reglab/statecodes huggingface dataset:
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 290 - MEDICAID ELIGIBILITY - HOME AND COMMUNITY-BASED SERVICES WAIVER (CATEGORIES 090, 091, 092, 093, 094, 095 AND 096) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.290.500.23 - POST ELIGIBILITY/MEDICAL CARE CREDIT

Current through Register Vol. 35, No. 13, July 16, 2024
There are no medical care credits in the waiver programs. The
				  applicant/recipient is allowed to keep all of their income to maintain their
				  household in the community.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 290 - MEDICAID ELIGIBILITY - HOME AND COMMUNITY-BASED SERVICES WAIVER (CATEGORIES 090, 091, 092, 093, 094, 095 AND 096) › Part 600 - BENEFIT DESCRIPTION › Section 8.290.600.1 - 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 290 - MEDICAID ELIGIBILITY - HOME AND COMMUNITY-BASED SERVICES WAIVER (CATEGORIES 090, 091, 092, 093, 094, 095 AND 096) › Part 600 - BENEFIT DESCRIPTION › Section 8.290.600.2 - 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 290 - MEDICAID ELIGIBILITY - HOME AND COMMUNITY-BASED SERVICES WAIVER (CATEGORIES 090, 091, 092, 093, 094, 095 AND 096) › Part 600 - BENEFIT DESCRIPTION › Section 8.290.600.3 - 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 (HCA) pursuant to state statute. See Section 27-2-12
et
				  seq.
, NMSA 1978. Section 9-8-1 et seq. NMSA 1978 establishes the 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 290 - MEDICAID ELIGIBILITY - HOME AND COMMUNITY-BASED SERVICES WAIVER (CATEGORIES 090, 091, 092, 093, 094, 095 AND 096) › Part 600 - BENEFIT DESCRIPTION › Section 8.290.600.4 - DURATION

Current through Register Vol. 35, No. 13, July 16, 2024
Permanent.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 290 - MEDICAID ELIGIBILITY - HOME AND COMMUNITY-BASED SERVICES WAIVER (CATEGORIES 090, 091, 092, 093, 094, 095 AND 096) › Part 600 - BENEFIT DESCRIPTION › Section 8.290.600.5 - 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 290 - MEDICAID ELIGIBILITY - HOME AND COMMUNITY-BASED SERVICES WAIVER (CATEGORIES 090, 091, 092, 093, 094, 095 AND 096) › Part 600 - BENEFIT DESCRIPTION › Section 8.290.600.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of this rule is to provide eligibility criteria
				  for the medical assistance division (MAD) programs.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 290 - MEDICAID ELIGIBILITY - HOME AND COMMUNITY-BASED SERVICES WAIVER (CATEGORIES 090, 091, 092, 093, 094, 095 AND 096) › Part 600 - BENEFIT DESCRIPTION › Section 8.290.600.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
See Section
				  8.290.400.7
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 290 - MEDICAID ELIGIBILITY - HOME AND COMMUNITY-BASED SERVICES WAIVER (CATEGORIES 090, 091, 092, 093, 094, 095 AND 096) › Part 600 - BENEFIT DESCRIPTION › Section 8.290.600.8 - RESERVED

Current through Register Vol. 35, No. 13, July 16, 2024
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 290 - MEDICAID ELIGIBILITY - HOME AND COMMUNITY-BASED SERVICES WAIVER (CATEGORIES 090, 091, 092, 093, 094, 095 AND 096) › Part 600 - BENEFIT DESCRIPTION › Section 8.290.600.9 - BENEFIT DESCRIPTION

Current through Register Vol. 35, No. 13, July 16, 2024
Eligible recipients are eligible for specified services
				  available under the particular waiver and ancillary services available under
				  the general medicaid program. See specific program policy sections for covered
				  services.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 290 - MEDICAID ELIGIBILITY - HOME AND COMMUNITY-BASED SERVICES WAIVER (CATEGORIES 090, 091, 092, 093, 094, 095 AND 096) › Part 600 - BENEFIT DESCRIPTION › Section 8.290.600.10 - BENEFIT DETERMINATION

Current through Register Vol. 35, No. 13, July 16, 2024
Application for the waiver programs is made using the HSD
				  100 application. Upon notification by the appropriate program manager that an
				  unduplicated recipient (UDR) is available for waiver services, applicants are
				  registered on the income support division (ISD) eligibility system.
				  Applications must be acted upon and notice of approval, denial, or delay sent
				  out within 45 calendar days from the date of application, or within 90 calendar
				  days if a disability determination is required from the disability
				  determination unit (DDU). The eligible recipients must assist in completing the
				  application, may complete the form themselves, or may receive help from a
				  relative, friend, guardian, or other designated representative.
A.
Representatives applying on behalf
				of individuals:
If a representative makes application on behalf of the
				eligible recipient, that representative will continue to be relied upon for
				information regarding the eligible recipient's circumstances. The ISD
				caseworker will send all notices to the eligible recipient in care of the
				representative.
B.
Additional
				forms:
The following forms are also required as part of the application
				process:
(1) the eligible recipient or
				representative must complete and sign the primary freedom of choice (PFOC) form
				at the time of allocation; and
(2)
				the eligible recipient or representative must sign the applicant's statement of
				understanding at the time waiver services are declined or terminated.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 290 - MEDICAID ELIGIBILITY - HOME AND COMMUNITY-BASED SERVICES WAIVER (CATEGORIES 090, 091, 092, 093, 094, 095 AND 096) › Part 600 - BENEFIT DESCRIPTION › Section 8.290.600.11 - INITIAL BENEFITS

Current through Register Vol. 35, No. 13, July 16, 2024
A. The
				application process begins once the letter of allocation and the medicaid
				application for assistance are received by ISD. Once ISD has confirmed the
				applicant/recipient meets all eligibility criteria, the application can be
				approved effective the first month for which an approved level of care has been
				established. Medicaid eligibility covers acute and ancillary medicaid services
				that are effective immediately on the first day of the first month of medicaid
				eligibility. Home and community-based waiver services are prospective and are
				only available once the individual services plan (ISP) or comprehensive care
				plan (CCP) is approved and implemented. Following initial approval, waiver
				services must be provided when appropriate to eligible waiver recipients within
				90 calendar days of approval. Medicaid eligibility under the waiver program is
				contingent on the receipt of waiver services. If an applicant/recipient is
				transitioning from one home and community-based services (HCBS) waiver program
				to another, ISD must be contacted to coordinate the start date based on the
				month the ISP or CCP is established for the new program. This is to ensure
				there is no interruption in services for the recipient.
B.
Notice of determination:
Applicants determined to be ineligible for waiver services are notified of the
				reason for the denial and provided with an explanation of appeal
				rights.
C. Applicants determined to
				be eligible for waiver services are notified of the approval.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 290 - MEDICAID ELIGIBILITY - HOME AND COMMUNITY-BASED SERVICES WAIVER (CATEGORIES 090, 091, 092, 093, 094, 095 AND 096) › Part 600 - BENEFIT DESCRIPTION › Section 8.290.600.12 - ONGOING BENEFITS

Current through Register Vol. 35, No. 13, July 16, 2024
A. A
				complete redetermination of eligibility must be performed annually by the ISD
				caseworker for each open case.
B.
				Level of care determinations are made by the utilization review contractor or a
				member's selected or assigned managed care organization, as applicable to the
				centennial care, community benefit program. Level of care reviews are required
				to be completed at least annually except for certain community benefit members
				whose chronic condition is not expected to improve. These individuals may be
				eligible for an ongoing nursing facility (NF) level of care (LOC). To qualify
				for ongoing NF LOC, the community benefit member must have met a NF LOC for the
				previous three years. The ongoing NF LOC status must be reviewed and approved
				annually by the managed care organization's medical director and must be
				supported in documentation by the member's physician. The complete criteria for
				an ongoing NF LOC can be found in the New Mexico medicaid nursing facility
				level of care criteria and instructions document.
C.
90 day reconsideration
				period
: HSD will reconsider in a timely manner the waiver eligibility of
				an individual who is terminated for failure to submit the renewal form or
				necessary information, if the individual subsequently submits the renewal form
				within 90 days after the date of termination without requiring a new
				application per 42 CFR 435.916(C)(iii).
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 290 - MEDICAID ELIGIBILITY - HOME AND COMMUNITY-BASED SERVICES WAIVER (CATEGORIES 090, 091, 092, 093, 094, 095 AND 096) › Part 600 - BENEFIT DESCRIPTION › Section 8.290.600.13 - RETROACTIVE BENEFITS

Current through Register Vol. 35, No. 13, July 16, 2024
Eligibility for these categories is prospective so
				  retroactive coverage is not available in accordance with
				  8.200.400.14
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 290 - MEDICAID ELIGIBILITY - HOME AND COMMUNITY-BASED SERVICES WAIVER (CATEGORIES 090, 091, 092, 093, 094, 095 AND 096) › Part 600 - BENEFIT DESCRIPTION › Section 8.290.600.14 - CHANGES IN ELIGIBILITY

Current through Register Vol. 35, No. 13, July 16, 2024
If the eligible recipient ceases to meet any of the
				  eligibility criteria, the case is closed following provision of advance notice
				  as appropriate. See Section
				  8.200.430.9
				  NMAC and following subsections for information about notices and hearing
				  rights.
A.
Non-provision of
				waiver services:
To continue to be eligible for waiver services, an
				eligible recipient must be receiving waiver services, early and periodic
				screening, diagnostic and treatment (EPSDT) benefits or managed care services,
				other than case management, ( 42 CFR Section 435.217 ). If at any time waiver
				services are no longer being provided (e.g., a suspension) and are not expected
				to be provided for 90 consecutive days, the recipient is
ineligible
for the waiver category and the case must be closed
				after appropriate notice is provided by the ISD caseworker.
B.
Admission to a hospital, nursing
				facility, or intermediate care facility for individuals with intellectual
				disabilities (ICF-IID):
If an eligible waiver recipient enters an acute
				care hospital, a nursing facility, or an ICF-IID and remains for more than 90
				consecutive days, the waiver case must be closed and an application for
				institutional care medicaid (ICM) must be processed. The eligible recipient is
				not required to complete a new application if the periodic review on the waiver
				case is not due in either the month of entry into the institution or the
				following month. If the waiver recipient is institutionalized within less than
				90 consecutive days and still receives waiver services within that time frame,
				the waiver case is not closed and an application for ICM need not be
				processed.
C.
Reporting
				changes in circumstances:
The primary responsibility for reporting
				changes in the eligible recipient's circumstances rests with the eligible
				recipient or his/her representative. At the initial eligibility determination
				and all on-going eligibility redeterminations, the ISD caseworker must explain
				the reporting responsibilities requirement to the eligible recipient or his/her
				representative and document that such explanation was given. In the event that
				waiver services cease to be provided, the case manager or the waiver program
				manager (or designee) must immediately notify the income support division
				office of that fact by telephone. The telephone call is to be followed by a
				written notice to the ISD caseworker.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 400 - ELIGIBILITY REQUIREMENTS › Section 8.291.400.3 - 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 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 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 400 - ELIGIBILITY REQUIREMENTS › Section 8.291.400.5 - 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 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 400 - ELIGIBILITY REQUIREMENTS › Section 8.291.400.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of this rule is to provide eligibility
				  guidelines when determining eligibility for the medical assistance division
				  (MAD) medicaid program and other health care programs it administers. Processes
				  for establishing and maintaining this category of eligibility are found in the
				  affordable care general provision chapter located at 8.291.400 NMAC through
				  8.291.430 NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 400 - ELIGIBILITY REQUIREMENTS › Section 8.291.400.8 - 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 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 400 - ELIGIBILITY REQUIREMENTS › Section 8.291.400.9 - LEGAL BASIS

Current through Register Vol. 35, No. 13, July 16, 2024
HSD is the single state agency designated to administer the
				  New Mexico Title XIX medicaid program in accordance with
				  42 CFR
				  431.10, single state agency. State authority
				  is provided by Section
				  27-2-12
				  NMSA 1978 (Repl. 1984). Title XIX of the Social Security Act and United States
				  department of health and human services rules establish the requirements for
				  state plans for medical assistance.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 400 - ELIGIBILITY REQUIREMENTS › Section 8.291.400.10 - BASIS FOR DEFINING GROUP

Current through Register Vol. 35, No. 13, July 16, 2024
Medicaid is a federally matched program that makes certain
				  essential health care services available to eligible New Mexico residents who
				  otherwise would not have the financial resources to obtain them. With certain
				  exceptions, medicaid benefits are provided through the department's medicaid
				  managed care program.
A. Requirements
				outlined in 8.291.400 through 8.298.600 NMAC provides eligibility requirements
				for the ACA related categories listed below.
B. ACA related categories include the
				following:
(1) other adult;
(2) parent caretaker;
(3) pregnant women;
(4) pregnancy-related services;
(5) children under 19 years of age;
(6) adult caretaker recipients who are in
				transition to self-support due to the amount of spousal support; and
(7) adult caretaker recipients who are in
				transition to self-support due to the amount of earned income.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 400 - ELIGIBILITY REQUIREMENTS › Section 8.291.400.11 - 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 8.291.400.11 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 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 400 - ELIGIBILITY REQUIREMENTS › Section 8.291.400.12 - REPORTING REQUIREMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
A medicaid eligible recipient is required to report certain
				  changes which might affect their eligibility to ISD within 10 calendar days
				  from the date the change occurred. A timely change that is reported within 10
				  calendar days that may result in a more beneficial medicaid eligibility
				  category shall be evaluated in the month the change occurred. An untimely
				  change that is reported after 10 calendar days that may result in a more
				  beneficial medicaid eligibility category shall be evaluated in the month the
				  change was reported. A reported change that does not result in the same or a
				  more beneficial medicaid category is considered an adverse action and is
				  applied prospectively in accordance with
				  8.100.180.10
				  NMAC. See
				  8.100.110.9
				  NMAC for the various ways applicants and recipients can submit changes to the
				  HSD. The following changes must be reported to ISD:
A. living arrangements or change of address:
				any change in where an individual lives or receives mail must be
				reported;
B. household size: any
				change in the household size must be reported, this includes the death of an
				individual included in the assistance unit or budget group;
C. enumeration: any new social security
				number must be reported; or
D.
				income: any increase or decrease in the amount of income or change in the
				source of income must be reported.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 400 - ELIGIBILITY REQUIREMENTS › Section 8.291.400.13 - PRESUMPTIVE ELIGIBILITY

Current through Register Vol. 35, No. 13, July 16, 2024
Presumptive eligibility (PE) provides medicaid benefits
				  under one of the eligible groups outlined in Subsection B of
				  8.291.400.10
				  NMAC, starting with the date of the PE determination and ending with the last
				  day of the following month or, if an ongoing application is submitted at the
				  time the PE is granted or at any time during the approved PE period, the PE
				  will remain open until the ongoing application is approved or denied.
A. Only one PE approval is allowed per
				pregnancy or per 12-month period for other ACA related categories.
B. Determinations can only be made by
				individuals employed by eligible entities and certified as presumptive
				eligibility determiners (PEDs) by the medical assistance division (MAD).
(1) Processing PE information: PEDs must
				notify MAD within 24 hours of the determination of presumptive
				eligibility.
(2) PE: The PED must
				process the presumptive eligibility and encourage clients to submit an ongoing
				application for medicaid eligibility. If the client elects to do so, the PED
				must assist the client with the submission of an application for medical
				assistance.
(3) Provider
				eligibility: Entities who may participate in the PE program must be:
(a) a qualified hospital that participates as
				a provider under the medicaid state plan or a medicaid 1115 demonstration who
				notifies the medicaid agency of its election to make presumptive eligibility
				determinations and agrees to make PE determinations consistent with state
				policies and procedures; or
(b) an
				entity or provider that has not been disqualified by the medicaid agency for
				failure to make PE determinations in accordance with applicable state policies
				and procedures or for failure to meet any standards that may have been
				established by the medicaid agency; or
(c) a federally qualified health center
				(FQHC), an Indian health service (IHS) facility, a state of New Mexico agency,
				a school, or a head start agency or a primary care provider who is contracted
				with at least one HSD contracted MCO; or
(d) other entities HSD has determined as an
				eligible presumptive participant.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 400 - ELIGIBILITY REQUIREMENTS › Section 8.291.400.14 - PREGNANT INDIVIDUALS ELIGIBLE FOR EXTENDED OR CONTINUOUS ELIGIBILITY (42 CFR 435.170)

Current through Register Vol. 35, No. 13, July 16, 2024
A.
				Extended eligibility for pregnant individuals: For a pregnant individual who
				was eligible and enrolled for mandatory or optional coverage under the state
				plan on the date their pregnancy ends (regardless of the reason the pregnancy
				ends), HSD provides full medicaid coverage through the last day of the month in
				which the 12-month postpartum period ends.
B. Continuous eligibility for pregnant
				individuals: For a pregnant individual who was eligible and enrolled for
				mandatory or optional coverage under the state plan and who, because of a
				change in circumstance (e.g., income, household, composition, aging out etc.),
				will not otherwise remain eligible, HSD provides full medicaid coverage through
				the last day of the month in which the 12-month postpartum period ends.
(1) The following populations are provided
				continuous eligibility effective April 1, 2022:
(a) Current medicaid recipients who are
				pregnant as of April 1, 2022 or who enroll based on pregnancy or become
				pregnant after April 1, 2022.
(b)
				Current medicaid recipients who are receiving medicaid while pregnant and who
				are no longer pregnant as of April 1, 2022, but who are still within a 12-month
				postpartum period; and
(c)
				Individuals who apply for medicaid after their pregnancy ends, who received
				medicaid-covered services while pregnant on or after April 1, 2022 if such
				services were received during an approved period of retroactive
				eligibility.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.291.410.3 - 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 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 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.291.410.5 - 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 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.291.410.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of this rule is to provide eligibility
				  guidelines when determining eligibility for the medical assistance division
				  (MAD) medical assistance programs (MAP) and other health care programs it
				  administers. Processes for establishing and maintaining this category of
				  eligibility are found in the affordable care general provision chapter located
				  at 8.291.400 NMAC through 8.291.430 NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.291.410.9 - GENERAL RECIPIENT REQUIREMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
To be eligible for MAP, applicants or recipients must meet
				  specific requirements as outlined in this part.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.291.410.10 - USE OF SOCIAL SECURITY NUMBER

Current through Register Vol. 35, No. 13, July 16, 2024
Refer to
				  8.200.410.10
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.291.410.11 - AGE

Current through Register Vol. 35, No. 13, July 16, 2024
The age of the applicant recipient is verified to determine
				  if he or she is under or over the specified age limit.
A. Age of child: Verification of age,
				including self-attestation of an applicant or recipient under 21 years of age
				is mandatory for MAP enrollment.
B.
				Age of adults: Age of an applicant or recipient 21 years of age or older is
				verified if questionable.
C.
				Documents that can be used to verify age can be found in 8.100.130
				NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.291.410.12 - RELATIONSHIP

Current through Register Vol. 35, No. 13, July 16, 2024
Verification of relationship is mandatory, see
				  8.291.410.20
				  NMAC
A. Documents that can be used to
				verify relationship can be found at 8.100.130 NMAC.
B. The documentary evidence must contain the
				names of related individuals in question.
(1)
				If the relative is other than a parent, the relationship must be traced if
				questionable.
(2) In situations in
				which both parents are living in the home and the father's paternity has not
				been established by operation of law or determined through court order, it will
				be necessary to establish the relationship of the applicant or recipient under
				21 years of age to the father by completion of the HSD child support
				enforcement division (CSED) acknowledgment of paternity packet.
(3) If the child is living with a relative,
				it will be necessary to establish the relationship of the absent parents. A
				CSED acknowledgement of paternity will be an acceptable means of establishing
				relationship.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.291.410.14 - CITIZENSHIP/ALIEN STATUS

Current through Register Vol. 35, No. 13, July 16, 2024
Refer to
				  8.200.410.12
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.291.410.15 - RESIDENCE

Current through Register Vol. 35, No. 13, July 16, 2024
To meet MAP requirements for eligibility, applicants or
				  recipients must be living in New Mexico on the date of application or final
				  determination of eligibility and have demonstrated an intention to remain in
				  the state.
A. Establishing residence:
				Residence in New Mexico 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 child(ren) in school, getting a state driver's license, or
				renting a post office box. 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: Applicants or recipients who receive 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 recipient of the abandonment of residence in
				that state.
C. Applicants or
				recipients court ordered into full or partial responsibility of the state
				children youth and families department (CYFD): When CYFD places an applicant or
				recipient in a new state of residence, the new state of residence is
				responsible for the provision of medicaid; however, New Mexico must provide
				limited coverage for services that are part of the New Mexico MAD benefit
				package and not available in the new state of residence.
D. Abandonment: Residence is not abandoned by
				temporary absences. Temporary absences occur when applicants or recipients
				leave New Mexico for specific purposes with time-limited goals. An applicant or
				recipient may be temporarily absent from the state is the person intends to
				return when the purpose of the absence has been accomplished, unless another
				state has determined he or she is a resident there for the purposes of MAP
				enrollment. Residence is considered abandoned when the applicant or recipient
				leaves New Mexico 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 calendar days, without notifying HSD of his or her departure or intention of
				returning.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.291.410.16 - NON-CONCURRENT RECEIPT OF ASSISTANCE

Current through Register Vol. 35, No. 13, July 16, 2024
A MAP applicant or recipient receiving medicaid in another
				  state is not eligible for MAP enrollment in accordance with 8.200.410
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.291.410.17 - APPLICATIONS FOR OTHER BENEFITS

Current through Register Vol. 35, No. 13, July 16, 2024
As a condition of eligibility, a MAP applicant or recipient
				  must take all necessary steps to obtain any benefits he or she is entitled to
				  in accordance with 8.200.410 NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.291.410.18 - APPLICATIONS (42 CFR 435.907)

Current through Register Vol. 35, No. 13, July 16, 2024
A.
				Basis and implementation
.
In accordance with section
				1413(b)(1)(A) of the Affordable Care Act, HSD will accept an application from
				the applicant, an adult who is in the applicant's household, as defined in
				42 CFR
				435.603, or family, as defined in section
				36B(d)(1) of the Code, an authorized representative, or if the applicant is a
				minor or incapacitated, someone acting responsibly for the applicant, and any
				documentation required to establish eligibility:
(1) Via the internet web site;
(2) By telephone;
(3) Via mail;
(4) In person; and
(5) Through other commonly available
				electronic means.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.291.410.19 - PERIODIC RENEWAL OF MEDICAID ELIGIBILITY (42 CFR 435.916)

Current through Register Vol. 35, No. 13, July 16, 2024
A. Renewal of
				individuals whose medicaid eligibility is based on MAGI.
(1) Except as provided in Subsection D of
				8.291.410.19 NMAC, the eligibility of medicaid beneficiaries whose financial
				eligibility is determined using MAGI-based income must be renewed once every 12
				months, and no more frequently than once every 12 months.
(2) Renewal on basis of information available
				to HSD. HSD will make a redetermination of eligibility without requiring
				information from the individual if able to do so based on reliable information
				contained in the individual's account or other more current information
				available to HSD, including but not limited to information accessed through any
				data bases accessed by HSD under
				42 CFR
				435.948,
				435.949
				and
				435.956.
				If the HSD is able to renew eligibility based on such information, HSD will
				notify the individual:
(a) Of the eligibility
				determination, and basis; and
(b)
				That the individual must inform the HSD, through any of the modes permitted for
				submission of applications under
				42
				CFR 435.907(a) and
				Subsection A of
				8.291.410.18
				NMAC, if any of the information contained in such notice is inaccurate, but
				that the individual is not required to sign and return such notice if all
				information provided on such notice is accurate.
(3) Use of a pre-populated renewal form. If
				HSD cannot renew eligibility in accordance with Paragraph (2) of Subsection A
				of 8.291.410.19 NMAC, HSD will:
(a) Provide
				the individual with:
(i) A renewal form
				containing information available to HSD that is needed to renew
				eligibility.
(ii) At least 30 days
				from the date of the renewal form to respond and provide any necessary
				information through any of the modes of submission specified in
				42
				CFR 435.907(a) and
				8.291.410.18
				(A) NMAC and to sign the renewal form in a manner consistent with
				42
				CFR 435.907(f) and
				Subsection F of 8.291.410.18 NMAC.
(iii) Notice of the HSD decision concerning
				the renewal of eligibility.
(b) Verify any information provided by the
				beneficiary in accordance with
				42 CFR
				435.945 through
				435.956.
(c) Reconsider in a timely manner the
				eligibility of an individual who is terminated for failure to submit the
				renewal form or necessary information, if the individual subsequently submits
				the renewal form within 90 days after the date of termination without requiring
				a new application;
(d) Not require
				an individual to complete an in-person interview as part of the renewal
				process.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.291.410.20 - VERIFICATION METHODS

Current through Register Vol. 35, No. 13, July 16, 2024
Verification will be obtained through various methods. Not
				  all methods will necessarily be used in each case. This section details the
				  specific types of methods to be used in establishing the applicant or
				  recipient's eligibility.
A. Prior case
				data not subject to change: Verification of an eligibility factor not subject
				to change, which previously has been verified and accepted, will not be subject
				to re-verification. The caseworker shall not ask an applicant or recipient for
				verification of any eligibility factors which have previously been established
				through documents in HSD's possession and are not subject to change. Such
				factors include U.S. citizenship, birth date, relationship and
				enumeration.
B. Electronic data:
				Every applicant or recipient shall be informed that the information provided is
				subject to verification through state, federal and contracted data systems. The
				caseworker shall not require further verification of such information unless it
				is disputed by the applicant or recipient, or the information is otherwise
				questionable as defined in 8.100.130 NMAC.
C. Self-attestation is the information that
				an applicant or recipient reports on an application and is certifying as true
				and correct to the best of their knowledge.
D. Documentary evidence is the primary source
				of verification for information not established in prior case information or
				electronic source data. Obtaining necessary verification through documentary
				evidence readily available to the applicant or recipient shall always be
				explored before collateral contacts or sworn statements are used. Documentary
				evidence consists of a written confirmation of a household's circumstances.
				Acceptable verification is not limited to any single type of document. The
				types of documents which may be accepted as verification are specified under
				the sections pertaining to verification methods later in this chapter. The
				caseworker shall provide applicants or recipients with receipts for
				verification documents provided subsequent to the interview.
E. Collateral contact is defined at 8.100.130
				NMAC.
F. Sworn statement is defined
				at 8.100.130 NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.291.410.21 - VERIFICATION STANDARDS

Current through Register Vol. 35, No. 13, July 16, 2024
Below is a list of standards HSD will utilize to determine
				  eligibility for MAP categories defined at
				  8.291.400.10
				  NMAC. If verification cannot be confirmed utilizing the various methods
				  described in each section of this rule, HSD may request additional information.
				  If information is provided and becomes questionable as defined at 8.100.130
				  NMAC, then additional documentation must be provided as described by 8.100.130
				  NMAC.
A. Income: Verification of
				income is mandatory for ACA related MAP and HSD will utilize electronic sources
				and documents provided by the applicant or recipient to verify his or her
				income. Examples of acceptable documentation can be found at 8.100.130
				NMAC.
B. Residency: Self
				attestation is an acceptable form of verification of residency.
C. Age: Self attestation is an acceptable
				form of verification of age.
D.
				Enumeration: HSD will utilize electronic sources to verify an applicant or
				recipient's enumeration.
E.
				Citizenship: HSD will utilize electronic sources to verify an applicant or
				recipient's citizenship.
F.
				Immigration status: HSD will utilize electronic sources to verify an applicant
				or recipient's immigration status.
G. Relationship: Self attestation is an
				acceptable form of verification of relationship.
H. Receipt of other benefits: HSD will
				utilize electronic sources to verify an applicant or recipient's receipt of
				other benefits.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.291.410.22 - VERIFYING FINANCIAL INFORMATION (42 CFR 435.948)

Current through Register Vol. 35, No. 13, July 16, 2024
A. HSD will request the following information
				relating to financial eligibility from other agencies in the state and other
				states and federal programs to the extent HSD determines such information is
				useful to verifying the financial eligibility of an individual.
(1) Information related to wages, net
				earnings from self-employment, unearned income and resources from the state
				wage information collection agency (SWICA), the internal revenue service (IRS),
				the social security administration (SSA), the agencies administering the state
				unemployment compensation laws, the state-administered supplementary payment
				programs under section 1616(a) of the Act, and any state program administered
				under a plan approved under Titles I, X, XIV, or XVI of the Act; and
(2) Information related to eligibility or
				enrollment from the supplemental nutrition assistance program (SNAP), the state
				program funded under Part A of Title IV of the Act, and other insurance
				affordability programs.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.291.410.23 - VERIFICATION OF INFORMATION THROUGH AN ELECTRONIC SERVICE (42 CFR 435.949(a) and (b))

Current through Register Vol. 35, No. 13, July 16, 2024
The federal government will establish an electronic service
				  through which HSD may verify certain information with, or obtain such
				  information from, federal agencies and other data sources, including SSA, the
				  department of treasury, and the department of homeland security. To the extent
				  that information related to eligibility for medicaid is available through the
				  electronic service, HSD must obtain the information through such
				  service.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.291.410.25 - VERIFICATION PLAN

Current through Register Vol. 35, No. 13, July 16, 2024
HSD has a verification plan describing the verification
				  policies and procedures to implement the provisions set forth in
				  42 CFR 435.940
				  through
				  435.956
				  and 8.100.130 and 8.291.410 NMAC. The state verification plan is posted on the
				  HSD website.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 410 - GENERAL RECIPIENT REQUIREMENTS › Section 8.291.410.26 - TIMEFRAME FOR DISPOSITION

Current through Register Vol. 35, No. 13, July 16, 2024
An applicant or recipient is given a timeframe to provide
				  necessary verification in order for ISD to process an application within the
				  timeframe set forth in this section. This requirement pertains to requests for
				  verification for initial applications as well as for verification for ongoing
				  eligibility. ISD shall make an eligibility decision within three working days
				  of the receipt of all necessary verification.
A. The application disposition deadline for
				MAP is 45 days from the date of application.
(1) Day one: the date of application is the
				first day.
(2) No later than day
				44, or by the preceding work day if day 44 falls on a weekend or holiday:
(a) if verification provided establishes
				eligibility or ineligibility; or
(b) if the day following day 44 is not a work
				day, then decision must be made earlier than day 44 to allow for mailing on or
				before the deadline.
(3)
				No later than day 45 by the next work day if day 45 falls on a weekend or
				holiday, if needed verification is not provided until day 42 - 44.
(4) Day 45 by the next work day if day 45
				falls on a weekend or holiday, if needed verification is provided on day 45, or
				is not provided.
(5) After day 45:
(a) When an applicant or recipient requests
				one or more 10-calendar day extensions of time to provide needed verification.
				An applicant or recipient is entitled to receive up to three 10- calendar day
				extensions of time upon request.
(b) The eligibility decision must be made as
				soon as possible and within three working days of receipt of all necessary
				verification.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 420 - RECIPIENT RIGHTS AND RESPONSIBILITIES › Section 8.291.420.3 - 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 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 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 420 - RECIPIENT RIGHTS AND RESPONSIBILITIES › Section 8.291.420.5 - 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 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 420 - RECIPIENT RIGHTS AND RESPONSIBILITIES › Section 8.291.420.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of this rule is to provide eligibility
				  guidelines when determining eligibility for the medical assistance division
				  (MAD) medicaid program and other health care programs it administers. Processes
				  for establishing and maintaining this category of eligibility are found in the
				  affordable care general provision chapter located at 8.291.400 NMAC through
				  8.291.430 NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 420 - RECIPIENT RIGHTS AND RESPONSIBILITIES › Section 8.291.420.8 - RIGHT TO APPLY

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
				MAD administers regardless of whether it appears he or she may be eligible.
(1) The income support division (ISD)
				determines eligibility for medicaid, unless otherwise determined by another
				entity as stated in another NMAC rule. A decision shall be made promptly on
				applications in accordance with the timeliness standards set forth in 8.291.410
				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 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 420 - RECIPIENT RIGHTS AND RESPONSIBILITIES › Section 8.291.420.9 - FREEDOM OF CHOICE OF PROVIDER

Current through Register Vol. 35, No. 13, July 16, 2024
Refer to
				  8.200.430.10
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 420 - RECIPIENT RIGHTS AND RESPONSIBILITIES › Section 8.291.420.10 - RELEASE OF INFORMATION/CONFIDENTIALITY

Current through Register Vol. 35, No. 13, July 16, 2024
Refer to
				  8.200.430.11
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE › Part 420 - RECIPIENT RIGHTS AND RESPONSIBILITIES › Section 8.291.420.11 - RIGHT TO ADEQUATE NOTICE AND ADMINISTRATIVE HEARING

Current through Register Vol. 35, No. 13, July 16, 2024
Refer to
				  8.200.430.12
				  NMAC.