reglab/statecodes huggingface dataset:
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 400 - RECIPIENT POLICIES › Section 8.281.400.20 - RECIPIENT RIGHTS AND RESPONSIBILITIES

Current through Register Vol. 35, No. 13, July 16, 2024
An applicant or recipient is responsible for establishing
				  their eligibility for medicaid. As part of this responsibility, the applicant
				  or recipient must provide required information and documents or take the
				  actions necessary to establish eligibility. Failure to do so must result in a
				  decision that eligibility does not exist. An applicant or recipient must also
				  grant the HSD permission to contact other persons, agencies or sources of
				  information, which are necessary to establish eligibility.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 400 - RECIPIENT POLICIES › Section 8.281.400.21 - RIGHT TO HEARING

Current through Register Vol. 35, No. 13, July 16, 2024
An applicant or recipient residing in an institution can
				  request an administrative hearing to dispute issues relating to the eligibility
				  determination process at the time of the eligibility determination (see Section
				  8.200.430.12
				  NMAC, Right to Hearing).
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 400 - RECIPIENT POLICIES › Section 8.281.400.22 - ASSIGNMENTS OF MEDICAL SUPPORT

Current through Register Vol. 35, No. 13, July 16, 2024
Refer to medical assistance program manual Subsection F of
				  Section
				  8.200.420.12
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 400 - RECIPIENT POLICIES › Section 8.281.400.23 - REPORTING REQUIREMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
Medicaid recipients must report any change in circumstances,
				  which may affect their eligibility to their local ISD office within 10 days of
				  the change in accordance with
				  8.200.430.18
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.281.500.1 - ISSUING AGENCY

Current through Register Vol. 35, No. 13, July 16, 2024
New Mexico Health Care Authority.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.281.500.2 - 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 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.281.500.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
The New Mexico medicaid program and other health care
				  programs are administered pursuant to regulations promulgated by the federal
				  department of health and human services under Title XIX of the Social Security
				  Act as amended or by state statute. See, Section 27-1-12 et seq. NMSA 1978.
				  Section 9-8-1 et seq. NMSA 1978 establishes the health care authority (HCA) as
				  a single, unified department to administer laws and exercise functions relating
				  to health care facility licensure and health care purchasing and
				  regulation.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.281.500.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
August 15, 2015, unless a later date is cited at the end of a
				  section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.281.500.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of this rule is to provide specific
				  instructions when determining eligibility for the medicaid program and other
				  health care programs it administers. Generally, applicable eligibility rules
				  are detailed in the medical assistance division (MAD) medical assistance
				  programs (MAP) eligibility rules manual, specifically 8.200.400 NMAC. Processes
				  for establishing and maintaining MAP eligibility are detailed in the income
				  support division (ISD) general provisions 8.100 NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.281.500.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Definitions beginning with "A":
(1)
Actuarially sound:
With
				respect to an annuity or promissory note, the payments made to the beneficiary
				must not exceed their life expectancy and returns to the beneficiary an amount
				at least equal to the amount used to establish the contract.
(2)
Annuity:
A financial
				instrument, usually sold by a life insurance company, that pays out a regular
				income at fixed intervals for a certain period of time, often beginning at a
				certain age and continuing for the life of the owner.
(3)
Asset limit:
An applicant or
				recipient may be eligible for a MAP category of institutional care on the
				factor of resources if countable resources do not exceed $2,000.
(4)
Assets:
All income and
				resources of an applicant or recipient and their spouse, if
				applicable.
(5)
Authorized
				representative:
The individual designated to represent and act on the
				applicant's or recipient's behalf during the eligibility process. The applicant
				or recipient or their authorized representative must provide formal
				documentation authorizing the named individual or individuals to access the
				identified case information for a specified purpose and time frame. An
				authorized representative may be an attorney representing a person or
				household, a person acting under the authority of a valid power of attorney, a
				guardian, or any other individual or individuals designated in writing by the
				claimant.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.281.500.8 - 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 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.281.500.9 - NEED DETERMINATION

Current through Register Vol. 35, No. 13, July 16, 2024
Applicants for and recipients of institutional care must
				  apply for and take all necessary steps to obtain any income or resources to
				  which they may be entitled. When an applicant or recipient is given
				  notification by HSD to apply for and obtain specific income and resources they
				  must take steps to do so within 30 calendar days.
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 or recipient becoming
				ineligible for a MAP category of eligibility for institutional care.
B.
Exceptions to general requirement:
Applicants or recipients who have elected a lower veterans
				administration (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
				MAP eligibility.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.281.500.10 - 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's or 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 for a MAP category of eligibility for institutional care
				is made as of the first moment of the first day of the month. An applicant or
				recipient is ineligible for any month in which their 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 or recipient until the following month becomes a resource.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.281.500.11 - APPLICABLE RESOURCE STANDARDS

Current through Register Vol. 35, No. 13, July 16, 2024
The resource criteria and eligibility standards of this
				  section apply to all applicants for and recipients of a MAP category of
				  eligibility for institutional care. An applicant or recipient is eligible for a
				  MAP category of eligibility for institutional care on the factor of resources
				  if countable resources do not exceed $2,000. Some of an applicant's or
				  recipient's resources are counted in the eligibility determination and some
				  resources are excluded. Any resource which is not specifically excluded in
				  8.281.500.13
				  NMAC is considered a countable resource for the purpose of determining a MAP
				  category of eligibility for institutional care.
A.
Liquid resources:
A liquid
				resource is cash or something that can easily be converted to cash within 20
				business days. The face or surrender value of liquid resources such as cash,
				savings or checking accounts, and other financial instruments are considered in
				determining a MAP category of eligibility. The countable value of liquid
				resources is based on their current fair market value.
(1) An applicant or 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 or recipient cannot provide this verification, the
				ISD worker provides the applicant or recipient with a detailed request of all
				documents needed to determine a MAP category of eligibility.
(2) If the applicant or 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 or recipient checking account
				balance to arrive at the amount to be considered a countable
				resource.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.281.500.12 - 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 or recipient must have an
				ownership interest in a resource for it to be countable. The fact that an
				applicant or recipient has access to a resource, or has a legal right to use
				it, does not make it countable unless the applicant or recipient also has an
				ownership interest in it.
B.
Legal right to convert resource to cash:
An applicant or 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 or recipient does not have physical
				possession of a resource does not mean it is not their resource. If they have
				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 or recipient is considered to have free access to
				the unrestricted use of a resource even if they can take those actions only
				through an agent, such as a representative payee, guardian, conservator,
				trustee, or another authorized representative. If there is a legal bar to the
				sale of a resource, the resource is not countable. However, if a co-owner of
				real property can bring an action to partition and sell the property, their
				interest in the property is a countable resource.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.281.500.14 - ASSET TRANSFERS

Current through Register Vol. 35, No. 13, July 16, 2024
The ISD caseworker must determine whether an applicant or
				  recipient or their spouse transferred assets within a specified period of time
				  (lookback period) before applying for a MAP category of eligibility for
				  institutional care or at any time after approval of the applicant's or
				  recipient's application. Then the ISD caseworker must determine if the
				  applicant or recipient or their spouse received fair market value for the
				  asset. If the applicant or recipient or their spouse did not receive fair
				  market value for the asset, then the applicant or recipient may be subject to a
				  penalty. In the case of an asset held by the applicant or recipient in common
				  with another individual or individuals in a joint tenancy, tenancy in common,
				  or similar arrangement including life estate or remainderman relation, the
				  asset (or the affected portion of such asset) is considered to be transferred
				  by the applicant or recipient when any action is taken, either by the applicant
				  or recipient or by any other individual, acting on behalf of the applicant or
				  recipient (including but not limited to a spouse, representative payee,
				  trustee, guardian, conservator, or another authorized representative), that
				  reduces or eliminates the applicant's or recipient's ownership or control of
				  such asset. Any asset transferred to a community spouse in excess of the
				  community spouse resource allowance (CSRA) is considered to be totally
				  available to the institutionalized spouse and must be spent down before
				  eligibility can be established.
A.
Lookback period:
Any transfer of assets made prior to February 8,
				2006, is subject to a 36-month lookback period prior to the date of the
				applicant's or recipient's application or at any time subsequent to the
				approval of an application for a MAP category of eligible for institutional
				care. Transfers made on or after February 8, 2006, are subject to a 60-month
				lookback period.
(1) The lookback period is
				60 months if the transfer occurred as the result of payments from a trust or
				portions of a trust that are treated as assets disposed of by the applicant or
				recipient.
(2) The lookback period
				starts on the date the applicant or recipient applies for a MAP category of
				institutional care and is in an institution.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.281.500.15 - RESOURCE STANDARDS FOR MARRIED COUPLES

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Community property resource
				determination methodology:
Community property resource determination
				methodology is used in the eligibility determination for a married applicant or
				recipient who began institutionalization for a continuous period prior to
				September 30, 1989.
(1) To determine the
				countable value of resources, the ISD worker must:
(a) add the total value of all resources
				owned by both spouses;
(b) exclude
				the separate property of the non- applicant or recipient spouse; and
(c) attribute one-half of the total value of
				the community property to the applicant or recipient spouse plus the value of
				their separate property;
(d) the
				resulting figure must be less than $2,000.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.281.500.16 - DEEMING RESOURCES

Current through Register Vol. 35, No. 13, July 16, 2024
Deeming of resources applies only during periods when an
				  eligible applicant/recipient under 18 years of age lives at home and during the
				  month the eligible applicant or recipient enters an institution. After the
				  initial month of entry into the institution, only those resources directly
				  attributable to or available to the applicant or recipient are counted and
				  compared to the $2,000 resource limit.
A.
Deeming of resources for children
				who are blind or have a disability:
If an applicant or recipient under
				18 years of age who is blind or disabled enters an institution, the resources
				of the parent(s) are deemed to the applicant or recipient if the parent(s) live
				in the same household. If an ineligible parent receives temporary assistance to
				needy families (TANF), resources are not deemed to the applicant or
				recipient.
B. To determine the
				amount of resources deemed to the applicant or recipient, the following
				computation is made:
(1) determine parent(s)
				resources;
(2) allow parent(s) all
				the resource exclusions that an eligible applicant or recipient would
				receive;
(3) the remaining
				resources in excess of $2,000 for one parent or $3,000 for two parents are
				deemed to the applicant or recipient child; if there is more than one applicant
				or recipient child, the deemed resources are divided equally; and
(4) the deemed resources are added to
				whatever countable resources the applicant or recipient child has in their own
				right; the applicant or recipient child is eligible for a MAP category of
				institutional care eligibility on the factor of resources if countable
				resources do not exceed $2,000.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.281.500.17 - INCOME

Current through Register Vol. 35, No. 13, July 16, 2024
An applicant's or recipient's gross countable monthly income
				  must be less than the maximum allowable monthly income standard. If an
				  applicant's or recipient's monthly gross countable income is below $50, the
				  application can still be processed; however, the applicant or the recipient
				  must be referred to the social security administration to apply for SSI. Income
				  may be in the form of cash, checks, and 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. The ISD worker
				  verifies all income and obtains appropriate documentation. Income is counted in
				  the month received. Income is considered available throughout the month
				  regardless of the date received.
A.
Types of income:
Countable income is the sum of unearned income or
				earned income, less disregards or exclusions, plus deemed income.
B.
Earned income:
Earned income
				consists of the total gross income received by an applicant or recipient for
				services performed as an employee or as a result of self-employment.
(1) Royalties earned in connection with the
				publication of an applicant's or recipient's work and any honorarium or fee
				received for services rendered are considered earned income.
(2) The self-employed applicant or recipient
				must provide an estimate of their 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.
(a) Consideration is given to the
				applicant's or recipient's explanation as to why they believe the estimated net
				earnings for the current year vary substantially from the information shown on
				their tax return for past years.
(b) 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 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.281.500.19 - UNEARNED INCOME

Current through Register Vol. 35, No. 13, July 16, 2024
Unearned income includes all income not earned in the course
				  of employment or self-employment. If payment is made in the name of either or
				  both spouses and another party, only the applicant's or recipient's
				  proportionate share is considered available to them. 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.
A.
Standards for
				unearned income:
Unearned income is computed on a monthly basis. If
				there are no expenses incurred with the receipt of unearned income, such as
				annuities, pensions, retirement payments or disability benefits, the gross
				amount is considered countable unearned income.
(1)
Social security
				overpayments:
If the social security administration withholds an amount
				because of an overpayment, the gross social security payment amount is used to
				determine eligibility. See Subsection B of
				8.281.500.22
				NMAC for instructions regarding calculation of the medical care
				credit.
(2)
Rental
				income:
If an applicant or recipient has rental property, the ISD worker
				allows the cost of real estate taxes, maintenance and repairs, advertising,
				mortgage insurance and interest payments on the mortgage as deductions from the
				amount received as rent.
(3)
Interest on promissory note or sales contract:
The portion of the
				payment representing interest received from a promissory note or sales contract
				is considered unearned income. The market value of promissory notes or sales
				contracts and the portion of the payment representing payment of the principal
				are considered resources. See also Subsection L of
				8.281.500.13
				NMAC.
(4)
Income from
				annuities, pensions and other periodic payments:
Payments from
				annuities, pensions, social security benefits, disability, veterans benefits,
				worker compensation, railroad retirement annuities and unemployment insurance
				benefits and other periodic payments are counted as unearned
				income.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.281.500.20 - DEEMED INCOME

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Availability:
Deemed income is income considered available to a
				minor applicant or recipient from their parents. Deeming of resources and
				income applies only during periods when an applicant or recipient under 18
				years of age is living with their parents and during the month of entry into an
				institution.
B.
Situations in
				which deeming occurs:
Deeming of income occurs:
(1) from ineligible parent to eligible child;
				or
(2) if there is both a MAP
				eligible parent and a MAP eligible child in the home.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.281.500.21 - DISREGARDS

Current through Register Vol. 35, No. 13, July 16, 2024
Income disregards are determined on an individual basis.
				  Disregards may be applied to any appropriate month of assistance, regardless of
				  which income maximum is used.
A. $20
				disregard: The first $20 of unearned or earned income received in a month is
				disregarded. This disregard is applied first to unearned income and, if any
				amount remains, to earned income. If there is no unearned income, the entire
				$20 disregard is applied to earned income. This disregard is not applied to any
				payment made to the applicant or recipient through government assistance
				programs or private charitable organizations, where payments are based on need.
				These payments include financial assistance, TANF, assistance from catholic
				charities, salvation army, bureau of Indian affairs, and VA pension (not
				compensation) payments.
B.
Additional earned income disregard:
After applying the $20
				disregard as specified in Subsection A of 8.281.500.21 NMAC if appropriate, the
				first $65 of monthly earned income plus one-half of the remainder is also
				disregarded.
C.
Work-related
				expenses of the blind:
Work-related expenses of an employed applicant or
				recipient or couple who are legally blind are disregarded. The dollar amount of
				expenses which may be disregarded must be reasonable. Expenses are disregarded
				when paid and must be verified.
(1) This
				disregard does not apply to an applicant or recipient who is blind and is 65
				years or age or older, unless they were receiving SSI payments due to blindness
				in the month before turning 65 or received payments under a state aid to the
				blind program.
(2) Types of
				work-related expenses which may be disregarded include:
(a) federal, state, and local income
				taxes;
(b) social security
				contributions;
(c) union
				dues;
(d) transportation costs,
				including actual cost of bus/taxi cab fare, or $0.15 per mile for private
				automobile;
(e) lunches;
(f) child care costs, if not otherwise
				provided;
(g) uniforms, tools and
				other necessary equipment; and
(h)
				special expenses necessary to enable an applicant or recipient who is blind to
				engage in employment, such as a seeing-eye dog or Braille
				instructions.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.281.500.22 - POST ELIGIBILITY/MEDICAL CARE CREDIT

Current through Register Vol. 35, No. 13, July 16, 2024
Once financial eligibility for a MAP category of
				  institutional care has been established, the ISD worker must determine the
				  following.
A.
Medical care
				credit:
The medical care credit is the amount of the applicant's or
				recipient's income used to reduce the MAD payment to the institution where they
				reside. An applicant or recipient must make this payment directly to the
				institution. Applicants or recipients eligible for a MAP category of
				institutional care due to institutionalization in an acute care hospital or an
				in-state in-patient rehabilitation center are not charged a medical care
				credit. The amount of the medical care credit is always determined
				prospectively. The ISD worker computes a medical care credit starting with the
				first full month of institutional care. No medical care credit is required for
				the month the recipient enters the institution if they are admitted after the
				first moment of the first day of the month.
(1)
No medical care credit for the
				month of discharge or death:
An applicant or recipient is not required
				to pay a medical care credit for the month of discharge from the institution.
				The medical care credit must be paid if the applicant or recipient is
				transferred to another institution or makes a short visit outside the
				institution. No medical care credit is charged for the month in which a
				recipient who received MAD institutional care services dies. This will prevent
				a deficit for the institution when a benefit, such as social security, must be
				returned due to the death of a beneficiary.
(2)
Application delay:
If there
				is a delay between application and approval, an applicant or recipient incurs a
				liability for a medical care credit. The ISD worker notifies the applicant or
				recipient of this liability during the application process and informs them of
				the amount of the medical care credit they should pay. The applicant or
				recipient is encouraged to pay the medical care credit to the institution
				before approval of the application.
(3)
Medical care credit during
				retroactive months:
No medical care credits are applied for any period
				of retroactive eligibility under this provision.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.281.500.23 - UNDUE HARDSHIP

Current through Register Vol. 35, No. 13, July 16, 2024
An applicant or recipient subject to a penalty for transfer
				  of assets for less than fair market value may apply for a waiver of the
				  regulation regarding transfer of assets as constituting an undue hardship. The
				  facility where an institutionalized applicant or recipient resides may file an
				  application for waiver of the requirement on behalf of the applicant or
				  recipient with the applicant's or recipient's or authorized representative's
				  consent.
A. The transfer must have
				been made to someone other than a family member. "Family member" includes son,
				daughter, grandson, granddaughter, step-son, step-daughter, in-laws, mother,
				father, step-mother, step-father, half-brother, half-sister, niece, nephew,
				grandmother, grandfather, aunt, uncle, sister, brother, step-sister,
				step-brother.
B. The applicant or
				recipient must demonstrate that the application of the transfer of assets
				regulation would deprive the applicant or recipient of:
(1) medical care such that the applicant's or
				recipient's health or life would be endangered; or
(2) food, clothing, shelter or other
				necessities of life.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 510 - TRUST STANDARDS › Section 8.281.510.3 - 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 health care
				  authority pursuant to state statute. See Sections 27-2-12 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 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 510 - TRUST STANDARDS › Section 8.281.510.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
October 1, 2012, unless a later date is cited at the end of a
				  section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 510 - TRUST STANDARDS › Section 8.281.510.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of this rule is to provide eligibility criteria
				  and procedures for the medicaid programs.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 510 - TRUST STANDARDS › Section 8.281.510.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A. "Assets" include
				all income and resources as described in 8.281.500 NMAC of an
				applicant/recipient and his/her spouse. Assets not in a trust are considered
				under the applicable rule to determine if they are countable or excludable for
				the purposes of medicaid eligibility.
B. "Beneficiary" is the individual(s) for
				whose benefit the assets are held by the trustee.
C. "Benefit" is something to the advantage of
				or profit to the recipient.
D.
				"Community spouse" is an individual as described in Subsection E of 8.281.500.7
				NMAC,
definitions
.
E. "Corporate trustee" means a bank, trust
				company, or company whose primary business is trust services. A corporate
				trustee may not have any affiliation with the beneficiary either through
				relatives working for the corporate trustee or investments by the beneficiary
				with the company other than for administrative fees.
F. "Corpus" is the body of the trust or the
				original asset used to establish the trust (to include principal, interest, and
				subsequent additions), such as a sum of money or real property.
G. "Department" is the New Mexico human
				services department or successor agency.
H. "Grantor" is the owner of or has legal
				control over the assets placed into a trust. A grantor may also be referred to
				as a settlor or trustor.
I.
				"Institutionalized individual" is an individual as described in Subsection K of
				8.281.500.7 NMAC.
J. "Irrevocable
				trust" is created when the grantor does not reserve any right to cancel or
				revoke any provision of the trust.
(1)
				Although termed irrevocable, a trust which provides that the trust can only be
				modified or terminated by a court is a revocable trust because the
				applicant/recipient (or his/her responsible party) or the trustee can petition
				the court to amend or terminate the trust.
(2) Although termed irrevocable, a trust that
				will terminate if a certain circumstance occurs during the lifetime of the
				applicant/recipient, such as the applicant/recipient leaving the nursing
				facility and returning home, is a revocable trust.
(3) Although termed irrevocable, a trust that
				can be revoked or terminated upon the agreement of any or all beneficiaries
				(including residual beneficiaries) is a revocable trust.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 510 - TRUST STANDARDS › Section 8.281.510.10 - TRUSTS ESTABLISHED ON OR AFTER AUGUST 11, 1993

Current through Register Vol. 35, No. 13, July 16, 2024
Trusts established on or after August 11, 1993 are evaluated
				  using the provisions of OBRA 93. The term "medicaid qualifying trust" or MQT is
				  no longer used after that date. Any trust which meets the basic definition of a
				  trust can be counted in determining eligibility for medicaid. No clause or
				  requirement in a trust, no matter how specifically it applies to medicaid or
				  other federal or state programs (i.e. exculpatory clauses) precludes a trust
				  from being considered under 8.281.500 NMAC. Depending on how the trust is
				  structured, the amounts in the trust may count as resources, income, or a
				  transfer of assets. All trusts submitted for review by the department must be
				  in writing, signed, and fully executed. Trusts that are not signed and executed
				  will not be considered as effective trusts until they are signed and executed.
				  Assets are not part of a trust and are considered outside of the trust until
				  the date they are actually transferred into the trust, as demonstrated by
				  verifiable documentation, regardless of the effective date of the trust.
A. The standards set forth in this section
				shall apply to trusts or similar legal devices without regard to:
(1) the purposes for which the trust is
				established;
(2) whether the
				trustee(s) has discretion or exercises such discretion under the
				trust;
(3) any restrictions on when
				or whether distributions can be made from the trust; and
(4) or any restrictions on the use of
				distributions from the trust.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 510 - TRUST STANDARDS › Section 8.281.510.12 - OTHER TRUSTS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Limited partnerships:
A limited partnership is a "similar legal
				device" to a trust. Trust provisions of the Omnibus Budget Reconciliation Act
				of 1993 (OBRA 93) direct that the term "trust" includes any legal device
				similar to a trust. Therefore, OBRA 93 trust provisions of this section apply
				to limited partnerships. The general partners act as trustee, and the limited
				partners are the equivalent of beneficiaries of an irrevocable trust. To the
				extent that the general partners can make each limited partner's ownership
				interest available to him, that interest is a countable resource and not a
				transfer of assets. However, a transfer of assets has occurred to the extent
				that:
(1) the value of the share of ownership
				purchased by the limited partner is less than the amount he invested;
(2) the general partners cannot make the
				limited partner's share available to him;
(3) if transfer-of-assets provisions apply,
				the look-back period is 60 months.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 510 - TRUST STANDARDS › Section 8.281.510.13 - UNDUE HARDSHIP

Current through Register Vol. 35, No. 13, July 16, 2024
An applicant/recipients who has excess resources and is
				  unable to access resources from an existing trust will not be found ineligible
				  for medicaid where the department determines, on a case by case basis, that
				  denial of eligibility on the basis of excess resources would work an undue
				  hardship.
A. The applicant/recipient
				must demonstrate that the application of the trust regulation would deprive the
				applicant/recipient or his/her spouse of:
(1)
				medical care such that the applicant/recipient's health or life would be
				endangered; or
(2) food, clothing,
				shelter or other necessities of life.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 510 - TRUST STANDARDS › Section 8.281.510.14 - USE OF TRUST V. TRANSFER RULES FOR ASSETS PLACED IN TRUST

Current through Register Vol. 35, No. 13, July 16, 2024
When a non-excluded asset is placed in a trust, a transfer of
				  assets for less than fair market value generally takes place. An
				  applicant/recipient (or someone acting on behalf of the applicant/recipient)
				  placing an asset in a trust generally gives up ownership of the asset to the
				  trust. If the applicant/recipient does not receive fair compensation in return,
				  a penalty is imposed under the transfer of assets provisions. However, the
				  trust provisions contain specific requirements for treatment of assets placed
				  in trusts. These requirements indicate when assets are considered countable as
				  income or resources, and as a transfer of assets depending on the specific
				  circumstances of the particular trust. Application of the trust regulations,
				  along with the imposition of a penalty for the transfer of the assets into the
				  trust, could result in the applicant/recipient being penalized twice for
				  actions involving the same asset. If an asset is subject to the trust
				  regulations and a transfer of asset penalty, the requirements of the trust
				  regulations take precedence over a transfer of assets penalty for the same
				  asset.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 510 - TRUST STANDARDS › Section 8.281.510.15 - EXCLUDED ASSETS PLACED IN A TRUST

Current through Register Vol. 35, No. 13, July 16, 2024
Placement of excluded assets in a trust, with the exception
				  of a home, shall not result in a penalty of ineligibility because the
				  transferred asset is not an asset for transfer purposes. However, a home,
				  whether excluded or not, when transferred into a trust shall be considered a
				  resource unless:
A. the trust is for
				the sole benefit for the applicant/recipient's spouse; or
B. was transferred to a trust that is in
				compliance with Subsections B or D of 8.281.510.11 NMAC that is established for
				the sole benefit of the applicant/recipient's disabled child, or
C. was transferred to a trust that is in
				compliance with Subsection B or D of 8.281.510.11 NMAC that is established
				solely for the benefit of an individual who is under 65 years of age and who is
				disabled.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 510 - TRUST STANDARDS › Section 8.281.510.16 - DOCUMENTATION OF TRUSTS AND TRUST RECORDS

Current through Register Vol. 35, No. 13, July 16, 2024
Applicants/recipients shall disclose the existence of any
				  trust to which they have contributed income, resources, or are a beneficiary.
				  Upon learning of the existence of a trust, the ISD caseworker must obtain a
				  copy of the trust document, including all attachments, and forward it to the
				  MAD eligibility unit so that it may be reviewed by MAD for a determination on
				  how the trust may affect medicaid eligibility. Trust records shall be open at
				  all reasonable times to inspection by the department and copies shall be
				  provided upon the request of an authorized representative of the department.
				  The department shall not be charged any fees or costs associated with providing
				  trust records to the department. Any records relating to a trust that are
				  sealed by a court order or settlement agreement shall be produced to the
				  department by the applicant/recipient or trustee upon request. Failure to
				  provide such records will result in the presumption that the
				  applicant/recipient's trust is a countable resource that exceeds the resource
				  limitation at 8.281.500 NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 510 - TRUST STANDARDS › Section 8.281.510.17 - COMMENCEMENT OF PROCEEDINGS

Current through Register Vol. 35, No. 13, July 16, 2024
The department may commence a proceeding against the trustee
				  of a trust, if the department considers any acts, omissions, or failures of the
				  trustee to be inconsistent with the terms of the trust, contrary to applicable
				  laws or regulations, or contrary to the fiduciary obligations of the
				  trustee.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 510 - TRUST STANDARDS › Section 8.281.510.18 - NON-COMPLIANCE WITH TERMS OF TRUST

Current through Register Vol. 35, No. 13, July 16, 2024
If the department suspects or determines that the trustee is
				  not complying with the terms of a trust that has been approved by the
				  department, the department will send a letter to the recipient of services or
				  his or her representative requesting more information or describing the
				  specific actions that are not in compliance with the trust which may include
				  but is not limited to proper management of the funds in the trust. The
				  recipient will have 15 days to provide the requested information or
				  demonstrate, through documentation, that the actions of the trustee are not in
				  violation of the terms of the trust. Failure to respond or to adequately
				  demonstrate that the terms of the trust have not been violated may result in a
				  transfer of assets penalty, disqualification from eligibility to receive
				  benefits, and legal action, as appropriate. If the department identifies that
				  the violation of the terms of the trust has been to inadequately fund the
				  trust, the recipient shall immediately obtain a corporate trustee and amend the
				  trust to be managed by that corporate trustee.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 510 - TRUST STANDARDS › Section 8.281.510.19 - AMENDMENTS TO CERTAIN TRUSTS

Current through Register Vol. 35, No. 13, July 16, 2024
A special needs trust, income diversion trust, or pooled
				  charitable trust that was created prior to the effective date of these
				  regulations must fully comply with these regulations as part of any subsequent
				  amendments made to those trusts on or after the effective date of these
				  regulations.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 600 - BENEFIT DESCRIPTION › Section 8.281.600.3 - 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 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084) › Part 600 - BENEFIT DESCRIPTION › Section 8.281.600.5 - 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.