New Mexico Administrative Code

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. Se…

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.

[RESERVED]

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.

Certain non-citizens who are undocumented or who do not meet the qualifying immigration criteria specified in 8.200.410 NMAC, but who meet all eligibility criteria for the following medical assistance categories of eligibility (COEs): other adults (COE 100), parent/caretaker (COE…

New Mexico Health Care Authority.

Non-citizens who receive emergency services must meet the applicable resource standards for an existing medicaid category.

Non-citizens who receive emergency services must meet the income standards for an existing medicaid category.

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 was 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.

New Mexico Health Care Authority.

A. Subsequent to the receipt of emergency services, an applicant must apply through the local county income support division (ISD) office. The application must be filed at the ISD office no later than the last day of the third month following the month the presumed emergency serv…

Applications for medicaid must be acted on within 45 days of the date of application. A. If an applicant is eligible for medicaid, the individual is sent a notice of case action (NOCA) form. The approval of financial eligibility is not a guarantee that medicaid will pay for the s…

No periodic review is necessary, since this category does not result in continuous eligibility. The eligibility for the specific period will only cover the bona fide emergency services. A medicaid card is not issued. No separate notice of case closure is necessary. Notice of appr…

There is no retroactive coverage for this category.

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 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.

An applicant/ recipient who is eligible for medicaid under this category is eligible for emergency services coverage only for the duration of the emergency.

New Mexico Health Care Authority.

Eligibility for applicants/recipients who apply for waiver services is determined as if he or she were actually institutionalized, although this requirement has been waived. Entry into some of the waiver programs may be based upon the number of UDRs (i.e., slots) available. The i…

Eligibility for the waiver programs is always prospective per 8.290.600.11 NMAC. Applicants/recipients must meet, or expect to meet, all non-financial eligibility criteria in the month for which determination of eligibility is made including any mandatory income or resources deem…

A. Age: To be considered elderly, an applicant/recipient must be 65 years of age or older. See Section 8.281.400.16 NMAC, AGE, for information on verification of age. B. Blind: To be considered blind, an applicant/recipient must have central visual acuity of 20/200 or less with c…

An applicant/recipient is responsible for establishing his 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 d…

A medicaid applicant/recipient, case manager, direct service provider or any other responsible party must report any changes in circumstances which may affect the applicant's/recipient's eligibility within 10 days of the date of the change to the county income support division (I…

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 this rule is to provide eligibility criteria for the medicaid program.

A. Adaptive behavior: The effectiveness or degree with which individuals meet the standards of personal independence and social responsibility expected for their age and cultural group. B. Comprehensive care plan (CCP): The comprehensive care plan of services that meets the membe…

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 human services department (HSD) is the single state agency designated to administer the medicaid program in New Mexico. HSD is charged with developing and implementing the community benefit to elderly, blind, and disabled individuals who meet both financial and medical criter…

New Mexico Health Care Authority.

See 8.281.500.10 NMAC and following subsections.

An applicant/recipient is eligible for medicaid on the factor of resources if countable resources do not exceed $2,000. A. Liquid resources: See Subsection A of 8.281.500.11 NMAC. B. Nonliquid resources: See Subsection B of 8.281.500.11 NMAC and following subsections.

See 8.281.500.12 NMAC and following subsections.

See 8.281.500.13 NMAC and following subsections.