New Mexico Administrative Code

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…

For Category 050, medicaid coverage is limited to payment of the medicare Part A premium. No medicaid card is issued.

New Mexico Health Care Authority.

Individuals eligible for medicaid coverage under the working disabled individuals program (WDI) must meet the following requirements: A. must meet the social security administration disability criteria without regard to "substantial gainful activity", and B. must have a recent at…

To be eligible an individual must report their social security account number(s) to the human services department (HSD). If an individual does not have a valid social security number, the individual must apply for one as a condition of medicaid eligibility. Applications for socia…

To be eligible for medicaid, an individual must be: A. a citizen of the United States; or B. a non-citizen who entered the United States prior to August 22, 1996, as one of the classes of non-citizens described in Subsection A of 8.200.410.11 NMAC, or a non-citizen who entered th…

To be eligible for medicaid, individuals must be living in New Mexico on the date of application or final determination of eligibility and have demonstrated intent to remain in the state. A. Establishing residence: Residence in New Mexico is established by living in the state and…

The individual may not be receiving assistance in another medicaid category with the exception of the qualified medicare beneficiaries (QMB) and specified low income medicare beneficiaries (SLIMB) programs. ISD staff will look at other categories of eligibility and make the appro…

The individual must be 18 years of age or older.

The individual must meet social security administration's disability or blindness criteria, without regard to "substantial gainful activity".

The individual is responsible for establishing their eligibility for medicaid. As part of this responsibility, the individual must provide required information and documents or take the actions necessary to establish eligibility. Failure to do so must result in a decision that el…

The individual must assign their right to medical support or other third party payments to the state. A. Assignment of medical support rights occurs through the application for medicaid benefits. B. Medicaid is not denied to an otherwise eligible individual solely because they ca…

This rule applies to the general public.

An applicant/recipient is responsible to report changes affecting eligibility by the end of the calendar quarter in which the change took place.

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 by the state human services department pursuant to state statute. See 27-2-12 et. seq.…

Permanent.

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.

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

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.

The working disabled individuals program covers: A. disabled individuals who are employed; or B. disabled individuals who have lost eligibility for supplemental security income (SSI) and medicaid due to initial receipt of social security disability insurance ( SSDI) and who are n…

New Mexico Health Care Authority (HCA).

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 eli…

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.

A. An individual's countable resources must be less than $10,000. B. Married individuals' countable resources must be less than $15,000.

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 …

See 8.215.500.15 NMAC.

See 8.281.510 NMAC and following subsections.

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.

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…

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 indivi…

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 g…

This rule applies to the general public.

RESERVED

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 govern…

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 by the state health care authority pursuant to state statute. See Section 27-2-12 et. …

Permanent

January 1, 2001, 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.

[RESERVED]

Income and resources are determined based on SSI methodology, except when deeming income from an ineligible spouse. See 8.215.500 NMAC. Individuals must meet all financial and non-financial eligibility criteria in the month(s) for which a determination of eligibility is made.

New Mexico Health Care Authority(HCA).

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.

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.

A re-determination of MAP eligibility is made every 12 months or at such time the MAP eligible recipient begins receiving medicare benefits.

Retroactive medicaid coverage is provided in accordance with 8.200.400.14 NMAC.