reglab/statecodes huggingface dataset:
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 248 - MEDICAID ELIGIBILITY - MEDICARE DRUG COVERAGE (CATEGORY 048) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.248.500.11 - RESOURCE STANDARDS

Current through Register Vol. 35, No. 13, July 16, 2024
A "resource" is defined as cash and other assets that can be
				  converted to cash within 20 days.
A.
				Resource determination: The resource determination is made as of the first
				moment of the first day of the month. An applicant/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/recipient until the following
				month becomes a resource.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 248 - MEDICAID ELIGIBILITY - MEDICARE DRUG COVERAGE (CATEGORY 048) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.248.500.12 - APPLICABLE RESOURCE STANDARDS

Current through Register Vol. 35, No. 13, July 16, 2024
The resource standard for the LIS is $10,000 for an
				  individual and $20,000 for a couple. Resources belonging to other dependent
				  family members are not considered.
A.
				Cash resources: The face value of cash, savings or checking accounts is
				considered in determining LIS eligibility.
(1)
				An applicant/recipient must provide verification of the value of all cash
				resources. The resource value of a bank account is customarily verified by a
				statement from the bank showing the account balance as of the first moment of
				the first day of the month in question. If an applicant/recipient cannot
				provide this verification, the ISD worker sends a bank or postal savings
				clearance to the appropriate institution(s).
(2) If the applicant/recipient can
				demonstrate that a check was written and delivered to a payee but not cashed by
				the payee prior to the first moment of the first day of the month, the amount
				of that check is subtracted from the applicant/recipient's checking account
				balance to arrive at the amount to be considered a countable
				resource.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 248 - MEDICAID ELIGIBILITY - MEDICARE DRUG COVERAGE (CATEGORY 048) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.248.500.13 - COUNTABLE RESOURCES

Current through Register Vol. 35, No. 13, July 16, 2024
Before a resource can be considered countable, the three
				  criteria listed below must be met.
A.
				Ownership interest: An applicant/recipient must have an ownership interest in a
				resource for it to be countable. The fact that an applicant/recipient has
				access to a resource, or has a legal right to use it, does not make it
				countable unless the applicant/recipient also has an ownership interest in
				it.
B. Legal right to convert
				resource to cash: An applicant/recipient must have the legal ability to spend
				the funds or to convert non-cash resources into cash.
(1) Physical possession of resource: The fact
				that an applicant/recipient does not have physical possession of a resource
				does not mean it is not 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/recipient is considered to have free access to the
				unrestricted use of a resource even if he can take those actions only through
				an agent, such as a representative payee or guardian.
(3) If there is a legal bar to the sale of a
				resource, such as a co-owner legally blocking the sale of jointly owned
				property, the resource is not countable. The applicant/recipient is not
				required to undertake litigation in order to accomplish the sale.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 248 - MEDICAID ELIGIBILITY - MEDICARE DRUG COVERAGE (CATEGORY 048) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.248.500.14 - RESOURCE EXCLUSIONS

Current through Register Vol. 35, No. 13, July 16, 2024
The following resources are not to be considered for purposes
				  of determining LIS eligibility:
A.
				Applicant's home: A home is any property in which the applicant and spouse have
				an ownership interest and which serves as the applicant's principal place of
				residence. There is no restriction on acreage of home property. This property
				includes the shelter in which an individual resides, the land on which the
				shelter is located, and any outbuildings.
B. Non-liquid resources, other than real
				property: These include, but are not limited to:
(1) household goods and personal
				effects;
(2) automobiles, trucks,
				tractors and other vehicles;
(3)
				machinery and livestock; and
(4)
				non-cash business property.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 248 - MEDICAID ELIGIBILITY - MEDICARE DRUG COVERAGE (CATEGORY 048) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.248.500.15 - INCOME STANDARDS

Current through Register Vol. 35, No. 13, July 16, 2024
Income is anything the applicant/spouse receives in cash or
				  in-kind that can be used to meet their needs for food or shelter. The gross
				  income of the applicant, and their spouse if living together, but not dependent
				  family members, will be considered. However, dependent family members will be
				  counted in the family size.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 248 - MEDICAID ELIGIBILITY - MEDICARE DRUG COVERAGE (CATEGORY 048) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.248.500.16 - EARNED INCOME

Current through Register Vol. 35, No. 13, July 16, 2024
A. Earned
				income:
Earned income consists of the following types of
				  payments:
(1) wages counted at the
				earliest of: when received, when credited to the person employed, or when set
				aside for the employee's use;
(2)
				net earnings from self-employment counted on a taxable year basis; net losses,
				if any, are deducted from other earned income, but not from unearned
				income;
(3) payments for services
				performed in a sheltered workshop or work activities center counted when
				received or set aside for the employee's use;
(4) royalties earned by an individual in
				connection with any publication of their work and any honoraria received for
				services rendered; and
(5) in-kind
				earned income is counted based on current market value. If the applicant/
				spouse receives an item that is not fully paid for and they are responsible for
				the balance, only the paid up value is income to the applicant.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 248 - MEDICAID ELIGIBILITY - MEDICARE DRUG COVERAGE (CATEGORY 048) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.248.500.17 - UNEARNED INCOME

Current through Register Vol. 35, No. 13, July 16, 2024
Unearned income is all income that is not earned income.
				  Unearned income is counted at the earliest of the following points: when
				  received, when credited to the recipient, or when set aside for the recipient's
				  use.
A. Unearned income includes, but
				is not limited to:
(1) social
				security;
(2) railroad
				retirement;
(3) veterans
				benefits;
(4) temporary assistance
				for needy families (TANF);
(5)
				pensions;
(6) annuities;
(7) alimony and support payments;
(8) rents;
(9) workmen's compensation;
(10) in-kind support and
				maintenance;
(11) death
				benefits;
(12) royalties not
				counted as earned income; and
(13)
				dividends and interest not otherwise excluded under SSI rules.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 248 - MEDICAID ELIGIBILITY - MEDICARE DRUG COVERAGE (CATEGORY 048) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.248.500.18 - DEEMED INCOME

Current through Register Vol. 35, No. 13, July 16, 2024
Deeming income from a spouse to their minor child(ren) or
				  from one spouse to the other spouse when living in the same household, does not
				  apply.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 248 - MEDICAID ELIGIBILITY - MEDICARE DRUG COVERAGE (CATEGORY 048) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.248.500.19 - TOTAL COUNTABLE INCOME

Current through Register Vol. 35, No. 13, July 16, 2024
Countable income is the sum of unearned income or earned
				  income for the individual or spouse less disregards or exclusions. Only one
				  earned income exclusion ($65 plus one half of the remainder) is applied and one
				  $20 disregard is applied if using income from both spouses.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 248 - MEDICAID ELIGIBILITY - MEDICARE DRUG COVERAGE (CATEGORY 048) › Part 600 - BENEFIT DESCRIPTION › Section 8.248.600.3 - 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 27-2-12 et. seq. NMSA 1978 (
				  Repl. Pamp. 1991). The legal basis for the low-income subsidy (LIS) program is
				  the Medicare Prescription Drug, Improvement and Modernization Act of 2003
				  (MMA), Public Law 108173. 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 248 - MEDICAID ELIGIBILITY - MEDICARE DRUG COVERAGE (CATEGORY 048) › Part 600 - BENEFIT DESCRIPTION › Section 8.248.600.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
July 1, 2024, unless a later date is cited at the end of a
				  section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 248 - MEDICAID ELIGIBILITY - MEDICARE DRUG COVERAGE (CATEGORY 048) › Part 600 - BENEFIT DESCRIPTION › Section 8.248.600.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of these regulations is to provide eligibility
				  policy and procedures for the medicare part D -low income subsidy
				  program.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 248 - MEDICAID ELIGIBILITY - MEDICARE DRUG COVERAGE (CATEGORY 048) › Part 600 - BENEFIT DESCRIPTION › Section 8.248.600.9 - GENERAL BENEFIT DESCRIPTION

Current through Register Vol. 35, No. 13, July 16, 2024
An individual or couple who is determined eligible for the
				  low income subsidy (LIS) under part D of medicare, is eligible for financial
				  assistance with the monthly premium, the yearly deductible, the
				  per-prescription co-payment, and continuous coverage with no gap prior to
				  reaching $3,600 in out-of-pocket spending. The financial assistance may be full
				  or partial depending on the income, family size and resources of the
				  beneficiary.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 248 - MEDICAID ELIGIBILITY - MEDICARE DRUG COVERAGE (CATEGORY 048) › Part 600 - BENEFIT DESCRIPTION › Section 8.248.600.10 - BENEFIT DETERMINATION

Current through Register Vol. 35, No. 13, July 16, 2024
Completed applications must be acted upon and notice of
				  approval, denial, or delay sent out within 45 days of the date of application.
				  The applicant will have time limits explained and be informed of the date by
				  which the application should be processed.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 248 - MEDICAID ELIGIBILITY - MEDICARE DRUG COVERAGE (CATEGORY 048) › Part 600 - BENEFIT DESCRIPTION › Section 8.248.600.11 - INITIAL BENEFITS

Current through Register Vol. 35, No. 13, July 16, 2024
Eligibility is always prospective and begins the month of
				  application, but not earlier than January 1, 2006. When an eligibility
				  determination is made, notice of the approval or denial is sent to the
				  individual. If the application is denied, the notice shall include reason for
				  denial and the applicant's right to request a fair hearing.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 248 - MEDICAID ELIGIBILITY - MEDICARE DRUG COVERAGE (CATEGORY 048) › Part 600 - BENEFIT DESCRIPTION › Section 8.248.600.12 - ONGOING BENEFITS

Current through Register Vol. 35, No. 13, July 16, 2024
The applicant/recipient is responsible to report changes
				  affecting eligibility within 10 days of when the change took place. A
				  re-determination of eligibility is made every 12 months. If a LIS
				  recipient/applicant becomes eligible for certain medicaid categories; SSI, QMB,
				  SLIMB, QI-1, WDI, IC, and HCBW, they will still be eligible for LIS. CMS will
				  notify the beneficiary that they are now deemed eligible, because of
				  categorical relatedness and will take over the re-determination of eligibility
				  on a yearly basis. A change notice will be sent to the LIS recipient. For the
				  year 2006, all certification periods will end December 31, 2006. Effective
				  January 1, 2007, the certification period will be 12 months from the month of
				  application or recertification.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 248 - MEDICAID ELIGIBILITY - MEDICARE DRUG COVERAGE (CATEGORY 048) › Part 600 - BENEFIT DESCRIPTION › Section 8.248.600.13 - RETROACTIVE BENEFIT COVERAGE

Current through Register Vol. 35, No. 13, July 16, 2024
There is no three month retroactive LIS coverage under this
				  program. The subsidy is effective the beginning of the month of application or
				  January 1, 2006, whichever is later.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 400 - RECIPIENT REQUIREMENTS › Section 8.249.400.3 - 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 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 400 - RECIPIENT REQUIREMENTS › Section 8.249.400.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
January 1, 2014, unless a later date is cited at the end of a
				  section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 400 - RECIPIENT REQUIREMENTS › Section 8.249.400.6 - 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. Generally, applicable eligibility rules are detailed in
				  the medical assistance division (MAD) eligibility policy manual 8.200 NMAC,
Medicaid Eligibility - General Recipients Policies
. Processes
				  for establishing and maintaining medicaid eligibility are detailed in the
				  income support division (ISD) general provisions policy manual 8.100 NMAC,
General Provisions for Public Assistance Programs
. Refugee
				  medical assistance (RMA): The RMA offers health coverage for a refugee within
				  the first 12 months from their date of entry to the United States (U.S.) when
				  they do not qualify for other medicaid eligibility categories. An RMA eligible
				  refugee has access to a benefit package that parallels the full medicaid
				  services. This program is not funded by medicaid; funds are provided through a
				  grant under Title IV of the Immigration and Nationality Act. The purpose of
				  this grant is to provide for the effective resettlement of a refugee and to
				  assist him or her to achieve economic self-sufficiency as quickly as
				  possible.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 400 - RECIPIENT REQUIREMENTS › Section 8.249.400.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
"Refugee" is an immigrant, who because of persecution or
				  fear of persecution on account of race, religion or political opinion, fled
				  from their home country and cannot return because of fear of persecution
				  because of race, religion or political opinion.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 400 - RECIPIENT REQUIREMENTS › Section 8.249.400.8 - MISSION

Current through Register Vol. 35, No. 13, July 16, 2024
To transform lives. Working with out 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 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 400 - RECIPIENT REQUIREMENTS › Section 8.249.400.9 - REFUGEE MEDICAL ASSISTANCE ONLY - CATEGORY 049 AND 059

Current through Register Vol. 35, No. 13, July 16, 2024
A. A medicaid
				eligible refugee recipient must meet the following non-financial eligibility
				requirements:
(1) is ineligible for full
				medicaid coverage;
(2) is not a
				full-time student in an institution of higher education, except where
				enrollment is part of an individual employability plan for a refugee enrolled
				in the refugee cash assistance program;
(3) is in the U.S. fewer than 12 months and
				meets one of the following statuses:
(a) is
				admitted as a refugee under Section 207 of the Immigration and Nationality
				Act;
(b) is paroled into the U.S.
				as a refugee or asylee under Section 212 (d)(5) of the Immigration and
				Nationality Act;
(c) is granted
				asylum under Section 208 of the Immigration and Nationality Act;
(d) is admitted as an Amerasian immigrant
				from Vietnam through the orderly departure program, under Section 584 of the
				Foreign Operations Appropriations Act, incorporated in the fiscal year 1988
				Continuing Resolution P.L.
				100-212;
(e) is a Cuban-Haitian entrant who was
				admitted as a public interest parolee under Section 212 (d)(5) of the
				Immigration and Nationality Act;
(f) is certified as a victim of human
				trafficking by the federal office of refugee resettlement (ORR);
(g) is an eligible family member of a victim
				of human trafficking certified by ORR who has a T-2, T-3, T-4, or T-5
				Visa;
(h) is admitted as a special
				immigrant from Iraq or Afghanistan under Section 101 (a)(27) of the Immigration
				and Nationality Act; or
(i) is a
				lawful permanent resident (LPR) when the individual had previously met a status
				as listed in Subparagraphs (a) through (h) above;
(4) an individual who meets the following
				eligibility requirements pursuant to 8.200.410 NMAC and 8.200.420 NMAC of
				citizenship or non-citizen status, enumeration, residence, non-concurrent
				receipt of assistance and applications for other benefits;
(5) appropriate to the size of the budget
				group (not including the ineligible parent due to citizenship or non-citizen
				status or enumeration), countable gross income must be less than one hundred
				and eighty-five percent of the standard of need (SON) countable net income must
				be less than the SON pursuant to 8.200.520 NMAC and 8.202.500 NMAC;
				and
(6) an applicant or an eligible
				recipient may have other creditable health insurance coverage.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 400 - RECIPIENT REQUIREMENTS › Section 8.249.400.10 - BASIS FOR DEFINING GROUP

Current through Register Vol. 35, No. 13, July 16, 2024
At the time of application, an applicant or an eligible
				  recipient and HSD shall identify everyone who is to be considered for inclusion
				  in the assistance unit and budget group. Each member of the assistance unit and
				  budget group, including each unborn child, is counted as one in the household
				  size.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 400 - RECIPIENT REQUIREMENTS › Section 8.249.400.12 - ENUMERATION

Current through Register Vol. 35, No. 13, July 16, 2024
Refer to
				  8.200.410.10
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 400 - RECIPIENT REQUIREMENTS › Section 8.249.400.13 - CITIZENSHIP

Current through Register Vol. 35, No. 13, July 16, 2024
Refer to
				  8.200.410.11
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 400 - RECIPIENT REQUIREMENTS › Section 8.249.400.14 - RESIDENCE

Current through Register Vol. 35, No. 13, July 16, 2024
Refer to
				  8.200.410.12
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 400 - RECIPIENT REQUIREMENTS › Section 8.249.400.18 - NON-CITIZEN SPONSORSHIP

Current through Register Vol. 35, No. 13, July 16, 2024
The income support division (ISD) caseworker must notify the
				  refugee's sponsor or local affiliate which provided for the resettlement of the
				  refugee, when a refugee applies for refugee medical
				  assistance.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 400 - RECIPIENT REQUIREMENTS › Section 8.249.400.19 - RECIPIENT RIGHTS AND RESPONSIBILITIES

Current through Register Vol. 35, No. 13, July 16, 2024
Refer to 8.200.430 NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 400 - RECIPIENT REQUIREMENTS › Section 8.249.400.20 - ASSIGNMENT OF SUPPORT

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Assignment of medical support:
Refer to 8.200.420.12
				NMAC.
B.
Assignments of child
				support:
Assignment of child support is not required for refugee medical
				assistance.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 400 - RECIPIENT REQUIREMENTS › Section 8.249.400.21 - REPORTING REQUIREMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
Refer to
				  8.200.430.19
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 400 - RECIPIENT REQUIREMENTS › Section 8.249.400.22 - ELIGIBLE ASSISTANCE UNIT

Current through Register Vol. 35, No. 13, July 16, 2024
The assistance unit includes individuals who apply for RMA
				  and who are determined eligible. Individuals may be ineligible for refugee cash
				  assistance and eligible for RMA. An eligible recipient of refugee cash
				  assistance who is not eligible for full medicaid services is eligible for
				  RMA.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 400 - RECIPIENT REQUIREMENTS › Section 8.249.400.23 - BUDGET GROUP

Current through Register Vol. 35, No. 13, July 16, 2024
The budget group includes all members of the assistance
				  unit. Additional budget group members include individuals who live in the
				  household with the assistance unit and have a financial obligation of
				  support.
A. Except for an supplemental
				security income (SSI) recipient, the following individuals have a financial
				obligation of support for medicaid eligibility:
(1) spouses: married individuals as defined
				under applicable New Mexico state law (New Mexico recognizes common law and
				same sex marriages established in other states); and
(2) parents for children: there is a
				presumption that a child born to a married woman is the child of the spouse, or
				if the individual established parentage by some other legally recognized
				process.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 400 - RECIPIENT REQUIREMENTS › Section 8.249.400.24 - LIVING IN THE HOME

Current through Register Vol. 35, No. 13, July 16, 2024
A. To be
				included in the assistance unit and budget group, an individual must be living,
				or considered to be living, in the budget group's home.
B.
A child considered to be living in
				the home:
A child is considered to be part of the budget group as
				evidenced by the child's customary physical presence in the home. If a child is
				living with more than one household, the following applies:
(1) when the child is actually spending more
				time with one household than the other, the child would be determined to be
				living with the household with whom the child spends the most time;
				or
(2) when the child is actually
				spending equal amounts of time with each household, the child shall be
				considered to be living with the household who first applies for medicaid
				enrollment.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.249.500.1 - ISSUING AGENCY

Current through Register Vol. 35, No. 13, July 16, 2024
New Mexico Health Care Authority (HCA).
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.249.500.3 - 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 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.249.500.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
January 1, 2014, unless a later date is cited at the end of a
				  section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.249.500.6 - 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. Generally, applicable eligibility rules are detailed in
				  the medical assistance division (MAD) eligibility policy manual, specifically
				  8.200.400 NMAC,
General Medicaid Eligibility
. Processes for
				  establishing and maintaining MAD eligibility are detailed in the income support
				  division (ISD) general provisions 8.100 NMAC,
General Provisions for
				  Public Assistance Programs
.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.249.500.8 - 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 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.249.500.9 - NEED DETERMINATION

Current through Register Vol. 35, No. 13, July 16, 2024
A.
				Financial need: The budget group's eligibility is based on financial need. See
				Section 1931 of the Social Security Act, the rules in this chapter and in
				8.200.520 NMAC.
B. Financial
				eligibility: Pursuant to Section 1931 of the Social Security Act, enacted by
				Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), a new
				medicaid financial eligibility standard was created. Refugee medical assistance
				(RMA) uses this same standard.
(1) Income
				eligibility criteria: The income eligibility criteria for Category 049 are
				based on New Mexico's aid to families with dependent children (AFDC) program as
				of July 16, 1996. This is defined as the standard of need (SON) used in AFDC as
				of July 16, 1996. A refugee can be eligible for Category 059 if income would be
				below AFDC after deducting medical expenses incurred and paid in that month.
				Eligibility for Category 059 is determined on a month-to-month basis.
(2) Less restrictive income and resource
				methodology: Pursuant to Section 1931 of the Social Security Act, as a state
				option, New Mexico may use income and resource eligibility methodologies that
				are less restrictive than the AFDC methodologies used as of July 16, 1996. This
				chapter defines less restrictive methodologies to be used by New Mexico for
				resources, countable and excluded earned or unearned income, available or
				unavailable income and income deductions or disregards.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.249.500.10 - RESOURCE STANDARDS

Current through Register Vol. 35, No. 13, July 16, 2024
Resources are not an eligibility factor.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.249.500.11 - INCOME STANDARDS

Current through Register Vol. 35, No. 13, July 16, 2024
Refer to
				  8.249.500.9
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.249.500.12 - INCOME ELIGIBILITY

Current through Register Vol. 35, No. 13, July 16, 2024
Income consists of money received by a person whose income is
				  considered available to the budget group as described in this chapter.
A. Income from a 30 day-period is used to
				determine eligibility. The 30-day period may be any consecutive 30-day period
				that is prior to the date of the application through the date of timely
				disposition. The applicant and the caseworker must agree on the 30-day period.
				Income from a terminated source is not counted.
B. Income received less frequently than
				monthly: If an amount of gross income is received less frequently than monthly,
				that amount is converted to a monthly amount to determine financial
				eligibility. The conversion is obtained by dividing the total income by the
				number of months the income is intended to cover. For the purposes of this
				calculation, a partial month is considered to be one full month. This includes,
				but is not limited to, income from sharecropping, farming, and self-employment.
				It includes contract income as well as income for a tenured teacher who may not
				have a contract.
C. Use of
				conversion factors: Whenever a full month's income is received on a weekly or
				biweekly basis, the income is converted to a monthly amount. Income is rounded
				down to the nearest whole dollar prior to application of the conversion factor.
				Weekly income is multiplied by four and biweekly income is multiplied by
				two.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.249.500.13 - AVAILABLE INCOME

Current through Register Vol. 35, No. 13, July 16, 2024
A.
				Determination of eligibility for the assistance unit is made by considering
				income that is available to the assistance unit and budget group. The amount of
				countable income is determined using allowable income exemptions, deductions
				and disregards. The income of a budget group member who is not included in the
				assistance unit is deemed available to the assistance unit.
B. Available income includes:
(1) income received by the budget
				group;
(2) income received by
				someone not included in the budget group for someone included in the budget
				group and which is available to the budget group;
(3) income that is withheld as a result of a
				garnishment or wage withholding; and
(4) income withheld by a source at the
				request of a budget group member.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.249.500.14 - UNAVAILABLE INCOME

Current through Register Vol. 35, No. 13, July 16, 2024
A. Individuals
				included in the budget group may have a legal right to income but not access to
				it; such income is not counted as available income:
(1) old age, survivors, and disability
				insurance (OASDI);
(2) railroad
				retirement benefits (RRB);
(3)
				veterans administration (VA) benefits:
(a)
				income available to veterans and their dependents from the VA as compensation
				for service-connected disability;
(b) pension for non-service connected
				disability;
(c) dependency and
				indemnity compensation; and
(d)
				death benefits paid from a government issue (GI) life insurance;
(4) unemployment compensation
				benefits (UCB);
(5) military
				allotments;
(6) worker's
				compensation;
(7) pension, annuity,
				and retirement benefits;
(8) union
				benefits;
(9) lodge or fraternal
				benefits;
(10) real property income
				that is not earned income;
(11)
				shared shelter and utility payments when the budget group shares shelter with
				others:
(a) payments which exceed the budget
				group's cost are considered income;
(b) payments which are less than the budget
				group's cost are not considered; these are the others' share of the shelter
				cost and are treated as pass-through payments;
(12) income from the sale of goods or
				property which are obtained in finished condition;
(13) child support payments received directly
				by the budget group and retained for its use;
(14) settlement payments which are received
				from worker's compensation settlements, insurance claims, damage claims,
				litigation, trust distributions which are made on a recurring basis;
(15) individual Indian monies (IIM) payments
				received and distributed by the bureau of Indian affairs (BIA) as a trustee for
				an individual member of a tribe;
(16) bureau of Indian affairs (BIA) or tribal
				general assistance (GA) payments; and
(17) income that is not listed as available
				in this chapter where the budget group cannot gain access to the income; this
				includes wages withheld by an employer that refuses to pay.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.249.500.15 - EARNED INCOME

Current through Register Vol. 35, No. 13, July 16, 2024
Includes all wages, salaries, tips, and other employee pay
				  from employment and net earnings from self-employment.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.249.500.16 - EARNED INCOME DEDUCTIONS/DISREGARDS

Current through Register Vol. 35, No. 13, July 16, 2024
A. Self employment: Certain self-employment
				deductions allowed by the federal internal revenue service (IRS) are allowed in
				the net and gross income test.
(1)
				Self-employment income will be annualized for income projection purposes. If
				the IRS Form 1040 has been filed, the previous year's tax return is used to
				anticipate future income, if no significant changes in circumstances have
				occurred. An alternative method of income anticipation should be used when the
				amount of self employment income reported on tax returns would no longer be a
				good indicator of expected income, i.e., loss of cattle or crops due to
				disease.
(2) If tax returns are
				used for annualized projected income, self-employment expenses listed on the
				return are allowable except:
(a) the mileage
				allowance is the New Mexico department of finance and administration (DFA) rate
				as detailed in 2.42.2 NMAC unless proof that the actual expense is greater;
				and
(b) no deduction is allowed for
				rent or purchase of the place of business if the individual operates the
				business out of his or her residence, unless the individual can demonstrate
				that the expense has been allowed under federal income tax
				guidelines.
(3) The
				following deductions are not allowed:
(a)
				depreciation;
(b) personal business
				and entertainment expenses;
(c)
				personal transportation to and from work;
(d) purchase of capital equipment;
				and
(e) payments on the principal
				of loans for capital assets or durable goods.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.249.500.17 - UNEARNED INCOME

Current through Register Vol. 35, No. 13, July 16, 2024
Unearned income includes benefits, pensions, etc.
A. The following types of unearned income are
				counted:
(1) old age, survivors, and
				disability insurance (OASDI);
(2)
				railroad retirement benefits (RRB);
(3) veterans administration (VA) benefits:
(a) income available to veterans and their
				dependents from the VA as compensation for service-connected
				disability;
(b) pension for
				non-service connected disability;
(c) dependency and indemnity compensation;
				and
(d) death benefits paid from a
				government issue (GI) life insurance;
(4) unemployment compensation benefits
				(UCB);
(5) military
				allotments;
(6) worker's
				compensation;
(7) pension, annuity,
				and retirement benefits;
(8) union
				benefits;
(9) lodge or fraternal
				benefits;
(10) real property income
				that is not earned income;
(11)
				shared shelter and utility payments when the budget group shares shelter with
				others:
(a) payments which exceed the budget
				group's cost are considered income;
(b) payments which are less than the budget
				group's cost are not considered; these are the others' share of the shelter
				cost and are treated as pass-through payments;
(12) income from the sale of goods or
				property which are obtained in finished condition;
(13) child support payments received directly
				by the budget group and retained for its use;
(14) settlement payments which are received
				from worker's compensation settlements, insurance claims, damage claims,
				litigation, trust distributions which are made on a recurring basis;
(15) individual Indian monies (IIM) payments
				received and distributed by the bureau of Indian affairs (BIA) as a trustee for
				an individual member of a tribe; and
(16) bureau of Indian affairs (BIA) or tribal
				general assistance (GA) payments.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 600 - BENEFIT DESCRIPTION › Section 8.249.600.3 - 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 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 600 - BENEFIT DESCRIPTION › Section 8.249.600.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
January 1, 2019, or upon a later approval date by the federal
				  centers for medicare and medicaid services (CMS), unless a later date is cited
				  at the end of the section.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 600 - BENEFIT DESCRIPTION › Section 8.249.600.6 - 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. Generally, applicable eligibility rules are detailed in
				  the medical assistance division (MAD) eligibility policy manual, specifically
				  8.200.400 NMAC,
General Medicaid Eligibility
. Processes for
				  establishing and maintaining MAD eligibility are detailed in the income support
				  division (ISD) general provisions 8.100 NMAC,
General Provisions for
				  Public Assistance Programs
.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 600 - BENEFIT DESCRIPTION › Section 8.249.600.9 - BENEFIT DESCRIPTION

Current through Register Vol. 35, No. 13, July 16, 2024
Refugee medical assistance (RMA) offers health coverage for
				  refugees within the first 12 months from their date of entry to the United
				  States, when they do not qualify for medicaid. RMA eligible refugees have
				  access to a benefit package that parallels the full coverage medicaid benefit
				  package. This program is not funded by medicaid. RMA is funded through a grant
				  under Title IV of the Immigration and Nationality Act. The purpose of this
				  grant is to provide for the effective resettlement of refugees and to assist
				  them to achieve economic self-sufficiency as quickly as possible. Refer to
				  8.100.100 NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 600 - BENEFIT DESCRIPTION › Section 8.249.600.10 - BENEFIT DETERMINATION

Current through Register Vol. 35, No. 13, July 16, 2024
Application for refugee medical assistance is made on the
				  assistance application form. The application is acted on and notice of the
				  action sent to the applicant within 45 days of the date of
				  application.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 600 - BENEFIT DESCRIPTION › Section 8.249.600.11 - INITIAL BENEFITS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Approval or
				denial of application:
After the eligibility determination is made, the
				income support specialist (ISS) sends notice to the applicant or applicant
				group. The denial notice contains information on the reason for the denial and
				explanation of appeal rights to the applicant(s).
B.
Date of eligibility:
Eligibility starts with the first day of the month of application after all
				eligibility requirements are met. The 12-month period begins with the month the
				refugee enters the United States, as documented by the immigration and
				naturalization service (INS) (form I-94). For cases involving children born in
				the United States, the child's eligibility period expires when the refugee
				parent who arrived last in the United States has been in this country for 12
				months.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 600 - BENEFIT DESCRIPTION › Section 8.249.600.12 - ONGOING BENEFITS

Current through Register Vol. 35, No. 13, July 16, 2024
No periodic review is required, since coverage is limited to
				  a maximum of 12 months from the date of entry into the United
				  States.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 600 - BENEFIT DESCRIPTION › Section 8.249.600.13 - RETROACTIVE BENEFIT COVERAGE

Current through Register Vol. 35, No. 13, July 16, 2024
Retroactive medicaid coverage is provided in accordance with
				  8.200.400.14
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 249 - MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - REFUGEE MEDICAL ASSISTANCE (RMA) PROGRAM › Part 600 - BENEFIT DESCRIPTION › Section 8.249.600.14 - CASE CLOSURES

Current through Register Vol. 35, No. 13, July 16, 2024
Cases are closed when refugee medical assistance recipients
				  no longer meet eligibility standards or after the 12-month eligibility period
				  expires, whichever comes first.