New Mexico Administrative Code

Refer to 8.200.410.12 NMAC.

Refer to 8.200.410.12 NMAC.

To meet MAP requirements for eligibility, applicants or recipients must be living in New Mexico on the date of application or final determination of eligibility and have demonstrated an intention to remain in the state. A. Establishing residence: Residence in New Mexico is establ…

A MAP applicant or recipient receiving medicaid in another state is not eligible for MAP enrollment in accordance with 8.200.410 NMAC.

As a condition of eligibility, a MAP applicant or recipient must take all necessary steps to obtain any benefits he or she is entitled to in accordance with 8.200.410 NMAC.

A. Basis and implementation. In accordance with section 1413(b)(1)(A) of the Affordable Care Act, HSD will accept an application from the applicant, an adult who is in the applicant's household, as defined in 42 CFR 435.603, or family, as defined in section 36B(d)(1) of the Code,…

A. Renewal of individuals whose medicaid eligibility is based on MAGI. (1) Except as provided in Subsection D of 8.291.410.19 NMAC, the eligibility of medicaid beneficiaries whose financial eligibility is determined using MAGI-based income must be renewed once every 12 months, an…

The rule applies to the general public.

Verification will be obtained through various methods. Not all methods will necessarily be used in each case. This section details the specific types of methods to be used in establishing the applicant or recipient's eligibility. A. Prior case data not subject to change: Verifica…

Below is a list of standards HSD will utilize to determine eligibility for MAP categories defined at 8.291.400.10 NMAC. If verification cannot be confirmed utilizing the various methods described in each section of this rule, HSD may request additional information. If information…

A. HSD will request the following information relating to financial eligibility from other agencies in the state and other states and federal programs to the extent HSD determines such information is useful to verifying the financial eligibility of an individual. (1) Information …

The federal government will establish an electronic service through which HSD may verify certain information with, or obtain such information from, federal agencies and other data sources, including SSA, the department of treasury, and the department of homeland security. To the …

A. HSD will promptly evaluate information received or obtained by it in accordance with regulations per 42 CFR 435.940 through 435.960 to determine whether such information may affect the eligibility of an individual or the benefits to which he or she is entitled. B. If informati…

HSD has a verification plan describing the verification policies and procedures to implement the provisions set forth in 42 CFR 435.940 through 435.956 and 8.100.130 and 8.291.410 NMAC. The state verification plan is posted on the HSD website.

An applicant or recipient is given a timeframe to provide necessary verification in order for ISD to process an application within the timeframe set forth in this section. This requirement pertains to requests for verification for initial applications as well as for verification …

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) medical assistance programs (MAP) and other health care programs it administers. Processes for establishing and maintaining this category of elig…

Refer to 8.291.400.7 NMAC.

To be eligible for MAP, applicants or recipients must meet specific requirements as outlined in this part.

New Mexico Health Care Authority.

Refer to 8.200.430.11 NMAC.

Refer to 8.200.430.12 NMAC.

Refer to 8.200.430.13 NMAC.

Refer to 8.200.430.14 NMAC.

Refer to 8.200.430.15 NMAC.

Refer to 8.200.430.16 NMAC.

Refer to 8.200.430.17 NMAC.

Refer to 8.200.420.12 NMAC.

Refer to 8.200.420.13 NMAC.

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.

January 1, 2014, 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…

Refer to 8.291.400.7 NMAC.

A. An individual has the right to apply for medicaid and other health care programs MAD administers regardless of whether it appears he or she may be eligible. (1) The income support division (ISD) determines eligibility for medicaid, unless otherwise determined by another entity…

Refer to 8.200.430.10 NMAC.

New Mexico Health Care Authority (HCA).

This part contains the monthly federal poverty level table for use in determining monthly income standards for MAP categories of eligibility outlined in 8.291.400.10 NMAC: HOUSEHOLD SIZE 100% 133% 138% 190% 240% 250% 300% 1 $1,305 $1,735 $1,800 $2,478 $3,130 $3,261 $3,913 2 $1,76…

This part contains the MAP category of pregnant women and parent caretaker eligibility's fixed monthly standard for an applicant or recipient: HOUSEHOLD SIZE MONTHLY INCOME LIMIT 1 $451 2 $608 3 $765 4 $923 5 $1,080 6 $1,238 7 $1,395 8 $1,553 +1 $158

A disregard of five percent of 100 percent of the current FPL, according to the applicant's or recipient's budget group size, will be given according to the Affordable Care Act (ACA) related category of eligibility. This income disregard will be subtracted from the countable inco…

All individuals listed on the MAP application are evaluated according to their living arrangement to determine if they can be included in an assistance group or budget group. A. Extended living in the home: An individual physically absent from the home is a member of the assistan…

At the time of a MAP application, an applicant or recipient and ISD shall identify everyone who is to be considered for inclusion in an assistance unit and budget group. The composition of the assistance unit and budget group is based on the following factors: A. Assistance group…

Verification of income, both earned and unearned, is mandatory for all MAP categories of ACA related eligibility. Verification methods can be found at 8.291.410 NMAC. A. All income will be calculated as defined by Section 36B of the Federal Tax Code to produce a MAGI. This amount…

Resources as defined in 8.100.130 NMAC are not a factor of eligibility for a MAP category of ACA eligibility.

The rule applies to the general public.

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 NMSA et seq.