New Mexico Administrative Code

See 8.281.500.14 NMAC, asset transfers, and following subsections for rules governing transfers of assets. All provisions pertaining to transfers under institutional care medicaid apply to transfers under the waiver programs with the exception of the penalty for transfers of asse…

See 8.281.500.15 NMAC and following subsections.

A. Community property resource determination methodology: See Subsection A of 8.281.500.16 NMAC and Paragraph (2) of Subsection A of 8.281.500.16 NMAC for methodology used in the determination of eligibility for married applicants/recipients who began receiving waiver services fo…

See 8.281.500.17 NMAC. The resources of the custodial parent(s) are deemed available to the applicant/recipient for the entire calendar month in which the allocation letter is issued by the waiver program manager or the representative notifies the ISD worker that a UDR is availab…

To qualify for medicaid under any of the waiver programs, the gross countable income of the applicant/recipient must be less than the maximum allowable monthly income standard. See 8.200.520.16 NMAC, Income Standards. See 8.281.500.18 NMAC and following subsections.

Income exclusions: See 8.281.500.19 NMAC and following subsections.

The rule applies to the general public.

See 8.281.500.20 NMAC and following subsections.

See 8.281.500.21 NMAC and following subsections. The income of the custodial parent(s) is deemed available to the applicant/ recipient for the entire calendar month in which the allocation letter is issued by the waiver program manager or the representative notifies the ISD worke…

See 8.281.500.22 NMAC and following subsections.

There are no medical care credits in the waiver programs. The applicant/recipient is allowed to keep all of their income to maintain their household in the community.

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 Sections 27-2-1…

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 criteria for the medicaid program.

See 8.290.400.7 NMAC.

To reduce the impact of poverty on people living in New Mexico and to assure low income and disabled individuals in New Mexico equal participation in the life of their communities.

Eligibility for the home and community-based services waiver programs is always prospective. Applicants/recipients must meet, or expect to meet, all financial eligibility criteria in the month for which a determination of eligibility is made. Applicants for and recipients of medi…

New Mexico Health Care Authority.

Application for the waiver programs is made using the HSD 100 application. Upon notification by the appropriate program manager that an unduplicated recipient (UDR) is available for waiver services, applicants are registered on the income support division (ISD) eligibility system…

A. The application process begins once the letter of allocation and the medicaid application for assistance are received by ISD. Once ISD has confirmed the applicant/recipient meets all eligibility criteria, the application can be approved effective the first month for which an a…

A. A complete redetermination of eligibility must be performed annually by the ISD caseworker for each open case. B. Level of care determinations are made by the utilization review contractor or a member's selected or assigned managed care organization, as applicable to the cente…

Eligibility for these categories is prospective so retroactive coverage is not available in accordance with 8.200.400.14 NMAC.

If the eligible recipient ceases to meet any of the eligibility criteria, the case is closed following provision of advance notice as appropriate. See Section 8.200.430.9 NMAC and following subsections for information about notices and hearing rights. A. Non-provision of waiver s…

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 (HCA) pursuant to state statute. See Section 27…

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 medical assistance division (MAD) programs.

See Section 8.290.400.7 NMAC.

Eligible recipients are eligible for specified services available under the particular waiver and ancillary services available under the general medicaid program. See specific program policy sections for covered services.

New Mexico Health Care Authority.

Medicaid is a federally matched program that makes certain essential health care services available to eligible New Mexico residents who otherwise would not have the financial resources to obtain them. With certain exceptions, medicaid benefits are provided through the department…

A. HSD provides continuous eligibility for the period specified in Subsection B and C of 8.291.400.11 NMAC for an individual who is:(1) under age 19; and (2) eligible and enrolled for mandatory or optional coverage under the state plan. B. The continuous eligibility period is up …

A medicaid eligible recipient is required to report certain changes which might affect their eligibility to ISD within 10 calendar days from the date the change occurred. A timely change that is reported within 10 calendar days that may result in a more beneficial medicaid eligib…

Presumptive eligibility (PE) provides medicaid benefits under one of the eligible groups outlined in Subsection B of 8.291.400.10 NMAC, starting with the date of the PE determination and ending with the last day of the following month or, if an ongoing application is submitted at…

A. Extended eligibility for pregnant individuals: For a pregnant individual who was eligible and enrolled for mandatory or optional coverage under the state plan on the date their pregnancy ends (regardless of the reason the pregnancy ends), HSD provides full medicaid coverage th…

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 or by state statute. See Section 27-1-12 et seq., NMSA 1978. Section 9-8-1 et seq. NMSA…

Permanent.

October 1, 2017, unless a later date is cited at the end of a section.

The objective of this rule is to provide eligibility guidelines when determining eligibility for the medical assistance division (MAD) medicaid program and other health care programs it administers. Processes for establishing and maintaining this category of eligibility are found…

A. Action: an approval, termination, suspension, or reduction of medicaid eligibility or a reduction in the level of benefits and services, including a determination of income for the purposes of imposing any premiums, enrollment fees, or cost-sharing. It also means determination…

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HSD is the single state agency designated to administer the New Mexico Title XIX medicaid program in accordance with 42 CFR 431.10, single state agency. State authority is provided by Section 27-2-12 NMSA 1978 (Repl. 1984). Title XIX of the Social Security Act and United States d…

New Mexico Health Care Authority (HCA).

Refer to 8.200.410.10 NMAC.

The age of the applicant recipient is verified to determine if he or she is under or over the specified age limit. A. Age of child: Verification of age, including self-attestation of an applicant or recipient under 21 years of age is mandatory for MAP enrollment. B. Age of adults…

Verification of relationship is mandatory, see 8.291.410.20 NMAC A. Documents that can be used to verify relationship can be found at 8.100.130 NMAC. B. The documentary evidence must contain the names of related individuals in question.(1) If the relative is other than a parent, …