New Mexico Administrative Code

September 30, 2013, unless a later date is cited at the end of a section.

The objective of these regulations is to provide regulations in accordance with federal and state laws and regulations for the ISD administered programs.

Unless otherwise apparent from the context, the following definitions shall apply throughout these regulations. A. Claim: means correcting the over-issuance of benefits an eligibility determination group received, but was not entitled to receive, subject to the recovery of such o…

An erroneous payment exists when an error is made by the client or the department that resulted in an underpayment or overpayment of program benefits. The difference between the amount issued and the corrected amount is the amount of the payment error. The department shall take a…

A. An erroneous payment occurs when an error is made by the client or the department that resulted in an underpayment or overpayment of program benefits or assistance. B. Restoration of benefits: If benefits must be restored to an eligibility determination group, the department s…

New Mexico Health Care Authority.

A. Notice of hearing: Unless the claimant or authorized representative requests an expedited scheduling of a fair hearing, the fair hearings bureau shall provide written notice of the scheduling of a fair hearing to all parties not less than 10 calendar days prior to date of the …

A. Rights during the fair hearing: The claimant or authorized representative shall be given an opportunity to: (1) examine the SOE and case record prior to, and during, the hearing in accordance with Subsection B of 8.100.970.8 NMAC; (2) present their case or have it presented by…

A fair hearing is conducted in an orderly manner and in an informal atmosphere. The fair hearing is not open to the public. The fair hearing is conducted by telephone, unless the claimant or the authorized representative makes a special request for the fair hearing to be held in …

The final fair hearing decision shall be made by the appropriate department division director after review of the fair hearing record and the hearing officer's report and recommendation. A. Hearing officer recommendation: The hearing officer reviews the record of the fair hearing…

Unless stayed by court order, the department's final fair hearing decision is binding on all issues that have been the subject of the fair hearing as to that claimant. The local county office is responsible for assuring that decisions are implemented within the timeframes specifi…

A. Right of appeal If a final fair hearing decision upholds the department's or NMHIX's original action, the claimant has the right to pursue judicial review of the final fair hearing decision and is notified of that right in the department's final fair hearing decision. In matte…

The rule applies to the general public.

A. Section 27 NMSA 1978 (1992 Repl.) provides for the department to "...adopt, amend and repeal bylaws, rules and regulations..." It also provides for administration of public assistance programs. B. The income support division (ISD) of the Health Care Authority (HCA) was created…

Permanent.

November 27, 2013, unless a later date is cited at the end of a section.

The objective of these regulations is to provide general policy and procedures for the public assistance programs administered by the department, as well as policy and procedures for the department to conduct hearings for claimants of adverse actions by NMHIX.

A. Agency review conference (ARC): means an optional conference offered by the department to households adversely affected by a department action that is normally held prior to a fair hearing. An ARC may be attended by all parties responsible for and affected by the adverse actio…

A. A household aggrieved by an adverse action taken by the department or NMHIX that affects the participation of the household in a department administered public assistance program or in the New Mexico health insurance exchange, if applicable, may appeal the department's or NMHI…

A. Initiation of the hearing process: (1) A request for a fair hearing can be made by the claimant or an authorized representative orally or in writing. (2) If a claimant requests a fair hearing orally, the department shall take such actions as are necessary to initiate the fair …

New Mexico Health Care Authority.

The rule applies to the general public.

A. New Mexico Statutes Annotated 1978 (Chapter 27, Articles 1 and 2) authorize the state to administer the aid to families with dependent children (AFDC), general assistance (GA), shelter care supplement, the burial assistance programs and such other public welfare functions as m…

Permanent.

November 1, 2023, unless a later date is cited at the end of a section.

A. The purpose of the New Mexico works (NMW) program is to improve the quality of life for parents and children by increasing family income, resources and support. The further purpose of the program is to increase family income through family employment and child support and by u…

A. Definitions beginning with "A": (1) Applicant: means person applying for cash assistance on behalf of a benefit group. (2) Application: means a written or electronic request, on the appropriate ISD form, with the signature of the applicant or on the applicant's behalf by an au…

A. ABBREVIATIONS AND ACRONYMS beginning with "A": AFDC: aid to families with dependent children (replaced by TANF effective July 1, 1997). B. ABBREVIATIONS AND ACRONYMS beginning with "B": (1) BG: benefit group; (2) BIA: bureau of Indian affairs; (3) BIA-GA: bureau of Indian affa…

New Mexico Health Care Authority.

A. Items completed: To be accepted and registered, the cash assistance application, at a minimum, must be submitted on a form designated by the HCA either electronically or in writing, identify the benefit group member applying, the program applied for, and have a signature of a …

A. Application interview: All applicants shall be interviewed in person at the local office or, when circumstances warrant, at another place reasonably accessible and agreeable to both the applicant and the caseworker. The applicant may bring any individual to the interview. B. A…

A. Timeliness: The caseworker shall explain time limits and the applicant's right to request an administrative hearing if the application is not processed within the applicable time limits. B. Processing time limit: Cash assistance applications shall be completed within 30 calend…

A. Denials: If an application is denied, ISD shall issue a written notice to the applicant of a denial. The denial notice shall include the date of denial, reason for denial, the regulation under which the denial was made, the applicant's right to a fair hearing concerning the de…

NMW cash assistance shall be approved effective the date of authorization or no later than 30 days following the date of application, whichever is earlier. Payment in the initial month shall be prorated from the date of authorization.

A. Documents in paper format will be imaged into an electronic case file (ECF). The ECF is located within the automatic system program and eligibility network (ASPEN). ASPEN will digitize the volume of paper documents received from individuals and manage them electronically in a …

The rule applies to the general public.

A. Articles 1 and 2 of Chapter 27, NMSA 1978 authorize the state to administer the aid to families with dependent children (AFDC), general assistance (GA), shelter care supplement, the burial assistance programs and such other public welfare functions as may be assumed by the sta…

Permanent.

July 1, 2024, unless a later date is cited at the end of a section.

A. The purpose of the New Mexico works (NMW) program is to improve the quality of life for parents and children by increasing family income, resources and support. The further purpose of the program is to increase family income through family employment and child support and by u…

A. Application form: The application shall be submitted on a form designated by the HCA either electronically or in writing and is made under oath by an applicant with whom a dependent child resides. The HCA shall assist an applicant in completing the application for cash assista…

A. An individual has the right to make a formal application for any cash, food or medical assistance program administered by the HCA, regardless of whether the individual appears to meet the conditions of eligibility. Any individual requesting information or assistance, who wishe…

New Mexico Health Care Authority.

A. Change of name or payee: Whenever there is a change in a participant's name or the payee for cash assistance, the caseworker shall immediately make the appropriate changes. (1) New caretaker: (a) If a new caretaker assumes responsibility for a dependent child in a case, the ca…

Simplified reporting (SR) is a periodic reporting requirement for benefit groups that receive NMW cash assistance. A benefit group assigned to SR must file an interim report form in the sixth month of a 12-month certification period. A. Certification period:(1) Initial applicatio…

The rule applies to the general public.

A. Articles 1 and 2 of Chapter 27, NMSA 1978 authorize the state to administer the aid to families with dependent children (AFDC), general assistance (GA), shelter care supplement, the burial assistance programs and such other public welfare functions as may be assumed by the sta…

Permanent.

July 1, 2024, unless a later date is cited at the end of a section.