cancer (COE 052); and
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 420 - SPECIAL RECIPIENT REQUIREMENTS › Section 8.200.420.3 - 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 NMSA 1978, Section 27-1-12 et seq.
				  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 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 420 - SPECIAL RECIPIENT REQUIREMENTS › Section 8.200.420.5 - 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 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 420 - SPECIAL RECIPIENT REQUIREMENTS › Section 8.200.420.6 - 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 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 420 - SPECIAL RECIPIENT REQUIREMENTS › Section 8.200.420.8 - 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 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 420 - SPECIAL RECIPIENT REQUIREMENTS › Section 8.200.420.9 - AGE

Current through Register Vol. 35, No. 13, July 16, 2024
For certain medicaid categories, an individual must meet
				  specified age requirements. See specific NMAC eligibility chapters for each
				  medicaid category for age requirements.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 420 - SPECIAL RECIPIENT REQUIREMENTS › Section 8.200.420.10 - SCHOOL ATTENDANCE

Current through Register Vol. 35, No. 13, July 16, 2024
School attendance is a factor in determining JUL medicaid
				  eligibility for 18 year-old applicants or re-determining recipients. School
				  attendance is not a factor in determining JUL medicaid for children under the
				  age of 18 years.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 420 - SPECIAL RECIPIENT REQUIREMENTS › Section 8.200.420.11 - DISABILITY

Current through Register Vol. 35, No. 13, July 16, 2024
For an individual applying for a specific medical assistance
				  division (MAD) category of eligibility, disability is a condition of
				  eligibility. The determination of disability is made by the disability
				  determination services unit. The social security administration's (SSA)
				  definition of disability is used for that determination.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 420 - SPECIAL RECIPIENT REQUIREMENTS › Section 8.200.420.12 - THIRD PARTY LIABILITY

Current through Register Vol. 35, No. 13, July 16, 2024
Refer to
				  8.200.430.13
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 420 - SPECIAL RECIPIENT REQUIREMENTS › Section 8.200.420.13 - MEDICAID ESTATE RECOVERY

Current through Register Vol. 35, No. 13, July 16, 2024
Refer to
				  8.200.430.20
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 430 - RECIPIENT RIGHTS AND RESPONSIBILITIES › Section 8.200.430.3 - 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 NMSA 1978, Section
				  27-1-12
				  et seq.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 430 - RECIPIENT RIGHTS AND RESPONSIBILITIES › Section 8.200.430.5 - 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 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 430 - RECIPIENT RIGHTS AND RESPONSIBILITIES › Section 8.200.430.6 - 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 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 430 - RECIPIENT RIGHTS AND RESPONSIBILITIES › Section 8.200.430.9 - RECIPIENT RIGHTS AND RESPONSIBILITIES

Current through Register Vol. 35, No. 13, July 16, 2024
A. An individual has the right to apply for
				medicaid and other health care programs HSD administers regardless of whether
				it appears he or she may be eligible.
(1)
				Income support division (ISD) determines eligibility for the medical assistance
				division's medical assistance programs (MAP), unless otherwise determined by
				another entity as stated in 8.200.400 NMAC. A decision shall be made promptly
				on applications in accordance with the timeliness standards set forth in
				8.100.130 NMAC.
(2) Individuals who
				might be eligible for supplemental security income (SSI) are referred to the
				social security administration (SSA) office to apply.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 430 - RECIPIENT RIGHTS AND RESPONSIBILITIES › Section 8.200.430.10 - FREEDOM OF CHOICE

Current through Register Vol. 35, No. 13, July 16, 2024
Except when specifically waived from MAD, an eligible
				  recipient has the freedom to obtain physical and behavioral health services
				  from a MAD provider of his or her choice.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 430 - RECIPIENT RIGHTS AND RESPONSIBILITIES › Section 8.200.430.11 - RELEASE OF INFORMATION

Current through Register Vol. 35, No. 13, July 16, 2024
By signing the MAP application, an applicant or a
				  re-determining eligible recipient gives HSD explicit consent to release
				  information to applicable state or federal agencies, physical or behavioral
				  health providers, or an HSD designee when the information is needed to provide,
				  monitor, or approve MAD services. Physical and behavioral health information is
				  confidential and is subject to the standards for confidentiality per 8.300.11
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT RULES › Part 430 - RECIPIENT RIGHTS AND RESPONSIBILITIES › Section 8.200.430.12 - RIGHT TO HEARING

Current through Register Vol. 35, No. 13, July 16, 2024
An applicant or an eligible recipient is entitled to adequate
				  notice of a HSD adverse action regarding his or her termination or
				  re-categorization of his or her MAP category of eligibility. The applicant or
				  re-determining eligible recipient has specific rights and responsibilities when
				  requesting a HSD administrative hearing. A HSD administrative hearing affords
				  the applicant or re-determining eligible recipient the opportunity to have an
				  impartial review of these decisions. See 8.352.2, 8.100.180 and 8.100.970 NMAC
				  for a detailed description of these rights, responsibilities and the HSD
				  administrative hearing process. 8.352.2 NMAC further details the rights,
				  responsibilities and the HSD administrative hearing process for other adverse
				  actions MAD, its utilization review contractor or a HSD contracted managed care
				  organization (MCO) may initiate (
				  42 CFR Section
				  431.220(a)(1)(2)
				  ).