New Mexico Administrative Code

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 2…

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.

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…

New Mexico Health Care Authority.

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. …

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…

Applicants/recipients must be enrolled in a part D prescription drug plan (PDP) or a medicare advantage prescription drug (MA-PD) plan.

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 LIS recipient must report to the local ISD office any change in their circumstances that might affect eligibility 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 27-2-12 et. seq…

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 medicare part D - low-income subsidy program.

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 Health Care Authority.

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…

A "resource" is defined as cash and other assets that can be converted to cash within 20 days. A. Resource determination: The resource determination is made as of the first moment of the first day of the month. An applicant/recipient is ineligible for any month in which their cou…

The resource standard for the LIS is $10,000 for an individual and $20,000 for a couple. Resources belonging to other dependent family members are not considered. A. Cash resources: The face value of cash, savings or checking accounts is considered in determining LIS eligibility.…

Before a resource can be considered countable, the three criteria listed below must be met. A. Ownership interest: An applicant/recipient must have an ownership interest in a resource for it to be countable. The fact that an applicant/recipient has access to a resource, or has a …

The following resources are not to be considered for purposes of determining LIS eligibility: A. Applicant's home: A home is any property in which the applicant and spouse have an ownership interest and which serves as the applicant's principal place of residence. There is no res…

Income is anything the applicant/spouse receives in cash or in-kind that can be used to meet their needs for food or shelter. The gross income of the applicant, and their spouse if living together, but not dependent family members, will be considered. However, dependent family me…

A. Earned income: Earned income consists of the following types of payments: (1) wages counted at the earliest of: when received, when credited to the person employed, or when set aside for the employee's use; (2) net earnings from self-employment counted on a taxable year basis;…

Unearned income is all income that is not earned income. Unearned income is counted at the earliest of the following points: when received, when credited to the recipient, or when set aside for the recipient's use. A. Unearned income includes, but is not limited to:(1) social sec…

Deeming income from a spouse to their minor child(ren) or from one spouse to the other spouse when living in the same household, does not apply.

Countable income is the sum of unearned income or earned income for the individual or spouse less disregards or exclusions. Only one earned income exclusion ($65 plus one half of the remainder) is applied and one $20 disregard is applied if using income from both spouses.

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 27-2-12 et. seq…

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 medicare part D (drug benefit) - low income subsidy program.

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 me…

New Mexico Health Care Authority.

Completed applications must be acted upon and notice of approval, denial, or delay sent out within 45 days of the date of application. The applicant will have time limits explained and be informed of the date by which the application should be processed.

Eligibility is always prospective and begins the month of application, but not earlier than January 1, 2006. When an eligibility determination is made, notice of the approval or denial is sent to the individual. If the application is denied, the notice shall include reason for de…

The applicant/recipient is responsible to report changes affecting eligibility within 10 days of when the change took place. A re-determination of eligibility is made every 12 months. If a LIS recipient/applicant becomes eligible for certain medicaid categories; SSI, QMB, SLIMB, …

There is no three month retroactive LIS coverage under this program. The subsidy is effective the beginning of the month of application or January 1, 2006, whichever is later.

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 27-2-12 et. seq…

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 medicare part D -low income subsidy program.