reglab/statecodes huggingface dataset:
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 243 - MEDICAID ELIGIBILITY - WORKING DISABLED INDIVIDUALS (WDI) (CATEGORY 043) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.243.500.10 - RESOURCE STANDARDS

Current through Register Vol. 35, No. 13, July 16, 2024
A "resource" is defined as cash or liquid assets and real or
				  personal property which is owned and can be used either directly, or by sale or
				  conversion, for the applicant's/recipient's support and maintenance. Resources
				  may be liquid or non-liquid and may be excluded from the eligibility
				  determination process under certain conditions.
A. A liquid resource is an asset, which can
				readily be converted to cash.
B. A
				non-liquid resource is an asset or property, which cannot readily be converted
				to cash.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 243 - MEDICAID ELIGIBILITY - WORKING DISABLED INDIVIDUALS (WDI) (CATEGORY 043) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.243.500.11 - APPLICABLE RESOURCE STANDARDS

Current through Register Vol. 35, No. 13, July 16, 2024
The resource determination is made as of the first moment of
				  the first day of the month. For determination of continued eligibility, see
				  Section
				  8.243.600.12
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 243 - MEDICAID ELIGIBILITY - WORKING DISABLED INDIVIDUALS (WDI) (CATEGORY 043) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.243.500.12 - COUNTABLE RESOURCES

Current through Register Vol. 35, No. 13, July 16, 2024
A. An
				individual's countable resources must be less than $10,000.
B. Married individuals' countable resources
				must be less than $15,000.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 243 - MEDICAID ELIGIBILITY - WORKING DISABLED INDIVIDUALS (WDI) (CATEGORY 043) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.243.500.13 - RESOURCE EXCLUSIONS

Current through Register Vol. 35, No. 13, July 16, 2024
Specified types of resources are excluded from the
				  calculation of countable resources as described in
				  8.215.500.14
				  NMAC as follows:
A.
Retirement
				funds:
Internal revenue service-recognized retirement fund accounts are
				excludable resources in the eligibility determination so long as funds are not
				withdrawn from the account.
B.
				Examples of such retirement fund accounts include: PERA, ERA, an employer's
				qualifying pension plan, 401(k) plan, civil service annuity, IRA, Roth IRA,
				KEOUGH plan, etc.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 243 - MEDICAID ELIGIBILITY - WORKING DISABLED INDIVIDUALS (WDI) (CATEGORY 043) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.243.500.14 - RESOURCES TRANSFERS

Current through Register Vol. 35, No. 13, July 16, 2024
See
				  8.215.500.15
				  NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 243 - MEDICAID ELIGIBILITY - WORKING DISABLED INDIVIDUALS (WDI) (CATEGORY 043) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.243.500.15 - TRUSTS

Current through Register Vol. 35, No. 13, July 16, 2024
See 8.281.510 NMAC and following
				  subsections.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 243 - MEDICAID ELIGIBILITY - WORKING DISABLED INDIVIDUALS (WDI) (CATEGORY 043) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.243.500.16 - DEEMING RESOURCES

Current through Register Vol. 35, No. 13, July 16, 2024
If an eligible noninstitutionalized applicant/recipient lives
				  in the same household with an ineligible spouse, resources are considered to
				  belong to the applicant/recipient. The resource standard for a couple
				  applies.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 243 - MEDICAID ELIGIBILITY - WORKING DISABLED INDIVIDUALS (WDI) (CATEGORY 043) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.243.500.17 - INCOME

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Earned
				income
consists of the total gross income received by an
				applicant/recipient for services performed as an employee or net income as a
				result of self-employment.
(1)
Royalties
earned in connection with the publication of the
				applicant's/recipient's work and any honoraria/fees received for services
				rendered are considered earned income.
(2) In any given calendar quarter, an
				applicant/recipient must have earnings equal to social security
				administration's definition of a covered quarter. See 8.200.520.20
				NMAC.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 243 - MEDICAID ELIGIBILITY - WORKING DISABLED INDIVIDUALS (WDI) (CATEGORY 043) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.243.500.18 - INCOME STANDARDS

Current through Register Vol. 35, No. 13, July 16, 2024
The applicable income standard of countable earned income for
				  this category is less than 250% of the federal poverty level for a household
				  size of one. See Subsection H of
				  8.200.520.11
				  NMAC. The applicant/recipient must meet two income tests to qualify for working
				  disabled individuals. These are as follows:
A.
TEST 1
(1) Determine applicant's/recipient's gross
				monthly earnings.
(2) Apply a
				$20.00 general disregard.
(3) Apply
				a $65.00 earned income disregard.
(4) Disregard ½ of the remainder of
				income.
(5) Disregard work-related
				expenses for the blind or disabled.
(6) If the countable earned income is less
				than 250% of the applicable federal poverty level (FPL) for a household of one,
				the individual is eligible.
(7) If
				the countable earned income is less than 250% of the applicable FPL for a
				household size of one, determine if there is an ineligible spouse and/or
				children in the household.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 243 - MEDICAID ELIGIBILITY - WORKING DISABLED INDIVIDUALS (WDI) (CATEGORY 043) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.243.500.19 - UNEARNED INCOME

Current through Register Vol. 35, No. 13, July 16, 2024
A. Standards
				for unearned income and exclusions: See 8.215.500.20.C. & D.
				NMAC.
B. Unearned income is
				computed on a monthly basis. If there are no expenses incurred with the receipt
				of unearned income, such as annuities, pensions, retirement payments or
				disability benefits, the gross amount is considered countable unearned
				income.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 243 - MEDICAID ELIGIBILITY - WORKING DISABLED INDIVIDUALS (WDI) (CATEGORY 043) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.243.500.21 - DISREGARDS

Current through Register Vol. 35, No. 13, July 16, 2024
Income disregards are allowed as described below when
				  applicable.
A.
Twenty dollar
				disregard:
The first $20 of unearned or earned income received in a
				month is disregarded. This disregard is not applicable to payments made to an
				applicant/recipient through a state or other government assistance program, or
				by a private charitable organization, where such payments are based on the
				applicant's/recipient's need.
B.
Additional earned income disregard:
If appropriate, earned income
				of $65 per month, plus one-half of the remainder is disregarded.
C.
Work-related expenses
				defined:
Work-related expenses of an employed applicant/recipient who is
				blind or disabled are disregarded. This disregard is applied to earned income
				only. Disregarded expenses must be for items or services directly related to
				enabling a person to work, and which are necessarily incurred by that
				individual because of a physical or mental disability or blindness. Such
				expenses are disregarded if not covered by other third party payers, including
				medicaid.
(1) Types of work-related expenses
				which may be disregarded include:
(a) federal,
				state, and local income taxes;
(b)
				social security contributions;
(c)
				union dues;
(d) transportation
				costs, including actual cost of bus or taxi cab fare, or fifteen (15) cents per
				mile for private automobile;
(e)
				lunches;
(f) child care costs, if
				not otherwise provided;
(g)
				uniforms, tools, and other necessary equipment;
(h) special vehicle modifications to enable
				transportation to and from work, but not the cost of the vehicle
				itself;
(i) attendants who may be
				hired for the purpose of taking applicant/recipient to and from work, and
				getting ready for work;
(j) durable
				medical equipment that is medically related and generally not useful in absence
				of the blindness or disability yet, are necessary to attend and perform tasks
				in the work place;
(k) expenses for
				work related equipment, which is impairment related and necessary for the
				individual to perform his/her tasks;
(l) prostheses necessary to perform work
				related tasks.
(m) design
				modifications related to blindness or disability that enable the
				applicant/recipient to leave home in order to attend work, or design
				modifications made to the work area of the home in the case where the
				applicant/recipient engages in a home-based business;
(n) special expenses necessary to enable an
				applicant/recipient who is blind or disabled to engage in employment, such as a
				seeing-eye dog, braille instructions, or instructions on using special
				equipment and,
(o) health insurance
				premiums.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 243 - MEDICAID ELIGIBILITY - WORKING DISABLED INDIVIDUALS (WDI) (CATEGORY 043) › Part 600 - BENEFIT DESCRIPTION › Section 8.243.600.1 - 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 243 - MEDICAID ELIGIBILITY - WORKING DISABLED INDIVIDUALS (WDI) (CATEGORY 043) › Part 600 - BENEFIT DESCRIPTION › Section 8.243.600.3 - 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 243 - MEDICAID ELIGIBILITY - WORKING DISABLED INDIVIDUALS (WDI) (CATEGORY 043) › Part 600 - BENEFIT DESCRIPTION › Section 8.243.600.5 - 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 243 - MEDICAID ELIGIBILITY - WORKING DISABLED INDIVIDUALS (WDI) (CATEGORY 043) › Part 600 - BENEFIT DESCRIPTION › Section 8.243.600.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of these rules is to provide eligibility policy
				  and procedures for the medical assistance programs.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 243 - MEDICAID ELIGIBILITY - WORKING DISABLED INDIVIDUALS (WDI) (CATEGORY 043) › Part 600 - BENEFIT DESCRIPTION › Section 8.243.600.9 - GENERAL BENEFIT DESCRIPTION

Current through Register Vol. 35, No. 13, July 16, 2024
An individual who meets a medical assistance programs (MAP)
				  category of eligibility for the working disabled individual program (WDI) is
				  eligible to receive full state plan benefits.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 243 - MEDICAID ELIGIBILITY - WORKING DISABLED INDIVIDUALS (WDI) (CATEGORY 043) › Part 600 - BENEFIT DESCRIPTION › Section 8.243.600.10 - 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 60 days of the date of application.
				  Individuals 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 243 - MEDICAID ELIGIBILITY - WORKING DISABLED INDIVIDUALS (WDI) (CATEGORY 043) › Part 600 - BENEFIT DESCRIPTION › Section 8.243.600.11 - INITIAL BENEFITS

Current through Register Vol. 35, No. 13, July 16, 2024
Eligibility begins the month of approval. When an eligibility
				  determination is made, notice of the approval or denial is sent to the
				  individual. If the application is denied, this notice includes the individual's
				  right to request a hearing.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 243 - MEDICAID ELIGIBILITY - WORKING DISABLED INDIVIDUALS (WDI) (CATEGORY 043) › Part 600 - BENEFIT DESCRIPTION › Section 8.243.600.12 - ONGOING BENEFITS

Current through Register Vol. 35, No. 13, July 16, 2024
A re-determination of MAP eligibility is made every 12 months
				  or at such time the MAP eligible recipient begins receiving medicare
				  benefits.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 243 - MEDICAID ELIGIBILITY - WORKING DISABLED INDIVIDUALS (WDI) (CATEGORY 043) › Part 600 - BENEFIT DESCRIPTION › Section 8.243.600.13 - 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 243 - MEDICAID ELIGIBILITY - WORKING DISABLED INDIVIDUALS (WDI) (CATEGORY 043) › Part 600 - BENEFIT DESCRIPTION › Section 8.243.600.14 - CHANGES IN ELIGIBILITY

Current through Register Vol. 35, No. 13, July 16, 2024
A case is closed, with provision of advance notice, when the
				  MAP eligible recipient becomes ineligible. If a MAP eligible recipient dies,
				  the case is closed the following month.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 400 - RECIPIENT POLICIES › Section 8.245.400.1 - ISSUING AGENCY

Current through Register Vol. 35, No. 13, July 16, 2024
New Mexico Health Care Authority.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 400 - RECIPIENT POLICIES › Section 8.245.400.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
The rule applies to the general public.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 400 - RECIPIENT POLICIES › Section 8.245.400.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
The New Mexico medicaid program is administered pursuant to
				  regulations promulgated by the federal department of health and human services
				  under Title XIX of the Social Security Act, as amended, and by the state health
				  care authority pursuant to state statute. See Section 27-2-12 et seq. NMSA 1978
				  (Repl. Pamp. 1991). Section 9-8-1 et seq. NMSA 1978 establishes the health care
				  authority (HCA) as a single, unified department to administer laws and exercise
				  functions relating to health care facility licensure and health care purchasing
				  and regulation.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 400 - RECIPIENT POLICIES › Section 8.245.400.5 - 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 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 400 - RECIPIENT POLICIES › Section 8.245.400.6 - 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 medicaid program.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 400 - RECIPIENT POLICIES › Section 8.245.400.8 - MISSION

Current through Register Vol. 35, No. 13, July 16, 2024
To reduce the impact of poverty on people living in New
				  Mexico and to assure low income and disabled individuals in New Mexico equal
				  participation in the life of their communities.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 400 - RECIPIENT POLICIES › Section 8.245.400.9 - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) -CATEGORY 045

Current through Register Vol. 35, No. 13, July 16, 2024
To be eligible for category 045, an applicant/recipient must
				  be covered by medicare part A. The part A insurance is a free entitlement to
				  social security beneficiaries who are 65 years of age or older or who have
				  received social security disability payments for 24 months. Fully or currently
				  insured workers, or their dependents, with end-stage renal disease are also
				  covered under medicare.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 400 - RECIPIENT POLICIES › Section 8.245.400.10 - BASIS FOR DEFINING THE GROUP

Current through Register Vol. 35, No. 13, July 16, 2024
Specified low income medicare beneficiaries (SLIMB) are
				  individuals who would be qualified medicare beneficiaries (QMBs) but for the
				  fact that their income exceeds the income levels established for QMB. Income
				  eligibility for the SLIMB is at least one hundred percent of the federal income
				  poverty level, but less than one hundred twenty percent.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 400 - RECIPIENT POLICIES › Section 8.245.400.12 - ENUMERATION

Current through Register Vol. 35, No. 13, July 16, 2024
SLIMB applicants/recipients must furnish their social
				  security account number(s). SLIMB eligibility must be denied or terminated for
				  applicants/ recipients who fail to furnish social security
				  numbers.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 400 - RECIPIENT POLICIES › Section 8.245.400.13 - CITIZENSHIP AND IDENTITY

Current through Register Vol. 35, No. 13, July 16, 2024
Individuals entitled to or receiving medicare already meet
				  citizenship and identity requirements.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 400 - RECIPIENT POLICIES › Section 8.245.400.14 - RESIDENCE

Current through Register Vol. 35, No. 13, July 16, 2024
To be eligible for SLIMB, an applicant/ recipient must be
				  physically present in New Mexico on the date of application or final
				  determination of eligibility and must have demonstrated intent to remain in the
				  state. A temporary absence from the state does not prevent eligibility. A
				  temporary absence exists when an applicant/recipient leaves the state for a
				  specific purpose with a timelimited goal and intends to return to New Mexico
				  when the purpose is accomplished.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 400 - RECIPIENT POLICIES › Section 8.245.400.15 - NONCONCURRENT RECEIPT OF ASSISTANCE

Current through Register Vol. 35, No. 13, July 16, 2024
SLIMB applicants on buy-in in another state cannot be
				  approved for the New Mexico SLIMB program until buy-in from the other state is
				  terminated.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 400 - RECIPIENT POLICIES › Section 8.245.400.16 - SPECIAL RECIPIENT REQUIREMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
Applicants/recipients for SLIMB eligibility must meet the
				  specified age or disability requirements to be eligible for medicare part A.
				  There is no age requirement for SLIMB eligibility.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 400 - RECIPIENT POLICIES › Section 8.245.400.17 - RECIPIENT RIGHTS AND RESPONSIBILITIES

Current through Register Vol. 35, No. 13, July 16, 2024
An applicant/recipient is responsible for establishing
				  his/her eligibility for medicaid. As part of this responsibility, the
				  applicant/recipient must provide required information and documents or take the
				  actions necessary to establish eligibility. Failure to do so must result in a
				  decision that eligibility does not exist. An applicant/recipient must also
				  grant the HCA permission to contact other persons, agencies or sources of
				  information which are necessary to establish eligibility.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 400 - RECIPIENT POLICIES › Section 8.245.400.18 - ASSIGNMENT OF SUPPORT

Current through Register Vol. 35, No. 13, July 16, 2024
Assignment of medical support:
As a condition of
				  eligibility, applicants for or recipients of benefits must do the following,
				  42 CFR Section
				  433.146; Subsection G of Section 27-2-28 NMSA
				  1978 (Repl. Pamp. 1991):
A. assign
				individual rights to medical support and payments to the HCA the assignment
				authorizes HCA to pursue and make recoveries from liable third parties on
				behalf of a recipient;
B. assign
				the rights to medical support and payments of other individuals eligible for
				medicaid, for whom they can legally make an assignment; and
C. assign their individual rights to any
				medical care support available under an order of a court or an administrative
				agency.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 400 - RECIPIENT POLICIES › Section 8.245.400.19 - REPORTING REQUIREMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
Medicaid recipients must report any change in their
				  circumstances which may affect eligibility within 10 days after the change to
				  the local income support division (ISD) office.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.245.500.1 - ISSUING AGENCY

Current through Register Vol. 35, No. 13, July 16, 2024
New Mexico Health Care Authority.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.245.500.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
The rule applies to the general public.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.245.500.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
The New Mexico medicaid program is administered pursuant to
				  regulations promulgated by the federal department of health and human services
				  under Title XIX of the Social Security Act, as amended, and by the state health
				  care authority pursuant to state statute. See Section 27-2-12 et seq. NMSA 1978
				  (Repl. Pamp. 1991). Section 9-8-1 et seq. NMSA 1978 establishes the health care
				  authority (HCA) as a single, unified department to administer laws and exercise
				  functions relating to health care facility licensure and health care purchasing
				  and regulation.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.245.500.4 - DURATION

Current through Register Vol. 35, No. 13, July 16, 2024
Permanent.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.245.500.5 - 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 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.245.500.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of this rule is to provide eligibility policy
				  and procedures for the medicaid program.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.245.500.7 - DEFINITIONS [RESERVED]

Current through Register Vol. 35, No. 13, July 16, 2024
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.245.500.8 - MISSION

Current through Register Vol. 35, No. 13, July 16, 2024
To reduce the impact of poverty on people living in New
				  Mexico by providing support services that help families break the cycle of
				  dependency on public assistance.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.245.500.9 - NEED DETERMINATION

Current through Register Vol. 35, No. 13, July 16, 2024
SLIMB applicants/recipients must apply for and take all
				  necessary steps to obtain any resources to which they may be
				  entitled.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.245.500.10 - RESOURCE STANDARDS

Current through Register Vol. 35, No. 13, July 16, 2024
The value of an applicant/recipient's countable resources
				  must not exceed the amount set forth in
				  8.200.510.14 NMAC,
resource
				  amounts for supplemental security income (SSI) related medicare savings
				  programs (QMB and SLIMB/QI1).
The resource limit for an applicant
				  couple cannot exceed the amount for a couple set forth in
				  8.200.510.14 NMAC. An
				  applicant/recipient with an ineligible spouse is eligible if the couple's
				  countable resources do not exceed the amount set forth in
				  8.200.510.14 NMAC, when resources
				  are deemed. A resource determination is always made as of the first moment of
				  the first day of the month. An applicant/ recipient is ineligible for any month
				  in which the countable resources exceed the current resource standard as of the
				  first moment of the first day of the month. Changes in the amount of resources
				  during a month do not affect eligibility for that month. See
				  8.215.500.13 NMAC,
countable resources,
and
				  8.215.500.14 NMAC,
resource
				  exclusions
, for information on exclusions, disregards, and countable
				  resources.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.245.500.11 - RESOURCE TRANSFERS

Current through Register Vol. 35, No. 13, July 16, 2024
The social security administration excluded transfer of
				  resources as a factor of eligible for non-institutionalized SSI recipients.
				  Transfer of resources is not a factor for consideration in the medicare savings
				  programs.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.245.500.12 - TRUSTS

Current through Register Vol. 35, No. 13, July 16, 2024
See 8.281.510 NMAC and following
				  subsections.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.245.500.13 - INCOME STANDARDS

Current through Register Vol. 35, No. 13, July 16, 2024
Income standards for this category are at least one hundred
				  percent but no more than one hundred twenty percent of the federal income
				  poverty guidelines. The federal income poverty guidelines are adjusted
				  annually, effective April 1. See 8.200.520 NMAC,
Income
				  Standards
, and
				  8.215.500.19 NMAC,
Income
				  Standards
, for information on exclusions, disregards, and countable
				  income. Verification of income must be documented in the case
				  file.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.245.500.14 - UNEARNED INCOME

Current through Register Vol. 35, No. 13, July 16, 2024
Unearned income exclusions: All social security and railroad
				  retirement beneficiaries receive cost of living adjustments (COLAs) in January
				  of each year. The ISD caseworker must disregard the COLA from January through
				  March when (re)determining SLIMB eligibility. For redeterminations made in
				  January, February and March and for new SLIMB applications registered in
				  January, February, or March, the ISD caseworker uses the December social
				  security and railroad retirement benefit amounts. For SLIMB applications
				  registered from April through December, total gross income including the new
				  COLA figures are used to determine income and compared to the new April federal
				  poverty levels. This exclusion does not apply to other types of
				  income.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.245.500.15 - DEEMED INCOME

Current through Register Vol. 35, No. 13, July 16, 2024
If an applicant/recipient is a minor who lives with a
				  parent(s), deemed income from the parent(s) must be considered. If an
				  applicant/ recipient is married and lives with a spouse, deemed income from the
				  spouse must be considered. See
				  8.215.500.21 NMAC,
Deemed
				  Income,
for information on deemed income.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 600 - BENEFIT DESCRIPTION › Section 8.245.600.1 - ISSUING AGENCY

Current through Register Vol. 35, No. 13, July 16, 2024
New Mexico Health Care Authority.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 600 - BENEFIT DESCRIPTION › Section 8.245.600.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
The rule applies to the general public.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 600 - BENEFIT DESCRIPTION › Section 8.245.600.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
The New Mexico medicaid program is administered pursuant to
				  regulations promulgated by the federal department of health and human services
				  under Title XIX of the Social Security Act, as amended and by the state health
				  care authority (HCA) pursuant to state statute. See, Section 27-2-12
et
				  seq
., NMSA 1978 (Repl. Pamp. 1991). Section 9-8-1 et seq. NMSA 1978
				  establishes the HCA as a single, unified department to administer laws and
				  exercise functions relating to health care facility licensure and health care
				  purchasing and regulation.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 600 - BENEFIT DESCRIPTION › Section 8.245.600.5 - 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 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 600 - BENEFIT DESCRIPTION › Section 8.245.600.6 - 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 medicaid program.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 600 - BENEFIT DESCRIPTION › Section 8.245.600.9 - BENEFIT DESCRIPTION

Current through Register Vol. 35, No. 13, July 16, 2024
Most individuals 65 or older receive free medicare part A.
				  Those who do not receive free part A can voluntarily enroll for hospital
				  insurance coverage and pay the monthly premium. Medicaid does not pay the
				  medicare part A monthly premium for this category of recipients. Voluntary
				  enrollees for premium/conditional medicare part A must enroll for supplementary
				  medical insurance, medicare part B, and pay that premium also. After an
				  application for SLIMB benefits is approved, medicaid begins to pay the medicare
				  part B premium. Applicants/recipients eligible for medicaid coverage under
				  another medicaid category may also be eligible for SLIMB. SLIMB eligibility
				  allows the state to receive federal matching funding for the purchase of
				  medicare part B. Since payment of the medicare part B premium is the only
				  benefit, no medicaid card is issued and there is no interaction with the
				  medicaid claims processing contractor.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 600 - BENEFIT DESCRIPTION › Section 8.245.600.10 - BENEFIT DETERMINATION

Current through Register Vol. 35, No. 13, July 16, 2024
Application for SLIMB is made on the assistance application
				  form. Applications are acted on and notice of action taken is sent to the
				  applicant within 45 days of the application. Determination of SLIMB eligibility
				  for current recipients of medicaid is made without a separate application.
				  Recipients of supplemental security income (SSI) or qualified medicare
				  beneficiaries are not eligible for SLIMB.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 600 - BENEFIT DESCRIPTION › Section 8.245.600.11 - INITIAL BENEFITS

Current through Register Vol. 35, No. 13, July 16, 2024
Eligibility begins the month the case is approved. When an
				  eligibility determination is made, notice of the approval or denial is sent to
				  the applicant. If the application is denied, this notice includes the
				  recipient's right to request a hearing.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 600 - BENEFIT DESCRIPTION › Section 8.245.600.12 - ONGOING BENEFITS

Current through Register Vol. 35, No. 13, July 16, 2024
A redetermination of eligibility is made every 12
				  months.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 600 - BENEFIT DESCRIPTION › Section 8.245.600.13 - 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 245 - MEDICAID ELIGIBILITY - SPECIFIED LOW INCOME MEDICARE BENEFICIARIES (SLIMB) (CATEGORY 045) › Part 600 - BENEFIT DESCRIPTION › Section 8.245.600.14 - CHANGES IN ELIGIBILITY

Current through Register Vol. 35, No. 13, July 16, 2024
A case is closed, with provision of advance notice, when the
				  recipient becomes ineligible. If a recipient dies, the case is closed the
				  following month.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 248 - MEDICAID ELIGIBILITY - MEDICARE DRUG COVERAGE (CATEGORY 048) › Part 400 - RECIPIENT POLICIES › Section 8.248.400.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
The New Mexico medicaid program is administered pursuant to
				  regulations promulgated by the federal department of health and human services
				  under Title XIX of the Social Security Act, as amended, 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 400 - RECIPIENT POLICIES › Section 8.248.400.5 - 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 400 - RECIPIENT POLICIES › Section 8.248.400.6 - 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 400 - RECIPIENT POLICIES › Section 8.248.400.9 - LOW-INCOME SUBSIDY FOR MEDICARE PART D ELIGIBLES

Current through Register Vol. 35, No. 13, July 16, 2024
Applicants/ recipients who meet certain income and other
				  non-financial requirements can be eligible for the low-income subsidy (LIS)
				  under medicare part D.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 248 - MEDICAID ELIGIBILITY - MEDICARE DRUG COVERAGE (CATEGORY 048) › Part 400 - RECIPIENT POLICIES › Section 8.248.400.10 - BASIS FOR DEFINING THE GROUP

Current through Register Vol. 35, No. 13, July 16, 2024
A.
				Medicare recipients who are eligible for part D medicare coverage under the MMA
				of 2003 may be eligible for the low-income subsidy program. Eligibility is
				based on financial criteria, both income and resources, of applicant and spouse
				(if any) for the appropriate family size.
B. Family size: The following persons are
				included in the family size:
(1) the
				applicant;
(2) the applicant's
				spouse, if living with the applicant; and
(3) any persons who are related by blood,
				marriage, or adoption, who are living with the applicant and spouse and who are
				dependent on the applicant or spouse for at least one half of their financial
				support.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 248 - MEDICAID ELIGIBILITY - MEDICARE DRUG COVERAGE (CATEGORY 048) › Part 400 - RECIPIENT POLICIES › Section 8.248.400.11 - GENERAL RECIPIENT REQUIREMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
A. Medicare: Applicants must be eligible for
				and receiving part A or part B medicare benefits.
B. Residence: To be eligible for the
				low-income subsidy, an applicant/recipient must be physically present in New
				Mexico on the date of application or final determination of eligibility and
				must have demonstrated intent to remain in the state. Eligibility for the
				low-income subsidy (LIS) will transfer to New Mexico if determined by the
				social security administration (SSA) in another state. If eligibility was
				determined by another state (not SSA), eligibility must be redetermined in New
				Mexico.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 248 - MEDICAID ELIGIBILITY - MEDICARE DRUG COVERAGE (CATEGORY 048) › Part 400 - RECIPIENT POLICIES › Section 8.248.400.12 - SPECIAL RECIPIENT REQUIREMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
Applicants/recipients must be enrolled in a part D
				  prescription drug plan (PDP) or a medicare advantage prescription drug (MA-PD)
				  plan.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 248 - MEDICAID ELIGIBILITY - MEDICARE DRUG COVERAGE (CATEGORY 048) › Part 400 - RECIPIENT POLICIES › Section 8.248.400.13 - RECIPIENT RIGHTS AND RESPONSIBILITIES

Current through Register Vol. 35, No. 13, July 16, 2024
An applicant/recipient is responsible for establishing their
				  eligibility for the LIS.
A. As part of
				this responsibility, the applicant/recipient must provide required information
				and documents or take the actions necessary to establish eligibility. Failure
				to do so must result in a decision that eligibility does not exist.
B. An applicant/ recipient must also grant
				the HCA permission to contact other persons, agencies or sources of information
				that are necessary to establish eligibility.
C. An applicant can voluntarily withdraw an
				application any time prior to the determination of eligibility. The ISD office
				advises an applicant that withdrawing an application has no effect upon their
				right to apply for assistance in the future.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 248 - MEDICAID ELIGIBILITY - MEDICARE DRUG COVERAGE (CATEGORY 048) › Part 400 - RECIPIENT POLICIES › Section 8.248.400.14 - REPORTING REQUIREMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
A LIS recipient must report to the local ISD office any
				  change in their circumstances that might affect eligibility within 10 days of
				  the change.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 248 - MEDICAID ELIGIBILITY - MEDICARE DRUG COVERAGE (CATEGORY 048) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.248.500.3 - 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 500 - INCOME AND RESOURCE STANDARDS › Section 8.248.500.5 - 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 500 - INCOME AND RESOURCE STANDARDS › Section 8.248.500.6 - 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 (drug benefit) - low income
				  subsidy program.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 248 - MEDICAID ELIGIBILITY - MEDICARE DRUG COVERAGE (CATEGORY 048) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.248.500.9 - NEED DETERMINATION

Current through Register Vol. 35, No. 13, July 16, 2024
This section describes the methodology to be used in
				  determining countable resources and income for the low-income subsidy (LIS)
				  program which is based in part on supplemental security income (SSI)
				  methodology. These guidelines are used for initial and on-going eligibility for
				  medicare beneficiaries enrolled in part A or part B medicare. LIS eligibility
				  is determined prospectively. Applicants/ recipients must meet, or expect to
				  meet, all financial and non-financial eligibility criteria in the month for
				  which a determination of eligibility is made.
New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 248 - MEDICAID ELIGIBILITY - MEDICARE DRUG COVERAGE (CATEGORY 048) › Part 500 - INCOME AND RESOURCE STANDARDS › Section 8.248.500.10 - APPLICATION PROCESS

Current through Register Vol. 35, No. 13, July 16, 2024
The income support division (ISD) office is responsible for
				  taking LIS applications from those individuals who do not want to submit their
				  application to the social security administration either directly or through
				  the ISD office.
A. Who does not have
				to apply: Certain groups of medicare beneficiaries who are also receiving
				medicaid do not have to apply for the LIS. These individuals are called "deemed
				eligible" and will automatically be put on the LIS:
(1) full-benefit dual eligibles, who are
				persons eligible for both medicare and have full medicaid benefits (including
				drug benefits);
(2) SSI
				recipients;
(3) medicare
				beneficiaries, who are participants in the medicare saving programs, which are:
				QMB, SLIMB, and QI-1;
(4) working
				disabled individuals (WDI) who are receiving medicare;
(5) HCBW recipients who are receiving
				medicare; and
(6) individuals
				screened for QMB, SLIMB, or QI-1 and determined eligible before the application
				for LIS is processed.