New Mexico Administrative Code

For certain medicaid categories, an individual must meet specified age requirements. See specific NMAC eligibility chapters for each medicaid category for age requirements.

Health Care Authority (HCA).

Except when specifically waived from MAD, an eligible recipient has the freedom to obtain physical and behavioral health services from a MAD provider of their choice.

By signing the MAP application, an applicant or a re-determining eligible recipient gives HCA explicit consent to release information to applicable state or federal agencies, physical or behavioral health providers, or an HCA designee when the information is needed to provide, mo…

An applicant or an eligible recipient is entitled to adequate notice of a HCA adverse action regarding their termination or re-categorization of their MAP category of eligibility. The applicant or re-determining eligible recipient has specific rights and responsibilities when req…

As a condition of MAP eligibility, HCA requires an applicant or a re-determining eligible recipient to assign their medical care support rights to HCA for medical support and any third party payments. The assignment authorizes HCA to pursue and make recoveries from liable third p…

A. Cooperation: As a condition of MAP eligibility, an applicant or an eligible recipient must cooperate with HCA to: (1) obtain physical and behavioral health support and payments for them and other individuals for whom they can legally assign rights; (2) pursue liable third part…

A. An eligible recipient is responsible for presenting a current MAP eligibility card and evidence of any other health insurance to a MAD provider each time service is requested.(1) An eligible recipient is responsible for any financial liability incurred if they fail to furnish …

A. A MAD provider agrees to accept the amount paid as payment in full. A provider cannot bill an eligible recipient for any unpaid portion of the bill (balance billing) or for a claim that is not paid because of a provider administrative error or failure of multiple providers to …

A. A MAP eligible recipient must return overpayments or medical payments received from liable third parties to the applicable medical service provider or to MAD. If payments are not returned or received, recoupment proceedings against the eligible recipient will be initiated. B. …

A medicaid eligible recipient is required to report certain changes which might affect their eligibility to ISD within 10 calendar days from the date the change occurred. A timely change that is reported within 10 calendar days that may result in a more beneficial medicaid eligib…

HCA is mandated to seek recovery from the estates of certain individuals up to the amount of medical assistance payments made by the HCA on behalf of the individual. See Social Security Act Section 1917 (42 USC 1396p(b) and Section 27-2A-1 et seq., NMSA 1978 "Medicaid Estate Reco…

The rule applies to the general public.

HSD is mandated to seek recovery from the estates of certain individuals up to the amount of medical assistance payments made by the HSD on behalf of the individual. See Social Security Act Section 1917 [42 USC 1396 p(b) and NMSA 1978, Section 27-2A-1 et seq. "Medicaid Estate Rec…

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 NMSA 1978, Section 27-1-12 et …

Permanent.

January 1, 2014, unless a later date is cited at the end of a section.

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, specifical…

[RESERVED]

A. An individual has the right to apply for medicaid and other health care programs HCA administers regardless of whether it appears they may be eligible. (1) Income support division (ISD) determines eligibility for the medical assistance division's medical assistance programs (M…

New Mexico Health Care Authority.

The rule applies to the general public.

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…

Permanent.

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

The objective of these regulations is to provide eligibility policy and procedures for the medicaid program.

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.

A medicaid applicant/recipient must report any change in circumstances which might affect their eligibility within 10 days after the change to the local income support division (ISD) office. This provision does not apply to children's medicaid (category of eligibility 032). See 8…

New Mexico Health Care Authority (HCA).

For specific information on liquid, non-liquid and countable resources, resource exclusions, deemed resources, resource transfers or trusts see specific medical assistance programs (MAP) eligibility categories. Standards for community spouse resource allowance, medical care credi…

The CSRA standard varies based on when the applicant or recipient become institutionalized for a continuous period. The CSRA remains constant even if it was calculated prior to submission of a formal MAP application. If institutionalization began: A. Between September 30, 1989 an…

Apply applicable deductions in the order listed below when determining the medical care credit for an institutionalized spouse. DEDUCTION AMOUNT A. Personal needs allowance for institutionalized spouse: July 1, 2024 $94 B. Minimum monthly maintenance needs allowance (MMMNA): July…

Costs of care are based on the date of application registration. DATE AVERAGE COST PER MONTH A. July 1, 1988 - Dec. 31, 1989 $1,726 per month B. Jan. 1, 1990 - Dec. 31, 1991 $2,004 per month C. Jan. 1, 1992 - Dec. 31, 1992 $2,217 per month D. Effective July 1, 1993, for applicati…

A. Jan. 2024 $730,000 B. Jan. 2024 $713,000 C. Jan. 2023 $688,000 D. Jan. 2022 $636,000 E. Jan. 2021 $603,000 F. Jan. 2020 $595,000 G. Jan. 2019 $585,000 H. Jan. 2018 $572,000 I. Oct. 2017 $560,000 J. Jan. 2017 $840,000 K. Jan. 2016 $828,000 L. Jan. 2015 $828,000 M. Jan. 2014 $81…

The rule applies to the general public.

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 1…

Permanent.

July 1, 2015, unless a later date is cited at the end of a section.

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, specifical…

We ensure that New Mexicans attain their highest level of health by providing whole-person, cost effective, accessible, and high-quality health care and safety-net services.

To be eligible for medical assistance division (MAD) benefits, an applicant or recipient must meet specific resource and income standards based on eligibility category.

New Mexico Health Care Authority (HCA).

This part contains the federal income poverty rate tables for use with all eligibility categories, cost of living (COLA) disregard calculations and other applicable income tables.

A. One hundred percent federal poverty limits (FPL): Size of budget group FPL per month 1 $1,305* 2 $1,763* 3 $2,221 4 $2,680 5 $3,138 6 $3,596 7 $4,055 8 $4,513 Add $458 for each additional person in the budget group. *FPL must be below 100% for an individual or couple for quali…

The countable social security benefit without the COLA is calculated using the COLA increase table as follows: A. divide the current gross social security benefit by the COLA increase in the most current year; the result is the social security benefit before the COLA increase; B.…

Year Individual Institution Individual Couple Institution Couple FBR FBR VTR FBR FBR VTR 1/89 to 1/90 $368 $30 $122.66 $553 $60 $184.33 1/90 to 1/91 $386 $30 $128.66 $579 $60 $193.00 1/91 to 1/92 $407 $30 $135.66 $610 $60 $203.33 1/92 to 1/93 $422 $30 $140.66 $633 $60 $211.00 1/9…