New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 100 - GENERAL PROVISIONS FOR PUBLIC ASSISTANCE PROGRAMS › Part 130 - GENERAL OPERATING POLICIES - ELIGIBILITY AND VERIFICATION STANDARDS › Section 8.100.130.8 - PRINCIPLES OF ELIGIBILITY

Current through Register Vol. 35, No. 13, July 16, 2024
The income support division (ISD) is responsible for
				  administering food, cash, energy, and medical assistance programs. These
				  programs are funded through federal or state sources and provide assistance to
				  individuals who meet certain eligibility factors. State and federal regulations
				  determine eligibility factors for each program. ISD determines if an individual
				  qualifies for a program, and ensures that eligible individuals receive the
				  assistance as quickly as possible and, in any event, within the application
				  time frames for the applicable program.
A. Proof of eligibility: Determining
				eligibility for assistance requires that certain verification regarding an
				applicant/recipient's circumstances be made available to ISD. This verification
				is retained in the case record or noted in the case narrative.
(1) Applicant/ recipient responsibility: The
				applicant/recipient is responsible to provide and obtain the verification
				necessary to determine eligibility.
(2) ISD responsibility: ISD is responsible
				for the following:
(a) to explain program
				participation requirements and the program specific eligibility factors to
				applicants/ recipients;
(b) to
				explain the information and documents that must be provided to establish
				eligibility under each eligibility factor for a specific program;
(c) to offer and provide assistance in
				obtaining verification of an eligibility factor when the applicant/recipient
				indicates that verification may be difficult or costly to obtain; difficulty in
				obtaining verification may arise as a result of such circumstances as an
				applicant/recipient's limited ability to read, speak or understand the English
				language, mental impairments, physical illness, disability, lack of funds, lack
				of transportation or lack of knowledge about how to obtain the information;
				assistance by ISD includes explaining written information orally in the
				applicant/ recipient's language, providing an interpreter, providing an address
				or telephone number of a person or agency, making telephone or written
				inquiries, allowing an applicant/ recipient to use the telephone, locating a
				document, instructing an applicant in obtaining a document, requesting a
				document on behalf of an applicant/recipient or contacting a collateral
				contact; the assistance offered and provided is based on the particular needs
				of the applicant and ISD's ability to address those needs;
(d) to inform applicants/recipients in
				writing of their responsibility to provide necessary verification.
(3) Incomplete information: When
				available information is inconclusive, incomplete or indefinite, ISD shall be
				responsible for explaining, in writing, what questions remain and how they can
				be resolved. The explanation must make it clear that eligibility cannot be
				established without the information or documents and that failure to provide
				them shall result in denial, reduction or termination of assistance.
(a) The applicant/recipient shall also be
				informed they may reapply at any time but that the information, documentation
				or actions may affect the reapplication. If the applicant/ recipient does not
				provide all of the verification needed, a decision shall be made to the extent
				possible, based on the existing verified information.
(b) For MAGI medicaid purposes, reasonable
				compatibility will be effectuated in accordance with
				42 CFR
				435.952.
(c) When assistance is denied, reduced,
				delayed or terminated due to failure to provide information or documents as
				requested, the case record must contain the explanation that such failure is
				the basis for the action. The client shall be informed in writing of the
				action.