New Mexico Administrative Code

(Reserved.)

(Reserved.)

(Reserved.)

(Reserved.)

(Reserved.)

(Reserved.)

(Reserved.)

(Reserved.)

(Reserved.)

New Mexico Health Care Authority.

Applicants/recipients eligible for medicaid coverage under any other category may be eligible for coverage under QMB. QMB eligibility affords two advantages when an applicant/ recipient is already eligible for medicaid: A. medicare premium part A is payable by medicaid; and B. me…

Applicants/recipients must furnish their social security account number(s). QMB eligibility is denied or terminated if applicants/recipients fail to furnish their social security numbers.

A. Refer to medical assistance program manual 8.200.410.11 NMAC. B. Verification of citizenship: Citizenship determinations rendered by the social security administration (SSA) for SSI are final.(1) Documentation of citizenship: Primary documentation of citizenship is a birth cer…

An applicant/recipient must be physically present in New Mexico on the date of application or final determination of eligibility and have demonstrated intent to remain in the state. If the applicant/recipient does not have the present mental capacity to declare intent, the parent…

A QMB applicant/recipient on buy-in in another state cannot be approved for QMB in New Mexico until the other state's buy-in is terminated.

There is no special recipient requirements such as age or disability for QMB.

An applicant/recipient is responsible for establishing their 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…

Refer to medical assistance program manual Subsection F of 8.200.420.12 NMAC.

All medicaid recipients must report any change in their circumstances which can affect eligibility to the local income support division (ISD) office within 10 days of the change.

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 be eligible for the qualified medicare beneficiaries program (QMB), an applicant/recipient must be covered by medicare part A. Medicare part A is a free entitlement to social security beneficiaries who are 65 years of age or older or who have received social security disabilit…

New Mexico Health Care Authority.

The value of an applicant/recipient's individual countable resources must not exceed the amount set forth in Section 8.200.510.14 NMAC, resource amounts for supplemental security income (SSI) related medicare savings programs (QMB and SLIMB/QI). The resource limit for an applican…

The social security administration excluded transfer of resources as a factor of eligibility for non-institutionalized SSI recipients. Transfer of resources is not a factor for consideration in categories that use SSI methodology in the eligibility determination.

See Section 8.281.510 NMAC and following subsections.

The income ceiling for QMB eligibility is one hundred percent of the federal income poverty guidelines. These guidelines are updated annually effective April 1st. See Section 8.200.520 NMAC, Income Standards. If the applicant is a minor child, income must be deemed from the paren…

A. 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 QMB eligibility. For redetermina…

A. Minor applicant/recipient living with parent(s): If the applicant/recipient is a minor who lives with a parent(s), deemed income from the parent(s) must be considered in accordance with Section 8.215.500.21 NMAC, deemed income, and applicable subsections. B. Applicant/recipien…

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 the section.

The objective of this rule is to provide eligibility policy and procedures for the medicaid program.

Applicants for, or recipients of, the qualified medicare beneficiaries (QMB) program must apply for and take all necessary steps to obtain any income or resources to which they may be entitled. Recipients of supplemental security income (SSI) or aid to families with dependent chi…

New Mexico Health Care Authority.

Application for QMB is made on the assistance application form. A separate application is not required if the recipient is receiving medicaid under another category. The income support specialist (ISS) must act on applications and send notice of action taken to the applicant with…

Eligibility begins the month after the month the case is approved. No retroactive coverage is available. Enrollment periods for medicare coverage: Individuals who are not entitled to free medicare Part A can purchase it. This is called "premium" or "conditional" Part A coverage. …

A redetermination of eligibility conditions must be made at least every 12 months but no more frequently than every six months.

No retroactive medicaid benefits are available for applicants/recipients in this category.

A case is closed when the recipient becomes ineligible, with provision of advance notice. If a recipient dies, the case is closed the following month.

The rule applies to the general public.