reglab/statecodes huggingface dataset:
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 100 - GENERAL PROVISIONS FOR PUBLIC ASSISTANCE PROGRAMS › Part 640 - RESTORATION AND CLAIMS › Section 8.100.640.8 - ERRONEOUS PAYMENT PROVISIONS

Current through Register Vol. 35, No. 13, July 16, 2024
An erroneous payment exists when an error is made by the
				  client or the department that resulted in an underpayment or overpayment of
				  program benefits. The difference between the amount issued and the corrected
				  amount is the amount of the payment error. The department shall take action to
				  correct errors in the supplemental nutrition assistance program (SNAP), state
				  SNAP supplement, New Mexico combined application project (NMCAP), New Mexico
				  works (NMW) cash assistance, general assistance for disabled adults and
				  unrelated children (GA), adult residential shelter care home (ARSCH), education
				  works (EWP), refugee cash assistance, medical assistance, and LIHEAP benefits
				  issued to an eligibility determination group regardless of the cause of the
				  error. NMW cash assistance, GA, ARSCH, EWP, refugee cash assistance will be
				  referenced as cash assistance programs throughout the regulations unless
				  otherwise specified.
A. The department
				will correct the error by restoring benefits for an underpayment or
				establishing claims for an overpayment.
B.
SNAP:
The amount of the
				restoration or claim is determined by using the maximum SNAP benefit amount and
				applying the allowable deductions in place for a particular month, including
				any federal law placing a restriction on the use of deductions.
C.
Cash assistance programs:
The amount of the restoration or claim is determined using the standard of need
				the case was eligible for on the first day of a month. If the standard of need
				increases during the month, the higher amount shall be allowed for the entire
				month.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 100 - GENERAL PROVISIONS FOR PUBLIC ASSISTANCE PROGRAMS › Part 640 - RESTORATION AND CLAIMS › Section 8.100.640.9 - ESTABLISHING PERIOD OF ERROR

Current through Register Vol. 35, No. 13, July 16, 2024
A. An
				erroneous payment occurs when an error is made by the client or the department
				that resulted in an underpayment or overpayment of program benefits or
				assistance.
B.
Restoration
				of benefits:
If benefits must be restored to an eligibility
				determination group, the department shall determine each month for which the
				eligibility determination group was underpaid benefits. The month(s) may or may
				not be consecutive. In some cases, federal regulations mandate the restoration
				of SNAP benefits to eligibility determination groups for a specific time
				period.
C.
Overpayment of
				benefits:
(1)
Establishing
				period of overpayment:
If benefits have been overpaid to an eligibility
				determination group, the department shall determine each month in which the
				eligibility determination group received benefits to which it was not entitled.
				The months may or may not be consecutive.
(a)
				The first month in which a benefit is considered erroneous is the month in
				which the eligibility determination group received a benefit amount differing
				from the amount that the eligibility determination group was entitled to
				receive.
(b) The last month of an
				erroneous payment ends on the last day of the last month in which payment is
				discovered. In the case of an overpayment, if the period of overpayment has
				been extended while a proposed reduction or termination is the subject of an
				administrative hearing decision, it is included in the overpayment claim
				period.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 100 - GENERAL PROVISIONS FOR PUBLIC ASSISTANCE PROGRAMS › Part 640 - RESTORATION AND CLAIMS › Section 8.100.640.10 - RESTORATION OF BENEFITS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Entitlement:
(1) Program benefits will
				be restored to an eligibility determination group when the loss was caused by:
(a) agency error;
(b) SNAP administrative disqualification for
				IPV that is later reversed; or
(c)
				a regulation specifically requiring restoration of lost benefits.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 100 - GENERAL PROVISIONS FOR PUBLIC ASSISTANCE PROGRAMS › Part 640 - RESTORATION AND CLAIMS › Section 8.100.640.11 - OVERPAYMENTS (CLAIMS AGAINST ELIGIBILITY DETERMINATION GROUPS)

Current through Register Vol. 35, No. 13, July 16, 2024
The department shall take action to establish a claim against
				  any eligibility determination group that received more benefits than it was
				  entitled to receive, including LIHEAP benefits paid to a vendor on behalf of
				  the eligibility determination group, whether or not the overpayment occurred
				  because of an IHE, an AE, or an IPV.
A.
Claim recovery:
(1) All adult eligibility determination group
				members will be jointly liable for any overpayment of benefits to the
				eligibility determination group.
(2) A claim will be established against any
				or all of the adult members of an eligibility determination group at the time
				an overpayment occurred.
(3) A
				claim will be established against any eligibility determination group that
				contains an adult member who was an adult member of another eligibility
				determination group that received more benefits than it was entitled to
				receive.
(4) The earned income
				deduction of twenty percent (20%) is not allowed when determining an
				overpayment due to the failure of an eligibility determination group to report
				earned income in a timely manner.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 100 - GENERAL PROVISIONS FOR PUBLIC ASSISTANCE PROGRAMS › Part 640 - RESTORATION AND CLAIMS › Section 8.100.640.12 - CALCULATING THE AMOUNT OF THE ERROR (CALCULATING CLAIMS)

Current through Register Vol. 35, No. 13, July 16, 2024
A.
SNAP:
(1)
Calculating the claim for an IHE
				and AE:
For each month that benefits have been over-issued to an
				eligibility determination group because of an IHE or AE, the department shall
				determine the correct benefit amount the eligibility determination group was
				entitled to receive.
(a) The total amount of
				the claim is calculated, based at a minimum, on the monthly overpayment amount
				which occurred during the twelve (12) months preceding the date the overpayment
				was discovered.
(b) The department
				shall calculate the amount of the claim back to the month the error occurred
				regardless of the length of time that elapsed until the error was
				discovered.
(c) The department
				shall not include in the calculation any overpayment amount that occurred in a
				month more than six (6) years before the date the overpayment was
				discovered.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 100 - GENERAL PROVISIONS FOR PUBLIC ASSISTANCE PROGRAMS › Part 640 - RESTORATION AND CLAIMS › Section 8.100.640.13 - RECOVERY (COLLECTION ACTION)

Current through Register Vol. 35, No. 13, July 16, 2024
The department shall initiate collection action by sending
				  the eligibility determination group an overpayment notice.
A.
Adverse action notice:
If
				the amount of the claim was not established by a fair hearing decision, the
				eligibility determination group will be provided with an adverse action notice.
				The adverse action notice is sent on all claims established after March 26,
				1990 and on any preexisting claims if at any time after March 26, 1990 a
				follow-up demand letter is sent on the claim. A one-time adverse action notice
				that informs the eligibility determination group that it has ninety (90) days
				to appeal the amount of the claim will satisfy notice requirements.
B.
Demand letter:
Collection
				action is initiated by sending the eligibility determination group a demand
				letter. The demand letter informs the eligibility determination group of the
				claim amount, the reason for the claim, time period for which there is a claim,
				any offset that reduces the claim and how the eligibility determination group
				may pay the claim. The first demand letter to a participating eligibility
				determination group shall inform the eligibility determination group:
(1) that unless the eligibility determination
				group selects an acceptable method of payment and informs the department within
				the specified time limit, or timely requests a fair hearing and continued
				benefits, their SNAP benefit amount will be reduced;
(2) that benefit reduction will affect the
				eligibility determination group's monthly benefits, only if the department has
				not otherwise informed the eligibility determination group;
(3) that if the eligibility determination
				group timely selects an acceptable benefit reduction amount, the reduction will
				begin with the first benefit month that is issued after the
				selection;
(4) that if the
				eligibility determination group fails to make a timely selection or fails to
				request a fair hearing and continued benefits, the benefit reduction will be
				effective with the first benefit issued after timely notice of such selection
				or request for hearing is due to the department; and
(5) advise the eligibility determination
				group of any individual or organization that provides free legal
				representation.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 100 - GENERAL PROVISIONS FOR PUBLIC ASSISTANCE PROGRAMS › Part 640 - RESTORATION AND CLAIMS › Section 8.100.640.14 - METHODS FOR COLLECTING OVERPAYMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Recoupment:
The department
				shall retain the value of benefits collected to repay a claim against a
				participating eligibility determination group, whether or not the claim
				occurred because of an IHE, an AE, or an IPV. The eligibility determination
				group's monthly SNAP or cash assistance benefit amount will be reduced to
				recover any amount of a claim that was not repaid through a lump sum cash or
				SNAP benefit payment, unless a payment schedule has been negotiated with the
				eligibility determination group. Collection of a claim by the department may
				also be obtained through recoupment of unemployment compensation benefits,
				federal pay, income tax intercepts, or any other method established by the
				department.
(1)
Recoupment from monthly
				benefit allotments:
A claim may be recovered from an eligibility
				determination group currently participating in SNAP or cash assistance programs
				by reducing the eligibility determination group's monthly benefit
				allotment.
(2)
Recoupment
				amount:
The amount of benefits that will be recovered each month through
				benefit reduction will be determined by one the following methods.
(a)
SNAP IHE and AE:
The amount
				of reduction will be ten percent (10%) of the eligibility determination group's
				monthly SNAP benefit amount, or ten dollars ($10) per month, or the agreed
				amount, whichever is greater.
(b)
SNAP IPV:
The SNAP benefit amount to be recovered will be twenty
				percent (20%) of the eligibility determination group's monthly SNAP benefit
				amount, or twenty dollars ($20) per month, or the agreed amount, whichever is
				greater.
(c)
Cash assistance
				errors:
The cash assistance benefit amount to be recouped is equal to
				fifteen percent (15%) of the eligibility determination group's payment
				standard.
(d) Recoupment is the
				last step in the calculation prior to determining the monthly benefit
				amount.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 100 - GENERAL PROVISIONS FOR PUBLIC ASSISTANCE PROGRAMS › Part 640 - RESTORATION AND CLAIMS › Section 8.100.640.15 - TERMINATING OVERPAYMENT CLAIMS

Current through Register Vol. 35, No. 13, July 16, 2024
A terminated claim is a claim in which all collection action
				  has ceased. The department may terminate a claim for any of the reasons
				  described in Subsections A through E of this section. SNAP, LIHEAP, TANF, AFDC,
				  GA and refugee cash assistance and support services for participation in the
				  SNAP and TANF work programs can be terminated.
A.
Invalid claims:
The
				overpayment is determined to be invalid based on an administrative hearing
				decision, a court decision or a department determination that the claim was
				established in error.
B.
Death:
All adult members responsible for repayment of the claim are
				deceased.
C.
Cost
				effectiveness:
The department has determined that the cost of further
				collection action is likely to exceed the amount that can be recovered because:
(1) the cumulative amount of all existing
				claims against the eligibility determination group equals twenty-five dollars
				($25) or less; and
(2) a payment on
				the claim has not been received by the department in at least ninety (90)
				days.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 100 - GENERAL PROVISIONS FOR PUBLIC ASSISTANCE PROGRAMS › Part 640 - RESTORATION AND CLAIMS › Section 8.100.640.16 - WRITING OFF A CLAIM

Current through Register Vol. 35, No. 13, July 16, 2024
Writing off a claim means that the claim is no longer
				  considered a receivable subject to any federal or state collection requirements
				  such as the Treasury Offset Program at 31 CFR 285 or the Supplemental Nutrition
				  Assistance Program at
				  7 CFR
				  273.18. A claim may be written off if the
				  claim is at least six (6) years old and at least one of the provisions of
				  Subsections A through E of
				  8.100.640.15
				  NMAC apply. Only SNAP, LIHEAP and NMW cash assistance claims may be written
				  off.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 100 - GENERAL PROVISIONS FOR PUBLIC ASSISTANCE PROGRAMS › Part 640 - RESTORATION AND CLAIMS › Section 8.100.640.17 - EBT ADJUSTMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
EBT adjustment pertains to any EBT transaction resulting in
				  a change to a client's cash or snap benefits. If a system error causes a
				  customer to receive funds to which they were not entitled or causes their
				  account to not be charged for an EBT transaction, an adjustment may be
				  completed to reclaim the funds or settle the transaction.
A.
Client-initiated adjustments:
The department must act on all requests for adjustments made by client
				households within 90 calendar days of the error transaction.
(1) For SNAP the department has 10 business
				days from the date the household notifies it of the error to investigate and
				reach a decision on an adjustment and move funds into the client account.
(2) For cash the department has 20
				business days from the date the household notifies it of the error to
				investigate and reach a decision on an adjustment and move funds into the
				client account.
(3) These
				timeframes also apply if the department or entity other than the household
				discovers a system error that requires a credit adjustment to the household.
				Business days are defined as calendar days other than Saturdays, Sundays, and
				federal holidays.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 100 - GENERAL PROVISIONS FOR PUBLIC ASSISTANCE PROGRAMS › Part 640 - RESTORATION AND CLAIMS › Section 8.100.640.18 - DORMANT BENEFIT ACCOUNTS

Current through Register Vol. 35, No. 13, July 16, 2024
Stale benefit accounts are those SNAP and cash assistance
				  accounts that have not been accessed for 90 days from the most recent date of
				  withdrawal.
A.
Offline
				accounts:
If EBT accounts are not accessed for 90 days, the department
				may store such benefits in an offline account.
(1)
Notification:
The department
				shall notify the eligibility determination group of this action before storing
				benefits in an offline account and how to reactivate the account.
(2)
Reinstatement:
An adult
				eligibility determination group member or authorized representative may contact
				the department or the EBT customer service help desk and request reinstatement
				of their EBT account.
(a)
SNAP:
SNAP benefits may be restored within 274 days of the initial date of benefit
				activity. Initial date of benefit activity is the first deposit made to the
				account upon initial approval of the eligibility determination group's
				benefits.
(b)
Cash
				assistance:
Cash assistance benefits may be restored within 364 days of
				the initial date of benefit activity. Initial date of benefit activity is the
				first deposit made to the account upon initial approval of the eligibility
				determination group's benefits.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 100 - GENERAL PROVISIONS FOR PUBLIC ASSISTANCE PROGRAMS › Part 970 - OVERSIGHT - PROGRAM PARTICIPATION HEARINGS › Section 8.100.970.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
A. Section
				27 NMSA 1978 (1992 Repl.) provides for the department to "...adopt, amend and
				repeal bylaws, rules and regulations..." It also provides for administration of
				public assistance programs.
B. The
				income support division (ISD) of the Health Care Authority (HCA) was created by
				the HSD secretary under authority granted by Paragraph (3) of Subsection B of
				Section 9-8-6 NMSA 1978.
C. The New
				Mexico health insurance exchange (NMHIX) was established by Section 59A-23F-1
				of NMSA 1978
et al
. Pursuant to
				45 CFR
				155.505(c) and
				155.510(a), NMHIX
				has designated to the New Mexico health care authority the authority to conduct
				fair hearings of NMHIX eligibility appeals pursuant to 45 CFR 155 Subpart
				F.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 100 - GENERAL PROVISIONS FOR PUBLIC ASSISTANCE PROGRAMS › Part 970 - OVERSIGHT - PROGRAM PARTICIPATION HEARINGS › Section 8.100.970.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
November 27, 2013, unless a later date is cited at the end of
				  a section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 100 - GENERAL PROVISIONS FOR PUBLIC ASSISTANCE PROGRAMS › Part 970 - OVERSIGHT - PROGRAM PARTICIPATION HEARINGS › Section 8.100.970.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of these regulations is to provide general
				  policy and procedures for the public assistance programs administered by the
				  department, as well as policy and procedures for the department to conduct
				  hearings for claimants of adverse actions by NMHIX.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 100 - GENERAL PROVISIONS FOR PUBLIC ASSISTANCE PROGRAMS › Part 970 - OVERSIGHT - PROGRAM PARTICIPATION HEARINGS › Section 8.100.970.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Agency
				review conference (ARC):
means an optional conference offered by the
				department to households adversely affected by a department action that is
				normally held prior to a fair hearing. An ARC may be attended by all parties
				responsible for and affected by the adverse action taken by the department,
				including but not limited to, the ISD field office staff, the child support
				enforcement division (CSED), a New Mexico works (NMW) representative and the
				household or its authorized representative for the purpose of informally
				resolving the dispute. The ARC is optional and shall in no way delay or replace
				the fair hearing process. This subsection does not apply to appeals of adverse
				actions by NMHIX.
B.
Authorized representative:
means an individual designated by a
				household to represent and act on its behalf during the fair hearing process.
				The household must provide formal documentation authorizing the named
				individual(s) 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 ad litem, or any other individual(s) designated by the
				household.
C.
Claimant or
				Appellant:
means the household requesting a fair hearing that is
				claiming to be adversely affected by an action(s) taken by the department or
				NMHIX.
D.
Informal resolution
				process:
means an opportunity for informal resolution between NMHIX and
				a household adversely affected by an NMHIX action in accordance with the
				requirements of
				45 CFR §
										155.535(a). The informal
				resolution process happens prior to a fair hearing. The appellant's right to a
				hearing is preserved in any case in which the appellant remains dissatisfied
				with the outcome of the informal resolution process. If the appeal does not
				advance to a hearing, the informal resolution is final and binding.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 100 - GENERAL PROVISIONS FOR PUBLIC ASSISTANCE PROGRAMS › Part 970 - OVERSIGHT - PROGRAM PARTICIPATION HEARINGS › Section 8.100.970.8 - FAIR HEARINGS

Current through Register Vol. 35, No. 13, July 16, 2024
A. A
				household aggrieved by an adverse action taken by the department or NMHIX that
				affects the participation of the household in a department administered public
				assistance program or in the New Mexico health insurance exchange, if
				applicable, may appeal the department's or NMHIX's decision by requesting a
				fair hearing in accordance with federal and state laws and regulations.
(1) Medicaid recipients wanting to request a
				fair hearing due to termination, modification, reduction or suspension of
				services must do so in accordance with any applicable federal and state laws
				and regulations, including
				8.200.430.12
				NMAC and 8.352 NMAC, et seq.
(2)
				Fair hearings related to adverse actions by NMHIX shall be held in accordance
				with any applicable federal and state laws and regulations, including those set
				forth in 45 CFR 155 Subpart F.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 100 - GENERAL PROVISIONS FOR PUBLIC ASSISTANCE PROGRAMS › Part 970 - OVERSIGHT - PROGRAM PARTICIPATION HEARINGS › Section 8.100.970.9 - THE HEARING PROCESS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Initiation of the hearing process:
(1) A request for a fair hearing can be made
				by the claimant or an authorized representative orally or in writing.
(2) If a claimant requests a fair hearing
				orally, the department shall take such actions as are necessary to initiate the
				fair hearing process.
(3) The fair
				hearings bureau shall promptly send written acknowledgement to the claimant and
				the authorized representative upon its receipt of a written or oral hearing
				request.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 100 - GENERAL PROVISIONS FOR PUBLIC ASSISTANCE PROGRAMS › Part 970 - OVERSIGHT - PROGRAM PARTICIPATION HEARINGS › Section 8.100.970.10 - PRE-HEARING PROCEDURE

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Notice of hearing:
Unless the claimant or authorized
				representative requests an expedited scheduling of a fair hearing, the fair
				hearings bureau shall provide written notice of the scheduling of a fair
				hearing to all parties not less than 10 calendar days prior to date of the fair
				hearing, or not less than 15 calendar days prior to the date of the fair
				hearing if the hearing involves an adverse action by the New Mexico health
				insurance exchange (NMHIX). The notice of hearing shall include:
(1) the date, time and place of the
				hearing;
(2) the name, address and
				phone number of the hearing officer;
(3) information regarding the fair hearing
				process and the procedures to be followed by the respective parties;
(4) the right of the claimant and the
				authorized representative to receive a copy of the SOE and any document, not
				specifically prohibited by federal and state law and regulation, contained in
				the claimant's case record in order to prepare for the fair hearing in
				accordance with Subsection B of
				8.100.970.8
				NMAC;
(5) notice that the appeal
				will be dismissed if the claimant or the authorized representative fails to
				appear without good cause;
(6)
				information about resources in the community that may provide free legal
				assistance with the fair hearing process; and
(7) notice that the department will not pay
				for any costs of the claimant or authorized representative, including legal
				counsel, that are incurred in the preparation for, or attendance at, an ARC,
				fair hearing or judicial appeal.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 100 - GENERAL PROVISIONS FOR PUBLIC ASSISTANCE PROGRAMS › Part 970 - OVERSIGHT - PROGRAM PARTICIPATION HEARINGS › Section 8.100.970.11 - HEARING STANDARDS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Rights during the fair hearing:
The claimant or authorized representative shall be given an
				  opportunity to:
(1) examine the SOE and
				case record prior to, and during, the hearing in accordance with Subsection B
				of
				8.100.970.8
				NMAC;
(2) present their case or
				have it presented by an authorized representative;
(3) introduce witnesses;
(4) establish all pertinent facts and
				circumstances;
(5) advance any
				arguments without undue interference; and
(6) question or refute any testimony or
				evidence, including an opportunity to confront and cross-examine the
				department's witnesses.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 100 - GENERAL PROVISIONS FOR PUBLIC ASSISTANCE PROGRAMS › Part 970 - OVERSIGHT - PROGRAM PARTICIPATION HEARINGS › Section 8.100.970.12 - CONDUCTING THE FAIR HEARING

Current through Register Vol. 35, No. 13, July 16, 2024
A fair hearing is conducted in an orderly manner and in an
				  informal atmosphere. The fair hearing is not open to the public. The fair
				  hearing is conducted by telephone, unless the claimant or the authorized
				  representative makes a special request for the fair hearing to be held in
				  person and the request is justified by special circumstances, as determined by
				  the hearing officer on a case-by-case basis. In cases involving NMHIX, the fair
				  hearings shall also be conducted in accordance with
				  45 CFR
				  155.535(c)-(f).
A.
Opening the fair hearing:
The
				fair hearing is opened by the hearing officer who will explain the telephonic
				fair hearing procedures to all present at the fair hearing. The hearing officer
				will then explain their role in the proceedings, and that the final fair
				hearing decision on the issue(s) appealed will be made by the appropriate
				department division director after review of the hearing officer's report and
				recommendation, including the fair hearing record. On the record, the
				individuals present are asked to identify themselves, the order of testimony is
				explained, the oath is administered to all witnesses who will testify during
				the hearing, the issue is identified, and all pleadings, papers, and requests,
				including but not limited to, the SOE and any evidence being presented, will be
				identified and entered into the record with any objections handled in
				accordance with applicable federal and state laws and regulations.
B.
Order of testimony:
The order
				of testimony is as follows:
(1)
Presentation of the department's case:
The department or NMHIX
				will present its case and the evidence, including testimony and exhibits, in
				support of the adverse action taken against the household, and:
(a) the claimant or authorized representative
				may cross-examine the department representative;
(b) the hearing officer may ask further
				clarifying questions; and
(c) if
				the department calls other witnesses, the order of examination of each witness
				is as follows:
(i) direct testimony by the
				witness(es);
(ii) cross-examination
				by the claimant or the authorized representative; and
(iii) examination or further clarifying
				questions by the hearing officer or, if requested, follow up questions from the
				department representative.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 100 - GENERAL PROVISIONS FOR PUBLIC ASSISTANCE PROGRAMS › Part 970 - OVERSIGHT - PROGRAM PARTICIPATION HEARINGS › Section 8.100.970.13 - FAIR HEARING DECISION

Current through Register Vol. 35, No. 13, July 16, 2024
The final fair hearing decision shall be made by the
				  appropriate department division director after review of the fair hearing
				  record and the hearing officer's report and recommendation.
A.
Hearing officer
				recommendation:
The hearing officer reviews the record of the fair
				hearing and all appropriate regulations, and evaluates the testimony and
				evidence admitted during the hearing. The hearing officer submits the complete
				record of the fair hearing, along with the hearing officer's report and
				recommendation, in a standard format to the appropriate division director(s)
				within 15 days of the hearing, or sooner, to ensure the timeframes set forth in
				Paragraph (2) of Subsection B of
				8.100.970.9
				NMAC are met.
B.
Content of
				recommendation:
The hearing officer specifies the reason(s) for all
				factual conclusions, identifies the supporting evidence, references the
				relevant federal and state laws and regulations, along with appropriate
				department policy and procedural guidance, and responds to the arguments of the
				parties in a written report and recommendation. The hearing officer shall
				submit a recommendation:
(1) in favor of the
				claimant when the adverse action taken by the department is not supported by a
				preponderance of the evidence available as a result of the fair
				hearing;
(2) in favor of the
				department when the preponderance of the evidence, available as a result of the
				fair hearing, supports the adverse action taken by the department is in
				accordance with federal and state laws and regulations; or
(3) any other result supported by the fair
				hearing record.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 100 - GENERAL PROVISIONS FOR PUBLIC ASSISTANCE PROGRAMS › Part 970 - OVERSIGHT - PROGRAM PARTICIPATION HEARINGS › Section 8.100.970.14 - IMPLEMENTATION OF DECISION

Current through Register Vol. 35, No. 13, July 16, 2024
Unless stayed by court order, the department's final fair
				  hearing decision is binding on all issues that have been the subject of the
				  fair hearing as to that claimant. The local county office is responsible for
				  assuring that decisions are implemented within the timeframes specified below.
				  The final fair hearing decision serves as advanced notice for changes in
				  benefits or services.
A.
Decision favorable to the department:
If assistance or benefits
				have been continued pending the outcome of the fair hearing and the decision is
				favorable to the department, the department shall take immediate action to
				adjust the payment and submit a claim for the excess benefit amount(s) paid
				pending the outcome of the fair hearing.
B.
Decision favorable to the
				claimant:
(1)
Cash assistance
				programs:
When a fair hearing decision is favorable to the claimant, the
				department authorizes corrective payment. For incorrectly denied cases,
				corrected benefits are issued retroactively in the following manner:
(a) to the date of adverse action or to the
				30th day from the application date, whichever is earlier; or
(b) to the first day of the month that the
				case is actually eligible for benefits;
(c) for ongoing cases, the corrected cash
				assistance payments are retroactive to the first day of the month that the
				incorrect action became effective.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 100 - GENERAL PROVISIONS FOR PUBLIC ASSISTANCE PROGRAMS › Part 970 - OVERSIGHT - PROGRAM PARTICIPATION HEARINGS › Section 8.100.970.15 - JUDICIAL REVIEW

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Right
				of appeal
If a final fair hearing decision upholds the department's or
				  NMHIX's original action, the claimant has the right to pursue judicial review
				  of the final fair hearing decision and is notified of that right in the
				  department's final fair hearing decision. In matters involving NMHIX, the
				  claimant may submit a second-tier appeal to the United States department of
				  health and human services and is notified of that right in the department's
				  final fair hearing decision.
B.
Timeliness:
(1)
SNAP, LIHEAP, general assistance
				(GA), and medical assistance programs:
Unless otherwise provided by law,
				within 30 days of the issuance of the department's final fair hearing decision,
				the claimant may appeal the final fair hearing decision by filing a notice of
				appeal with the appropriate district court pursuant to the provisions of
				Section
				39-3-1.1
				NMSA 1978.
(2)
NMW:
Unless otherwise provided by law, within 30 days of the issuance of the
				department's final fair hearing decision, the claimant may appeal the final
				fair hearing decision by filing a notice of appeal with the court of appeals
				pursuant to the provisions of Section
				27-2B-13
				NMSA 1978.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 102 - CASH ASSISTANCE PROGRAMS › Part 100 - RECIPIENT POLICIES -GENERAL RECIPIENT REQUIREMENTS › Section 8.102.100.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
A. New
				Mexico Statutes Annotated 1978 (Chapter 27, Articles 1 and 2) authorize the
				state to administer the aid to families with dependent children (AFDC), general
				assistance (GA), shelter care supplement, the burial assistance programs and
				such other public welfare functions as may be assumed by the state.
B. Federal legislation contained in the
				Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of
				1996 abolished the AFDC program. The federal act created the temporary
				assistance for needy families (TANF) block grant under Title IV of the Social
				Security Act. Through the New Mexico Works Act of 1998, the New Mexico works
				(NMW) program was created to replace the AFDC program.
C. Under authority granted to the governor by
				the federal Social Security Act, the health care authority (HCA) is designated
				as the state agency responsible for the TANF program in New Mexico.
D. Effective April 1, 1998, in accordance
				with the requirements of the New Mexico Works Act and Title IV-A of the federal
				Social Security Act, the department is creating the New Mexico works program as
				one of its cash assistance programs.
E. In close coordination with the NMW
				program, the department administers the food stamp employment and training
				program (E&T) pursuant to the Food Security Act of 1985 and federal
				regulations at Title 7, Code of Federal Regulations.
F. Section 9-8-1 et seq. NMSA 1978
				establishes the health care authority 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 102 - CASH ASSISTANCE PROGRAMS › Part 100 - RECIPIENT POLICIES -GENERAL RECIPIENT REQUIREMENTS › Section 8.102.100.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
November 1, 2023, unless a later date is cited at the end of
				  a section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 102 - CASH ASSISTANCE PROGRAMS › Part 100 - RECIPIENT POLICIES -GENERAL RECIPIENT REQUIREMENTS › Section 8.102.100.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
A. The purpose of
				the New Mexico works (NMW) program is to improve the quality of life for
				parents and children by increasing family income, resources and support. The
				further purpose of the program is to increase family income through family
				employment and child support and by utilizing cash assistance as a support
				service to enable and assist parents to participate in employment.
B. The objective of education works program
				(EWP) is to provide cash assistance to a benefit group where at least one
				individual is enrolled in a post-secondary, graduate or post-graduate
				institution. Education and training are essential to long-term career
				development. The applicant or recipient benefit group would be otherwise
				eligible for NMW cash assistance, but chooses to participate in EWP.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 102 - CASH ASSISTANCE PROGRAMS › Part 100 - RECIPIENT POLICIES -GENERAL RECIPIENT REQUIREMENTS › Section 8.102.100.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Definitions beginning with "A":
(1)
Applicant:
means person
				applying for cash assistance on behalf of a benefit group.
(2)
Application:
means a written
				or electronic request, on the appropriate ISD form, with the signature of the
				applicant or on the applicant's behalf by an authorized representative, for
				assistance.
(3)
Attendant:
means an individual needed in the home for medical,
				housekeeping, or childcare reasons.
(4)
Authorized representative:
means an adult, who is designated in writing by the applicant, who is
				sufficiently knowledgeable about the applicant/ benefit group's circumstances
				to complete the application form correctly and can represent the benefit
				group.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 102 - CASH ASSISTANCE PROGRAMS › Part 100 - RECIPIENT POLICIES -GENERAL RECIPIENT REQUIREMENTS › Section 8.102.100.8 - ABBREVIATIONS AND ACRONYMS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
ABBREVIATIONS AND ACRONYMS beginning with "A": AFDC:
aid to
				families with dependent children (replaced by TANF effective July 1,
				1997).
B.
ABBREVIATIONS AND
				ACRONYMS beginning with "B":
(1)
BG:
benefit group;
(2)
BIA:
bureau of Indian affairs;
(3)
BIA-GA:
bureau of Indian
				affairs-general assistance.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 102 - CASH ASSISTANCE PROGRAMS › Part 110 - GENERAL OPERATING POLICIES - APPLICATIONS › Section 8.102.110.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
A.
				Articles 1 and 2 of Chapter 27, NMSA 1978 authorize the state to administer the
				aid to families with dependent children (AFDC), general assistance (GA),
				shelter care supplement, the burial assistance programs and such other public
				welfare functions as may be assumed by the state.
B. Federal legislation contained in the
				Personal Responsibility and Work Opportunity Reconciliation Act of 1996
				abolished the AFDC program. The federal act created the temporary assistance
				for needy families (TANF) block grant under Title IV of the Social Security
				Act. Through the New Mexico Works Act of 1998, the New Mexico works program was
				created to replace the aid to families with dependent children
				program.
C. Under authority granted
				to the governor by the federal Social Security Act, the health care authority
				(HCA) is designated as the state agency responsible for the TANF program in New
				Mexico.
D. Effective April 1, 1998,
				in accordance with the requirements of the New Mexico Works Act and Title IV-A
				of the federal Social Security Act, the HCA is creating the New Mexico works
				program as one of its cash assistance programs.
E. In close coordination with the NMW
				program, the HCA administers the food stamp employment and training program
				(E&T) pursuant to the Food Security Act of 1985 and federal regulations at
				Title 7, Code of Federal Regulations.
F. Section 9-8-1 et seq. NMSA 1978
				establishes the health care authority (HCA) as a single, unified authority 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 102 - CASH ASSISTANCE PROGRAMS › Part 110 - GENERAL OPERATING POLICIES - APPLICATIONS › Section 8.102.110.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
July 1, 2024, unless a later date is cited at the end of a
				  section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 102 - CASH ASSISTANCE PROGRAMS › Part 110 - GENERAL OPERATING POLICIES - APPLICATIONS › Section 8.102.110.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
A. The purpose of
				the New Mexico works (NMW) program is to improve the quality of life for
				parents and children by increasing family income, resources and support. The
				further purpose of the program is to increase family income through family
				employment and child support and by utilizing cash assistance as a support
				service to enable and assist parents to participate in employment.
B. The objective of the education works
				program (EWP) is to provide cash assistance to a benefit group where at least
				one individual is enrolled in a post-secondary, graduate or post-graduate
				institution. Education and training are essential to long-term career
				development. The applicant or recipient benefit group would be otherwise
				eligible for NMW cash assistance, but chooses to participate in EWP.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 102 - CASH ASSISTANCE PROGRAMS › Part 110 - GENERAL OPERATING POLICIES - APPLICATIONS › Section 8.102.110.8 - GENERAL

Current through Register Vol. 35, No. 13, July 16, 2024
A. Application
				form: The application shall be submitted on a form designated by the HCA either
				electronically or in writing and is made under oath by an applicant with whom a
				dependent child resides. The HCA shall assist an applicant in completing the
				application for cash assistance or services. The application must contain a
				statement of the age of the child; residence; a statement of property in which
				the applicant has an interest; a statement of the income that the applicant or
				other benefit group members have at the time the application is filed; a
				signature under penalty of perjury from the applicant; and other information
				required by the HCA.
B. Interview:
(1) A face-to-face interview with the
				applicant shall be required in order to obtain information needed to the
				determine eligibility, verify, and record the facts supporting the application;
				and to give the applicant information about HCA programs and program
				requirements. When circumstances warrant, the household shall be interviewed by
				telephone or another place reasonably accessible and agreeable to by the
				applicant and the caseworker in accordance with
				8.102.110.11 NMAC.
(2) The applicant must identify all
				individuals living in the residence whether or not the individuals are
				requesting assistance. The applicant and the HCA shall identify all individuals
				who must be included in the benefit group.
(3) Other information, documents, and
				collateral contacts may be required to determine eligibility. Requests for
				verification are made in accordance with provisions set forth in 8.100.130
				NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 102 - CASH ASSISTANCE PROGRAMS › Part 110 - GENERAL OPERATING POLICIES - APPLICATIONS › Section 8.102.110.9 - RIGHT TO APPLY

Current through Register Vol. 35, No. 13, July 16, 2024
A. An
				individual has the right to make a formal application for any cash, food or
				medical assistance program administered by the HCA, regardless of whether the
				individual appears to meet the conditions of eligibility. Any individual
				requesting information or assistance, who wishes to apply for assistance, shall
				be encouraged to complete the application that same day. The individual shall
				be informed:
(1) of the right to apply,
				whether or not it appears the individual may be found eligible; and
(2) that the date of application affects the
				benefits.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 102 - CASH ASSISTANCE PROGRAMS › Part 110 - GENERAL OPERATING POLICIES - APPLICATIONS › Section 8.102.110.10 - SUBMISSION OF THE APPLICATION FORM

Current through Register Vol. 35, No. 13, July 16, 2024
A. Items completed: To be accepted and
				registered, the cash assistance application, at a minimum, must be submitted on
				a form designated by the HCA either electronically or in writing, identify the
				benefit group member applying, the program applied for, and have a signature of
				a responsible benefit group member or authorized representative.
B. Who completes the application: The
				application form must be completed by the applicant, an authorized
				representative, guardian, or another appropriate individual.
(1) Authorized representatives must be:
(a) designated in writing by the applicant/
				head of household; and
(b) be an
				adult who has sufficient knowledge about the applicant's circumstances to
				complete the application form correctly.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 102 - CASH ASSISTANCE PROGRAMS › Part 110 - GENERAL OPERATING POLICIES - APPLICATIONS › Section 8.102.110.11 - INTERVIEWS

Current through Register Vol. 35, No. 13, July 16, 2024
A. Application
				interview: All applicants shall be interviewed in person at the local office
				or, when circumstances warrant, at another place reasonably accessible and
				agreeable to both the applicant and the caseworker. The applicant may bring any
				individual to the interview.
B.
				Alternative interviews:
(1) A cash assistance
				applicant shall not be required to have a face-to-face interview if the
				applicant is unable to appoint an authorized representative and the household
				has no member(s) able to come to the HCA due to one of the hardship conditions
				listed in Paragraph (2) of Subsection B of this section.
(2) Hardship conditions: The face-to-face
				interview for cash assistance households shall be waived when the applicant
				meets one of the following conditions:
(a)
				over the age of 60;
(b)
				disabled;
(c) employed 20 or more
				hours per week;
(d) has
				transportation difficulties;
(e)
				prolonged severe weather;
(f) other
				hardship identified as situations warrant; as authorized by the county
				director.
(3) A
				face-to-face interview must be granted to any recipient who requests one. If
				the recipient is unable to come to the office due to the issues listed in
				Paragraph (1) or (2) of this subsection, then an interview may be scheduled at
				a location agreed upon by the caseworker and the applicant.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 102 - CASH ASSISTANCE PROGRAMS › Part 110 - GENERAL OPERATING POLICIES - APPLICATIONS › Section 8.102.110.12 - APPLICATION PROCESSING TIME LIMITS

Current through Register Vol. 35, No. 13, July 16, 2024
A. Timeliness: The caseworker shall explain
				time limits and the applicant's right to request an administrative hearing if
				the application is not processed within the applicable time limits.
B. Processing time limit: Cash assistance
				applications shall be completed within 30 calendar days from the date of
				application.
C. "Clocking" of time
				limits: "Clocking" of time limits begins on the day after the date of
				application.
D. Delayed assistance:
				If an eligibility determination is not made within the required time limits,
				the applicant shall be notified in writing of the reason for the delay. The
				notice shall also inform the applicant of the applicant's right to request an
				administrative hearing regarding the issue of ISD's failure to act within the
				time limits.