New Mexico Register / Volume XXIX, Issue 4 / February 27, 2018

This is an amendment to 8.290.400 NMAC, Section 11, effective 3/1/2018.

Explanatory statement: Statute citations throughout the rule were corrected to conform to correct legislative styles.

8.290.400.11 GENERAL RECIPIENT REQUIREMENTS: Eligibility for the waiver programs is always prospective. Applicants/recipients must meet, or expect to meet, all non-financial eligibility criteria in the month for which determination of eligibility is made. The application process begins once the letter of allocation, level of care, and the application for medical assistance is received by the income support division worker. After the individual service plan (ISP) has been in effect for 30 days or if it can be reasonably anticipated that services will be in effect for 30 days, the application is approved effective the first day of the month of the start date of the individualized service plan, unless income/resources deemed to a minor child from his parents results in the child's ineligibility for the initial month. The eligibility start date is based on the date of application or the start date of the ISP, whichever is later.

A. Enumeration: An applicant/recipient must furnish his social security number. Medicaid eligibility is denied or terminated for an applicant/recipient who fails to furnish social security number.

B. Citizenship: Refer to medical assistance Eligibility Manual Section 11 of 8.200.410 NMAC.

C. Residence: To be eligible for medicaid, an applicant/recipient must be physically present in New Mexico on the date of application or final determination of eligibility and must have declared an intent to remain in the state. If the applicant/recipient does not have the present mental capacity to declare intent, the applicant’s/recipient's representative may assume responsibility for the declaration of intent. If the applicant/recipient does not have the mental capacity to declare intent and there is no representative to assume this responsibility, the state where the applicant/recipient is living will be recognized as the state of residence. If waiver services are suspended because the recipient is temporarily absent from the state but is expected to return within 60 consecutive days at which time waiver services will resume, the medicaid case remains open. If waiver services are suspended for any other reason for 60 consecutive days, the medicaid case is closed after appropriate notice is provided to the recipient.

D. Non-concurrent receipt of assistance: Home and community-based services waiver (HCBSW) services furnish medicaid benefits to an applicant/recipient who qualifies both financially and medically for institutional care but who, with provision of waiver services, can receive the care he needs in the community at less cost to the medicaid program than the appropriate level of institutional care. Individuals receiving services under a HCBSW may not receive concurrent services under nursing facility (NF), ICF-MR, personal care or any other HCBSW.

(1) SSI recipients: Applicants receiving supplemental security income (SSI) benefits are categorically eligible for waiver services. No further verification of income, resources, citizenship, age, disability, or blindness is required. The applicant must, however, meet the level of care requirement. (An SSI recipient must meet the assignment of rights and TPL requirements and not be ineligible because of a trust.)

(2) Married SSI couples: All married SSI couples where neither member is institutionalized in a medicaid-certified facility are treated as separate individuals for purposes of determining eligibility and benefit amounts beginning the month after the month they began living apart. See Section 8012 of the Omnibus Budget Reconciliation Act of 1989. In the case of an initial application, or reinstatement following a period of ineligibility, when members of a married couple are not living together on the date of application or date of request for reinstatement, each member of the couple is considered separately as of the date of application or request, regardless of how recently the separation occurred.

E. Interview requirements: An interview is required at initial application for all home and community-based waiver medical assistance programs in accordance with all of the requirements set forth at Section 8.281.400.11 NMAC.

[2/1/1995, 4/30/98; 8.290.400.11 NMAC - Rn, 8 NMAC 4.WAV.410, 411, 412, 413, 414 & A, 5/1/2002; A, 11/1/2007; A, 3/1/2018]