New Mexico Administrative Code

If the recipient ceases to meet any of the eligibility criteria, the case is closed following provision of advance notice as appropriate. See 8.200.430 NMAC for information about notices and hearing rights. A. Non-provision of PACE services: To be eligible for PACE, an applicant/…

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.

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.

An applicant/recipient who is eligible for PACE is eligible for specified services available under the program. See specific program policy sections for covered services.

New Mexico Health Care Authority.

An applicant or recipient must require institutional care as certified by a physician licensed to practice medicine or osteopathy. The applicant or recipient must be institutionalized in a medicaid qualifying bed in a New Mexico medicaid approved institution or in a hospital admi…

An interview is not required for institutional care medicaid. An applicant or recipient can request an interview from the income support division (ISD).

An applicant or recipient must furnish their social security number in accordance with 8.200.410.10 NMAC.

Refer to medical assistance program manual Section 8.200.410.11 NMAC.

A. Residence in the United States: An applicant or recipient must be residing in the United States at the time of approval. An applicant or recipient who leaves the United States for an entire calendar month loses eligibility. The applicant or recipient must re-establish their re…

A. Institutional care medicaid: To be eligible for institutional care medicaid an applicant or recipient must be aged, blind, or disabled as defined by the social security administration (SSA). Recipients of institutional care medicaid in New Mexico are terminated from assistance…

To be considered aged, an applicant or recipient must be 65 years of age or older. Age is verified by the following: A. decision from SSA regarding age; B. acceptable documentary evidence including: (1) birth certificate or delayed birth certificate; (2) World War II ration books…

To be considered blind, an applicant or recipient must have central visual acuity of 20/200 or less with corrective lenses. A. Documentation of blindness: An applicant or recipient must meet the SSA's definition of blindness. If the applicant or recipient is receiving social secu…

To be considered disabled, an applicant or recipient under 65 years of age is considered to have a qualifying disability if they are unable to engage in any substantial gainful activity because of any medically determinable physical, developmental, or mental impairment which has …

The ISD worker determines whether an applicant or recipient's SSI eligibility will continue while they are institutionalized. A. Applicant/recipient currently eligible for SSI: If an applicant or recipient will not continue to be eligible for SSI while institutionalized, the ISD …

The rule applies to the general public.

An applicant or recipient is responsible for establishing their eligibility for medicaid. As part of this responsibility, the applicant or recipient must provide required information and documents or take the actions necessary to establish eligibility. Failure to do so must resul…

An applicant or recipient residing in an institution can request an administrative hearing to dispute issues relating to the eligibility determination process at the time of the eligibility determination (see Section 8.200.430.12 NMAC, Right to Hearing).

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

Medicaid recipients must report any change in circumstances, which may affect their eligibility to their local ISD office within 10 days of the change in accordance with 8.200.430.18 NMAC.

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.

January 1, 2019, 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 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 New Mexico medicaid program (medicaid) pays for services furnished to individuals who require institutional care and who meet all supplemental security income (SSI) eligibility criteria and whose monthly gross countable income is less than the maximum allowed amount for insti…

New Mexico Health Care Authority.

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 or recipient's support and maintenance. Resources may be liquid or non-liquid and may be excluded from the …

The resource criteria and eligibility standards of this section apply to all applicants for and recipients of a MAP category of eligibility for institutional care. An applicant or recipient is eligible for a MAP category of eligibility for institutional care on the factor of reso…

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

Some types of resources can be excluded from the calculation of countable resources if they meet the specific criteria listed below. A. Burial fund exclusion: Up to $1,500 can be excluded from the countable liquid resources of an applicant or recipient if designated as their buri…

The ISD caseworker must determine whether an applicant or recipient or their spouse transferred assets within a specified period of time (lookback period) before applying for a MAP category of eligibility for institutional care or at any time after approval of the applicant's or …

A. Community property resource determination methodology: Community property resource determination methodology is used in the eligibility determination for a married applicant or recipient who began institutionalization for a continuous period prior to September 30, 1989. (1) To…

Deeming of resources applies only during periods when an eligible applicant/recipient under 18 years of age lives at home and during the month the eligible applicant or recipient enters an institution. After the initial month of entry into the institution, only those resources di…

An applicant's or recipient's gross countable monthly income must be less than the maximum allowable monthly income standard. If an applicant's or recipient's monthly gross countable income is below $50, the application can still be processed; however, the applicant or the recipi…

The applicable income standard used in the determination of a MAP category of institutional care eligibility for an applicant or recipient who has not been institutionalized for a period of 30 consecutive days is the SSI federal benefit rate (FBR) for a non-institutionalized indi…

Unearned income includes all income not earned in the course of employment or self-employment. If payment is made in the name of either or both spouses and another party, only the applicant's or recipient's proportionate share is considered available to them. If income is derived…

The rule applies to the general public.

A. Availability: Deemed income is income considered available to a minor applicant or recipient from their parents. Deeming of resources and income applies only during periods when an applicant or recipient under 18 years of age is living with their parents and during the month o…

Income disregards are determined on an individual basis. Disregards may be applied to any appropriate month of assistance, regardless of which income maximum is used. A. $20 disregard: The first $20 of unearned or earned income received in a month is disregarded. This disregard i…

Once financial eligibility for a MAP category of institutional care has been established, the ISD worker must determine the following. A. Medical care credit: The medical care credit is the amount of the applicant's or recipient's income used to reduce the MAD payment to the inst…

An applicant or recipient subject to a penalty for transfer of assets for less than fair market value may apply for a waiver of the regulation regarding transfer of assets as constituting an undue hardship. The facility where an institutionalized applicant or recipient resides ma…

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 …

Permanent.