reglab/statecodes huggingface dataset:
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 206 - MEDICAID ELIGIBILITY - CYFD CHILDREN (CATEGORIES 006, 017, 037, 046, 047, 060, 061, 066 and 086) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.206.500.14 - RESOURCE TRANSFERS

Current through Register Vol. 35, No. 13, July 16, 2024
To be eligible for CYFD Medicaid, the applicant/ recipient
				  must not have transferred resources within two years prior to application for
				  the purpose of qualifying for CYFD medicaid. An applicant/recipient under
				  eighteen years of age cannot transfer property, except through a guardian.
				  Normally, such applicants/recipients do not own property in their own right. If
				  facts indicate the existences of a trust, inheritance, or prior gift, the CYFD
				  representative completing the application must determine if a transfer has
				  taken place within the two year period.
A. Transfers made for the purpose of
				qualifying for medicaid: A transfer is considered to have been made for the
				purpose of becoming eligible if:
(1) the
				transfer was made without a reasonable return; and
(2) the applicant/recipient had no reasonable
				plan for support at the time of the transfer other than receiving CYFD
				medicaid.
(3) if the value of the
				applicant/recipient's equity in the transferred property plus all other
				countable resources is less than $1,000, the transfer is not considered to be
				for the purpose of becoming eligible.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 206 - MEDICAID ELIGIBILITY - CYFD CHILDREN (CATEGORIES 006, 017, 037, 046, 047, 060, 061, 066 and 086) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.206.500.15 - TRUSTS

Current through Register Vol. 35, No. 13, July 16, 2024
If an applicant/recipient is the beneficiary of a trust fund,
				  a copy of the trust document and any other documents pertaining to the creation
				  of the trust must be submitted to the eligibility unit of the medical
				  assistance division for coordination of the trust analysis with the HCA's
				  office of general counsel.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 206 - MEDICAID ELIGIBILITY - CYFD CHILDREN (CATEGORIES 006, 017, 037, 046, 047, 060, 061, 066 and 086) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.206.500.16 - INCOME STANDARDS

Current through Register Vol. 35, No. 13, July 16, 2024
A. To be
				eligible for CYFD medicaid, the applicant/ recipient's income must be less than
				the maximum aid to families with dependent children (AFDC) standard for one
				person. See
				8.200.520.10 NMAC,
Income
				Standards
. Any earned and unearned income that belongs to the
				applicant/recipient must be totaled and compared to the standard.
B. The authorized representative of CYFD who
				completes the medicaid application on behalf of the applicant/recipient must
				take all necessary steps to apply for or obtain any other income which the
				applicant/recipient may qualify for when the individual becomes aware of the
				income. If income becomes available to the applicant/recipient, their
				eligibility for CYFD medicaid must be re-evaluated.
C. Sources of potential income include social
				security, veterans benefits, supplement security income, trust funds, and
				contingent claims.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 206 - MEDICAID ELIGIBILITY - CYFD CHILDREN (CATEGORIES 006, 017, 037, 046, 047, 060, 061, 066 and 086) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.206.500.17 - EARNED INCOME

Current through Register Vol. 35, No. 13, July 16, 2024
A. If an
				applicant/recipient of CYFD medicaid has earned income and is not a full-time
				student in elementary school, high school, or a course of vocational or
				technical training, their earnings are considered in the earned income
				calculation.
B. Earned income
				exclusions:
(1) Exclusion for full-time
				students: If an applicant/ recipient of CYFD medicaid has earned income and is
				a full-time student in elementary school, high school, or in a course of
				vocational or technical training, their earnings are totally
				excluded.
(2) Job Training
				Partnership Act (JTPA) earnings and earned income tax credit exclusion: JTPA
				earning/ reimbursement and earned income tax credit payments are excluded from
				consideration as income regardless of whether the applicant/recipient is a
				full-time student.
(3) Work-related
				expense disregard: An applicant/recipient of CYFD medicaid with earned income
				from employment is entitled to a deduction of $90 from gross monthly earnings
				for work-related expenses.
(4)
				Census bureau employment: Wages paid by the census bureau for temporary
				employment related to the census are excluded from consideration as income in
				the eligibility determination process.
(5) Recipients of Chafee medicaid: All earned
				income of an applicant/recipient between 18 and 21 years of age is excluded
				while receiving chafee independent living assistance from CYFD.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 206 - MEDICAID ELIGIBILITY - CYFD CHILDREN (CATEGORIES 006, 017, 037, 046, 047, 060, 061, 066 and 086) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.206.500.19 - DEEMED INCOME

Current through Register Vol. 35, No. 13, July 16, 2024
Income is not deemed to an applicant/recipient from their
				  parents if the applicant/recipient is the full or partial financial
				  responsibility of CYFD. Any voluntary contributions made by the applicant/
				  recipient's parent(s) is considered as unearned income.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 206 - MEDICAID ELIGIBILITY - CYFD CHILDREN (CATEGORIES 006, 017, 037, 046, 047, 060, 061, 066 and 086) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.206.500.20 - TOTAL INCOME

Current through Register Vol. 35, No. 13, July 16, 2024
The combination of the applicant/recipient's earned income
				  and unearned income minus any applicable exclusions and disregards is compared
				  to the maximum income standard for one person to determine if the
				  applicant/recipient is eligible for CYFD medicaid.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 206 - MEDICAID ELIGIBILITY - CYFD CHILDREN (CATEGORIES 006, 017, 037, 046, 047, 060, 061, 066 and 086) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.206.500.21 - LUMP SUM PAYMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
Lump sums are considered as income in the month received and
				  resources (if retained) as of the first moment of the first day of the
				  following month.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 206 - MEDICAID ELIGIBILITY - CYFD CHILDREN (CATEGORIES 006, 017, 037, 046, 047, 060, 061, 066 and 086) › Part 600 - BENEFIT DESCRIPTION › Section 8.206.600.1 - 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 206 - MEDICAID ELIGIBILITY - CYFD CHILDREN (CATEGORIES 006, 017, 037, 046, 047, 060, 061, 066 and 086) › Part 600 - BENEFIT DESCRIPTION › Section 8.206.600.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
The rule applies to the general public.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 206 - MEDICAID ELIGIBILITY - CYFD CHILDREN (CATEGORIES 006, 017, 037, 046, 047, 060, 061, 066 and 086) › Part 600 - BENEFIT DESCRIPTION › Section 8.206.600.3 - 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 206 - MEDICAID ELIGIBILITY - CYFD CHILDREN (CATEGORIES 006, 017, 037, 046, 047, 060, 061, 066 and 086) › Part 600 - BENEFIT DESCRIPTION › Section 8.206.600.4 - DURATION

Current through Register Vol. 35, No. 13, July 16, 2024
Permanent.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 206 - MEDICAID ELIGIBILITY - CYFD CHILDREN (CATEGORIES 006, 017, 037, 046, 047, 060, 061, 066 and 086) › Part 600 - BENEFIT DESCRIPTION › Section 8.206.600.5 - 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 206 - MEDICAID ELIGIBILITY - CYFD CHILDREN (CATEGORIES 006, 017, 037, 046, 047, 060, 061, 066 and 086) › Part 600 - BENEFIT DESCRIPTION › Section 8.206.600.6 - 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 206 - MEDICAID ELIGIBILITY - CYFD CHILDREN (CATEGORIES 006, 017, 037, 046, 047, 060, 061, 066 and 086) › Part 600 - BENEFIT DESCRIPTION › Section 8.206.600.7 - DEFINITIONS [RESERVED]

Current through Register Vol. 35, No. 13, July 16, 2024
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 206 - MEDICAID ELIGIBILITY - CYFD CHILDREN (CATEGORIES 006, 017, 037, 046, 047, 060, 061, 066 and 086) › Part 600 - BENEFIT DESCRIPTION › Section 8.206.600.8 - RESERVED

Current through Register Vol. 35, No. 13, July 16, 2024
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 206 - MEDICAID ELIGIBILITY - CYFD CHILDREN (CATEGORIES 006, 017, 037, 046, 047, 060, 061, 066 and 086) › Part 600 - BENEFIT DESCRIPTION › Section 8.206.600.9 - BENEFIT DESCRIPTION

Current through Register Vol. 35, No. 13, July 16, 2024
An applicant/ recipient who is eligible for medicaid under
				  this category is eligible to receive the full range of medicaid-covered
				  services.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 206 - MEDICAID ELIGIBILITY - CYFD CHILDREN (CATEGORIES 006, 017, 037, 046, 047, 060, 061, 066 and 086) › Part 600 - BENEFIT DESCRIPTION › Section 8.206.600.10 - BENEFIT DETERMINATION

Current through Register Vol. 35, No. 13, July 16, 2024
A. A
				written signed application must be made for every approved CYFD medicaid case.
(1) For voluntary placements, the parent(s)
				or guardian(s) must complete and sign the application on behalf of the
				child.
(2) For involuntary
				placements, information should be obtained from the parents. The social worker
				from CYFD may complete and sign the application on behalf of the
				child.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 206 - MEDICAID ELIGIBILITY - CYFD CHILDREN (CATEGORIES 006, 017, 037, 046, 047, 060, 061, 066 and 086) › Part 600 - BENEFIT DESCRIPTION › Section 8.206.600.11 - INITIAL BENEFITS

Current through Register Vol. 35, No. 13, July 16, 2024
Notice of approval or denial of the application for CYFD
				  medicaid is prepared. If the applicant is ineligible, the denial notice
				  contains the reason for denial and explanation of the applicant's right to
				  request an administrative hearing.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 206 - MEDICAID ELIGIBILITY - CYFD CHILDREN (CATEGORIES 006, 017, 037, 046, 047, 060, 061, 066 and 086) › Part 600 - BENEFIT DESCRIPTION › Section 8.206.600.12 - ONGOING BENEFITS

Current through Register Vol. 35, No. 13, July 16, 2024
A periodic review to reestablish eligibility for medicaid
				  must be done every six months.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 206 - MEDICAID ELIGIBILITY - CYFD CHILDREN (CATEGORIES 006, 017, 037, 046, 047, 060, 061, 066 and 086) › Part 600 - BENEFIT DESCRIPTION › Section 8.206.600.13 - RETROACTIVE BENEFIT COVERAGE

Current through Register Vol. 35, No. 13, July 16, 2024
Up to three months of retroactive medicaid coverage can be
				  furnished to applicants who have received medicaid-covered services during the
				  retroactive period and would have met applicable eligibility criteria had they
				  applied during the three months prior to the month of application
				  42 CFR Section
				  435.914. Retroactive coverage is not
				  available prior to January 1, 1995, to applicants/ recipients of Category 060
				  and 061.
A. Application for
				retroactive benefit coverage: Application for retroactive medicaid can be made
				by checking "yes" in the "application for retroactive medicaid payments" box on
				the application/ redetermination of eligibility for medicaid assistance (MAD
				381) form or by checking "yes" to the question "Does anyone in your household
				have unpaid medical expenses in the last three months?" on the application for
				assistance (ISD 100 S) form. Applications for retroactive medicaid benefits
				must be made by 180 days from the date of application for assistance.
				Medicaid-covered services which were furnished more than two years prior to
				application are not covered.
B.
				Approval requirements: To establish retroactive eligibility, the ISS must
				verify that all conditions of eligibility were met for each of the three
				retroactive months and that the applicant received medicaid-covered services.
				Each month must be approved or denied on its own merits. Retroactive
				eligibility can be approved on either the ISD2 system (for categories
				programmed on that system) or on the retroactive medicaid eligibility
				authorization (ISD 333) form.
C.
				Notice:
(1) Notice to applicant: The
				applicant must be informed if any of the retroactive months are
				denied.
(2) Recipient
				responsibility to notify provider: After the retroactive eligibility has been
				established, the ISS must notify the recipient that they are responsible for
				informing all providers with outstanding bills of the retroactive eligibility
				determination. If the recipient does not inform all providers and furnish
				verification of eligibility which can be used for billing and the provider
				consequently does not submit the billing within 120 days from the date of
				approval of retroactive coverage, the recipient is responsible for payment of
				the bill.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 206 - MEDICAID ELIGIBILITY - CYFD CHILDREN (CATEGORIES 006, 017, 037, 046, 047, 060, 061, 066 and 086) › Part 600 - BENEFIT DESCRIPTION › Section 8.206.600.14 - CHANGES IN ELIGIBILITY

Current through Register Vol. 35, No. 13, July 16, 2024
Case closure must be effective the month following the month
				  the case ceases to meet any of the financial or non-financial eligibility
				  requirements. Case closure information must be transmitted to the medicaid
				  claims processing contractor within 30 days of closure.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 215 - MEDICAID ELIGIBILITY - SUPPLEMENT SECURITY INCOME (SSI) METHODOLOGY › Part 400 - RECIPIENT POLICIES › Section 8.215.400.3 - 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 215 - MEDICAID ELIGIBILITY - SUPPLEMENT SECURITY INCOME (SSI) METHODOLOGY › Part 400 - RECIPIENT POLICIES › Section 8.215.400.5 - 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
				  the section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 215 - MEDICAID ELIGIBILITY - SUPPLEMENT SECURITY INCOME (SSI) METHODOLOGY › Part 400 - RECIPIENT POLICIES › Section 8.215.400.6 - 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 215 - MEDICAID ELIGIBILITY - SUPPLEMENT SECURITY INCOME (SSI) METHODOLOGY › Part 400 - RECIPIENT POLICIES › Section 8.215.400.9 - SUPPLEMENTAL SECURITY INCOME METHODOLOGY

Current through Register Vol. 35, No. 13, July 16, 2024
All noninstitutionalized married couples who are eligible for
				  supplemental security income (SSI) are treated as separate individuals for
				  determining eligibility and benefit amounts, beginning the month after the
				  month they begin living apart. In the case of an initial application or
				  reinstatement following a period of ineligibility, each member of a married
				  couple not living together is considered an individual as of the date of
				  application or request for reinstatement, regardless of when the separation
				  occurred. See
Title 8, Chapter 281, Medicaid Eligibility -
				  Institutional Care
(
Categories 081, 083 and 084
), for
				  information on separation caused by the institutionalization of one member of a
				  married couple.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 215 - MEDICAID ELIGIBILITY - SUPPLEMENT SECURITY INCOME (SSI) METHODOLOGY › Part 400 - RECIPIENT POLICIES › Section 8.215.400.10 - SUPPLEMENTAL SECURITY INCOME (Categories 001, 003, and 004)

Current through Register Vol. 35, No. 13, July 16, 2024
A. The human services department (HSD) has an
				agreement under Section 1634 of the Social Security Act with the social
				security administration (SSA) for SSA to make medicaid eligibility
				determinations. Supplemental security income (SSI) recipients (categories 001,
				003, and 004) who receive an SSI cash payment or are Section 1619(b) recipients
				automatically have medicaid eligibility unless they fail to meet the assignment
				of rights or third party liability requirements; or HSD has determined
				ineligibility under the medicaid trust provision.
B.
Section 1619(b) recipients
:
				To qualify for continuing medicaid coverage, a 1619(b) individual must:
(1) have been eligible for an SSI cash
				payment for at least one month; and
(2) still meet the disability requirement;
				and
(3) still meet all other
				non-disability SSI requirements; and
(4) need medicaid benefits to continue to
				work; and
(5) have gross earnings
				that are insufficient to replace SSI, medicaid and publicly funded attendant
				care services.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 215 - MEDICAID ELIGIBILITY - SUPPLEMENT SECURITY INCOME (SSI) METHODOLOGY › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.215.500.3 - 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 215 - MEDICAID ELIGIBILITY - SUPPLEMENT SECURITY INCOME (SSI) METHODOLOGY › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.215.500.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
March 1, 2018, unless a later date is cited at the end of a
				  section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 215 - MEDICAID ELIGIBILITY - SUPPLEMENT SECURITY INCOME (SSI) METHODOLOGY › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.215.500.6 - 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 215 - MEDICAID ELIGIBILITY - SUPPLEMENT SECURITY INCOME (SSI) METHODOLOGY › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.215.500.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
Relative:
A son/daughter;
				  grandson/granddaughter; step-son/step-daughter; in-laws; mother/father;
				  step-mother/step-father; half sister/half brother; grandmother/grandfather;
				  aunt/uncle; sister/brother; step-brother/step-sister; and
				  niece/nephew.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 215 - MEDICAID ELIGIBILITY - SUPPLEMENT SECURITY INCOME (SSI) METHODOLOGY › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.215.500.8 - 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 215 - MEDICAID ELIGIBILITY - SUPPLEMENT SECURITY INCOME (SSI) METHODOLOGY › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.215.500.9 - NEED DETERMINATION

Current through Register Vol. 35, No. 13, July 16, 2024
This section describes the methodology to be used in
				  determining countable resources and income for medicaid eligibility categories
				  which use supplemental security income (SSI) methodology. Medicaid eligibility
				  is determined prospectively. Applicants/recipients must meet, or expect to
				  meet, all financial and nonfinancial eligibility criteria in the month for
				  which a determination of eligibility is made. Applicants for and recipients of
				  medicaid 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 human services department (HSD) furnishes notice of the
				  potential entitlement.
A.
Failure
				to apply for and take steps to determine eligibility for other benefits:
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.
B.
Exceptions to general
				requirement:
Applicants/recipients who have elected a lower VA payment
				do not need to reapply for veterans administration improved pension (VAIP)
				benefits. Crime victims are not required to accept victims compensation
				payments from a state-administered fund as a condition of medicaid
				eligibility.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 215 - MEDICAID ELIGIBILITY - SUPPLEMENT SECURITY INCOME (SSI) METHODOLOGY › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.215.500.11 - RESOURCE STANDARDS

Current through Register Vol. 35, No. 13, July 16, 2024
A "resource" is defined as cash or liquid assets and real or
				  personal property which is owned and can be used either directly, or by sale or
				  conversion, for the applicant/recipient's support and maintenance. Resources
				  may be liquid or non-liquid and may be excluded from the eligibility
				  determination process under certain conditions. A liquid resource is an asset
				  which can readily be converted to cash. A non-liquid resource is an asset or
				  property which cannot readily be converted to cash.
A.
Resource determination:
The
				resource determination is made as of the first moment of the first day of the
				month of application. An applicant/recipient is ineligible for any month in
				which his/her countable resources exceed the allowable resource standard as of
				the first moment of the first day of the month. Changes in the amount of
				countable resources during a month do not affect eligibility or ineligibility
				for that month.
B.
Distinguishing between resources and income:
Resources must be
				distinguished from income to avoid counting a single asset twice. As a general
				rule, ownership of a resource precedes the current month while income is
				received in the current month. Income held by an applicant/recipient until the
				following month becomes a resource.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 215 - MEDICAID ELIGIBILITY - SUPPLEMENT SECURITY INCOME (SSI) METHODOLOGY › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.215.500.12 - APPLICABLE RESOURCE STANDARDS

Current through Register Vol. 35, No. 13, July 16, 2024
The resource standard for medicaid extension as well as
				  retroactive SSI medicaid eligibility determinations is $2,000.
A.
Liquid resources:
The face
				value of liquid resources such as cash, savings or checking accounts is
				considered in determining medicaid eligibility. The countable value of
				resources such as securities, bonds, real estate contracts and promissory notes
				is based on their current fair market value.
(1) An applicant/recipient must provide
				verification of the value of all liquid resources. The resource value of a bank
				account is customarily verified by a statement from the bank showing the
				account balance as of the first moment of the first day of the month in
				question. If an applicant/recipient cannot provide this verification, the ISD
				worker sends a bank or postal savings clearance to the appropriate
				institution(s).
(2) If the
				applicant/recipient can demonstrate that a check was written and delivered to a
				payee but not cashed by the payee prior to the first moment of the first day of
				the month, the amount of that check is subtracted from the
				applicant/recipient's checking account balance to arrive at the amount to be
				considered a countable resource.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 215 - MEDICAID ELIGIBILITY - SUPPLEMENT SECURITY INCOME (SSI) METHODOLOGY › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.215.500.13 - COUNTABLE RESOURCES

Current through Register Vol. 35, No. 13, July 16, 2024
Before a resource can be considered countable, the three
				  criteria listed below must be met.
A.
Ownership interest:
An applicant/recipient must have an ownership
				interest in a resource for it to be countable. The fact that an
				applicant/recipient has access to a resource, or has a legal right to use it,
				does not make it countable unless the applicant/recipient also has an ownership
				interest in it.
B.
Legal
				right to convert resource to cash:
An applicant/recipient must have the
				legal ability to spend the funds or to convert non-cash resources into cash.
(1)
Physical possession of
				resource:
The fact that an applicant/recipient does not have physical
				possession of a resource does not mean it is not his/her resource. If he/she
				has the legal ability to spend the funds or convert the resource to cash, the
				resource is considered countable. Physical possession of savings bonds is a
				legal requirement for cashing them.
(2)
Unrestricted use of
				resource:
An applicant/recipient is considered to have free access to
				the unrestricted use of a resource even if he/she can take those actions only
				through an agent, such as a representative payee or guardian.
(3) If there is a legal bar to the sale of a
				resource, the resource is not countable. If the co-owner of real property can
				bring an action to partition and sell the property, his/her interest in the
				property is a countable resource.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 215 - MEDICAID ELIGIBILITY - SUPPLEMENT SECURITY INCOME (SSI) METHODOLOGY › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.215.500.15 - ASSET TRANSFERS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Transfers of assets for less than fair market value
by SSI
				applicants/recipients are considered only if/when an applicant/recipient
				becomes institutionalized. For medicaid categories using SSI resource
				determination methodology, transfers by non-institutionalized
				applicants/recipients are not considered a factor of eligibility.
B.
Transfer of resources by an SSI
				recipient:
An institutionalized SSI applicant/recipient who transfers
				resources without fair return may become ineligible for medicaid coverage of
				nursing home care for a specified period of time. See Section
				8.281.500.14 NMAC
				and following subsections for information on resource transfer policies and
				penalties applicable to institutionalized applicants/recipients.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 215 - MEDICAID ELIGIBILITY - SUPPLEMENT SECURITY INCOME (SSI) METHODOLOGY › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.215.500.17 - DEEMING RESOURCES

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Deeming resources when an applicant/recipient lives with an ineligible
				spouse:
If an eligible noninstitutionalized applicant/recipient lives in
				the same household with an ineligible spouse, the resources of the ineligible
				spouse are considered to belong to the applicant/recipient. The resource
				standard for a couple applies.
B.
Deeming resources for minor applicant living with ineligible
				parent(s):
If an applicant/recipient is a minor under 18 years of age,
				the resources of the parent(s) are deemed to the applicant/recipient if the
				parent(s) live in the same household.
(1)
Computing deemed resources:
To determine the amount of resources
				deemed to an applicant/recipient who is a minor, the following computation is
				made:
(a) determine the parent(s)
				resources;
(b) allow the parent(s)
				all the resource exclusions that an applicant/recipient receives; and
(c) remaining resources in excess of two
				thousand dollars ($2,000) for one parent or three thousand dollars ($2,000) for
				two parents are deemed to the eligible minor.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 215 - MEDICAID ELIGIBILITY - SUPPLEMENT SECURITY INCOME (SSI) METHODOLOGY › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.215.500.18 - INCOME

Current through Register Vol. 35, No. 13, July 16, 2024
A. An
				applicant/recipient's gross countable monthly income must be less than the
				maximum allowable monthly standard for the applicable medicaid category. Income
				may be in the form of cash, checks, money orders, or in-kind, including
				personal property or food. If income is not received in the form of cash, the
				cash value of the item is determined and counted as income. Income is counted
				in the month received. Income is considered available throughout the month,
				regardless of when in the month it is received. The ISD worker verifies and
				documents all income.
B.
Types of income:
Countable income is the sum of unearned income or
				earned income, less disregards or exclusions, plus deemed income.
(1)
Earned income:
Earned income
				consists of the total gross income received by an individual for services
				performed as an employee or as a result of self-employment.
(a) Royalties earned in connection with the
				publication of the applicant/recipient's work and any honorarium/fees received
				for services rendered are considered earned income.
(b) The self-employed applicant/recipient
				must provide an estimate of his/her current income based on the tax return
				filed for the previous year or current records maintained in the regular course
				of business. The estimate of net earnings for the entire previous taxable year
				is prorated equally among all months of the current year, even if the business
				is seasonal.
(i) Consideration is given to the
				applicant/recipient's explanation as to why he/she believes the estimated net
				earnings for the current year vary substantially from the information shown on
				his/her tax return for past years.
(ii) A satisfactory explanation is that the
				business suffered heavy loss or damage from fire, flood, burglary, serious
				illness or disability of the owner, or other such catastrophic events.
				Documentation must include copies of newspaper accounts or medical reports and
				must be filed in the case record to substantiate the need for a reduced
				estimate of current self-employment income.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 215 - MEDICAID ELIGIBILITY - SUPPLEMENT SECURITY INCOME (SSI) METHODOLOGY › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.215.500.19 - INCOME STANDARDS

Current through Register Vol. 35, No. 13, July 16, 2024
See 8.200.520 NMAC and following subsections for income
				  standards applicable to the SSI-related medicaid categories.
A.
Income exclusions:
Income
				exclusions are applied before income disregards. Exclusions are applied in
				determining eligibility whether the income belongs to the applicant/recipient
				or to an individual from whom income is deemed.
B.
Infrequent or irregular
				income:
Exclude the first thirty dollars ($30) per calendar quarter of
				earned income; and the first sixty dollars ($60) per calendar quarter of
				unearned income. The following definitions apply.
(1) "Irregular income" is income received on
				an unscheduled or unpredictable basis.
(2) "Infrequent income" is income received
				only once during a calendar quarter from a single source and includes:
(a) proceeds of life insurance
				policies;
(b) prizes and
				awards;
(c) gifts;
(d) support and alimony;
(e) inheritances;
(f) interest per account, and
				royalties;
(g) one-time lump sum
				payments, such as social security or retroactive SSI.
(3) "Frequency" is evaluated for the calendar
				quarter (i.e., January - March, April - June, July - September, October -
				December) but the dollar amount is considered in the month received.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 215 - MEDICAID ELIGIBILITY - SUPPLEMENT SECURITY INCOME (SSI) METHODOLOGY › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.215.500.20 - UNEARNED INCOME

Current through Register Vol. 35, No. 13, July 16, 2024
A. Unearned
				income includes all income not earned in the course of employment or
				self-employment.
B. Income paid to
				one spouse is considered the income of that spouse. One-half the total income
				paid to a couple is considered available to each member of the couple.
(1) If payment is made in the name of either
				or both spouses and another party, only the applicant/recipient's proportionate
				share is considered available to him/her.
(2) If income is derived from property for
				which ownership is not established, such as unprobated property, one-half of
				the income is considered available to each member of a married
				couple.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 215 - MEDICAID ELIGIBILITY - SUPPLEMENT SECURITY INCOME (SSI) METHODOLOGY › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.215.500.21 - DEEMED INCOME

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Availability:
Deemed income is income which must be considered
				available to members of an assistance unit regardless of whether the income is
				actually made available.
B.
Situations in which deeming occurs:
For household member(s) who
				are not members of the assistance unit but who have a support obligation to the
				assistance unit member(s), income can only be deemed from a parent(s) to
				his/her minor child(ren) who live in the same household and from one spouse to
				the other when both live in the same household.
C.
Parent or spouse receiving benefits
				based on economic need:
In a deeming situation where one parent or the
				spouse is receiving a needs benefit, the benefit plus all of the income of the
				spouse/parent who receives the benefit is excluded from the deeming process.
				This exclusion applies only to the income of the individual who receives the
				benefit.
(1)
Needs benefit
				defined:
"Needs benefit" is any benefit or assistance which is paid by a
				governmental agency on the basis of economic need.
(2)
Consideration of household
				membership:
Even if the income of one parent is excluded from the
				deeming process, the parent is considered a member of the household for
				purposes of determining the parental allocation. This does not apply to
				benefits received under the temporary assistance to needy families (TANF)
				program. No income is allocated to a parent or child if that parent or child is
				receiving TANF assistance.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 215 - MEDICAID ELIGIBILITY - SUPPLEMENT SECURITY INCOME (SSI) METHODOLOGY › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.215.500.23 - INCOME STANDARD

Current through Register Vol. 35, No. 13, July 16, 2024
When computing an applicant/recipient's eligibility, the
				  applicable income standard is that of the SSI-related category being applied
				  for/received. See Section 8.200.520 NMAC and following subsections.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 215 - MEDICAID ELIGIBILITY - SUPPLEMENT SECURITY INCOME (SSI) METHODOLOGY › Part 600 - BENEFIT DESCRIPTION › Section 8.215.600.3 - 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 215 - MEDICAID ELIGIBILITY - SUPPLEMENT SECURITY INCOME (SSI) METHODOLOGY › Part 600 - BENEFIT DESCRIPTION › Section 8.215.600.5 - 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 215 - MEDICAID ELIGIBILITY - SUPPLEMENT SECURITY INCOME (SSI) METHODOLOGY › Part 600 - BENEFIT DESCRIPTION › Section 8.215.600.6 - 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 215 - MEDICAID ELIGIBILITY - SUPPLEMENT SECURITY INCOME (SSI) METHODOLOGY › Part 600 - BENEFIT DESCRIPTION › Section 8.215.600.9 - GENERAL BENEFIT COVERAGE

Current through Register Vol. 35, No. 13, July 16, 2024
Medicaid coverage for services based on determinations made
				  using the SSI methodology varies based on the category of eligibility. For
				  applicants/recipients who are eligible for SSI, full medicaid coverage for
				  services is available. If applicants/recipients are eligible for medicare
				  coverage, medicaid covers medicare premium amounts.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 215 - MEDICAID ELIGIBILITY - SUPPLEMENT SECURITY INCOME (SSI) METHODOLOGY › Part 600 - BENEFIT DESCRIPTION › Section 8.215.600.10 - SSI 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 215 - MEDICAID ELIGIBILITY - SUPPLEMENT SECURITY INCOME (SSI) METHODOLOGY › Part 600 - BENEFIT DESCRIPTION › Section 8.215.600.11 - CHANGES IN ELIGIBILITY

Current through Register Vol. 35, No. 13, July 16, 2024
A case is closed, with provision of advance notice when the
				  recipient becomes ineligible. If a recipient dies, the case is closed the
				  following month.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 231 - MEDICAID ELIGIBILITY - INFANTS OF MOTHERS WHO ARE MEDICAID OR MEDICAL ASSISTANCE PROGRAM ELIGIBLE › Part 400 - RECIPIENT POLICIES › Section 8.231.400.1 - 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 231 - MEDICAID ELIGIBILITY - INFANTS OF MOTHERS WHO ARE MEDICAID OR MEDICAL ASSISTANCE PROGRAM ELIGIBLE › Part 400 - RECIPIENT POLICIES › Section 8.231.400.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
The rule applies to the general public.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 231 - MEDICAID ELIGIBILITY - INFANTS OF MOTHERS WHO ARE MEDICAID OR MEDICAL ASSISTANCE PROGRAM ELIGIBLE › Part 400 - RECIPIENT POLICIES › Section 8.231.400.3 - 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 231 - MEDICAID ELIGIBILITY - INFANTS OF MOTHERS WHO ARE MEDICAID OR MEDICAL ASSISTANCE PROGRAM ELIGIBLE › Part 400 - RECIPIENT POLICIES › Section 8.231.400.5 - 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 231 - MEDICAID ELIGIBILITY - INFANTS OF MOTHERS WHO ARE MEDICAID OR MEDICAL ASSISTANCE PROGRAM ELIGIBLE › Part 400 - RECIPIENT POLICIES › Section 8.231.400.6 - 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 231 - MEDICAID ELIGIBILITY - INFANTS OF MOTHERS WHO ARE MEDICAID OR MEDICAL ASSISTANCE PROGRAM ELIGIBLE › Part 400 - RECIPIENT POLICIES › Section 8.231.400.8 - 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 231 - MEDICAID ELIGIBILITY - INFANTS OF MOTHERS WHO ARE MEDICAID OR MEDICAL ASSISTANCE PROGRAM ELIGIBLE › Part 400 - RECIPIENT POLICIES › Section 8.231.400.9 - NEWBORN - CATEGORY 031

Current through Register Vol. 35, No. 13, July 16, 2024
The New Mexico medicaid program covers infants for 13 months
				  born to mothers who are eligible for and receiving New Mexico medicaid at the
				  time of the child's birth including during a period of retroactive eligibility.
				  Mothers eligible to receive emergency medical services for non-citizens (EMSNC)
				  at the time of labor and delivery are considered to meet the standard of
				  medicaid eligibility for the mother.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 231 - MEDICAID ELIGIBILITY - INFANTS OF MOTHERS WHO ARE MEDICAID OR MEDICAL ASSISTANCE PROGRAM ELIGIBLE › Part 400 - RECIPIENT POLICIES › Section 8.231.400.10 - BASIS FOR DEFINING THE GROUP (42 CFR 435.177)

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Eligibility:
HSD provides
				medicaid to children from birth through the month of the child's first birthday
				without application if, for the date of the child's birth, the child's mother
				was eligible for and received covered services under:
(1) the medicaid state plan (including during
				a period of retroactive eligibility under
				42 CFR 435.915)
				regardless of whether payment for services for the mother is limited to
				services necessary to treat an emergency medical condition, as defined in
				section 1903(v)(3) of the Act and 8.285.400.10 NMAC under the emergency medical
				services for non-citizens (EMSNC) program.
(2) the child is deemed to have applied and
				been determined eligible under the medicaid state plan effective as of the date
				of birth, and remains eligible regardless of changes in circumstances through
				the month of the child's first birthday, unless the child dies or ceases to be
				a resident of the state or the child's representative requests a voluntary
				termination of eligibility.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 231 - MEDICAID ELIGIBILITY - INFANTS OF MOTHERS WHO ARE MEDICAID OR MEDICAL ASSISTANCE PROGRAM ELIGIBLE › Part 400 - RECIPIENT POLICIES › Section 8.231.400.11 - GENERAL RECIPIENT REQUIREMENTS: [RESERVED]

Current through Register Vol. 35, No. 13, July 16, 2024
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 231 - MEDICAID ELIGIBILITY - INFANTS OF MOTHERS WHO ARE MEDICAID OR MEDICAL ASSISTANCE PROGRAM ELIGIBLE › Part 400 - RECIPIENT POLICIES › Section 8.231.400.12 - USE OF SOCIAL SECURITY NUMBER

Current through Register Vol. 35, No. 13, July 16, 2024
The infant is not required to have a social security number
				  as a condition of eligibility.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 231 - MEDICAID ELIGIBILITY - INFANTS OF MOTHERS WHO ARE MEDICAID OR MEDICAL ASSISTANCE PROGRAM ELIGIBLE › Part 400 - RECIPIENT POLICIES › Section 8.231.400.13 - CITIZENSHIP

Current through Register Vol. 35, No. 13, July 16, 2024
An eligible newborn is considered to have met the citizenship
				  and identity requirements.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 231 - MEDICAID ELIGIBILITY - INFANTS OF MOTHERS WHO ARE MEDICAID OR MEDICAL ASSISTANCE PROGRAM ELIGIBLE › Part 400 - RECIPIENT POLICIES › Section 8.231.400.14 - RESIDENCE

Current through Register Vol. 35, No. 13, July 16, 2024
To be eligible for medicaid, an applicant/recipient must be
				  physically present in New Mexico on the date of application or final
				  determination of eligibility and must have demonstrated intent to remain in the
				  state. A temporary absence from the state does not prevent eligibility. A
				  temporary absence exists if the applicant/recipient leaves the state for a
				  specific purpose with a time-limited goal, and intends to return to New Mexico
				  when the purpose is accomplished.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 231 - MEDICAID ELIGIBILITY - INFANTS OF MOTHERS WHO ARE MEDICAID OR MEDICAL ASSISTANCE PROGRAM ELIGIBLE › Part 400 - RECIPIENT POLICIES › Section 8.231.400.15 - SPECIAL RECIPIENT RESPONSIBILITIES: [RESERVED]

Current through Register Vol. 35, No. 13, July 16, 2024