TITLE 8 SOCIAL SERVICES
CHAPTER 206 MEDICAID
ELIGIBILITY - CYFD CHILDREN (CATEGORIES 006, 017, 037, 046, 047,
060,
061, 066 & 086)
PART 500 INCOME
AND RESOURCE STANDARDS
8.206.500.1 ISSUING
AGENCY: New Mexico Human Services Department.
[10-1-94; 8.206.500.1 NMAC - Rn, 8 NMAC
4.CYM.000.1, 3-1-01]
8.206.500.2 SCOPE: This
rule applies to the general public.
[10-1-94; 8.206.500.2 NMAC - Rn, 8 NMAC
4.CYM.000.2, 3-1-01]
8.206.500.3 STATUTORY
AUTHORITY: 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 human services department pursuant to state statute.
See NMSA 1978 Section 27-2-12 et. seq. (Repl. Pamp. 1991).
[10-1-94; 8.206.500.3 NMAC - Rn, 8 NMAC
4.CYM.000.3, 3-1-01]
8.206.500.4 DURATION:
Permanent.
[10-01-94; 8.206.500.4 NMAC - Rn, 8 NMAC
4.CYM.000.4, 3-1-01]
8.206.500.5 EFFECTIVE
DATE: October 1, 1994, unless a later date is cited
at the end of a section.
[10-1-94; 8.206.500.5 NMAC - Rn, 8 NMAC
4.CYM.000.5, 3-1-01; A, 10-1-06]
8.206.500.6 OBJECTIVE: The
objective of these regulations is to provide eligibility policy and procedures
for the medicaid program.
[10-1-94; 8.206.500.6 NMAC - Rn, 8 NMAC
4.MAD.000.6, 3-1-01]
8.206.500.7 DEFINITIONS:
[RESERVED]
8.206.500.8 [RESERVED]
8.206.500.9 NEED DETERMINATION:
[10-1-94;
8.206.500.9 NMAC - Rn, 8 NMAC 4.CYM.500, 3-1-01]
8.206.500.10 RESOURCE STANDARDS: To be
eligible for CYFD medicaid, the value of all countable personal and real
property, considered belonging to or available to an applicant/recipient under
eighteen (18) years of age or twenty-one (21) years of age in expanded foster
care medicaid category 006 or 066 cannot exceed $1,000. If an applicant/recipients owns resource or
saving in excess of this amount, he/she is not eligible for CYFD medicaid.
[10-1-94;
8.206.500.10 NMAC - Rn, 8 NMAC 4.CYM.510, 3-1-01; A, 10-1-06]
8.206.500.11 APPLICABLE RESOURCE STANDARDS: The
authorized representative from CYFD who completes the application on behalf of
the applicant/recipient must initiate all appropriate steps to make available
property or resources to which the applicant/recipient may be entitled. Normally, individuals under eighteen (18) do
not own/controlled property. Property
that is held and/or control on behalf of an applicant/recipient is considered
available unless some specific provision in the title to the property precludes
it availability.
A. Property
not readily marketable: Even
property that is not marketable must be assessed in the eligibility
determination and is subject to transfer restrictions and penalties.
B. Property
share owned: The current value of
property which must be partitioned to be accessible is not considered available
if the net value after estimated costs of partition and other closing costs is
less than the resource limit. If the
amount likely to be derived from the sale of the applicant/recipient's share of
the property exceeds the resource limit, he/she must initiate attempts to
obtain his/her share of the property.
C. Property
owned by parent: The value of
property owen by the parent who does not live with the applicant/recipient is
not considered available to the applicant/recipient.
[10-1-94;
8.206.500.11 NMAC - Rn, 8 NMAC 4.CYM.511, 3-1-01]
8.206.500.12 COUNTABLE RESOURCES:
Countable resources include but are not limited to the following:
A. cash value of life insurance policy owned by the
applicant/recipient;
B. cash, bank accounts and other readily negotiable assets
owned by the applicant/recipient are countable resources;
C. equipment, tools, and motor vehicles (which do not fit
the vehicle exemption);
D. livestock; and
E. asset conversion; money received from one-time or
sporadic sales of real or personal property such as crops, rugs, or jewelry is
considered a resource if the property is not sold or transferred in connection
with a business of self-employment activity.
(1) Actual verified expenses associated with
the purchase, sale, or production of the property are deducted from money
received from the sale to arrive at the net resource value.
(2) Property converted into money is subject
to the resource limitation regardless of whether it was fully or partially
exempt prior to conversion.
[2-1-95;
8.206.500.12 NMAC - Rn, 8 NMAC 4.CYM.512, 3-1-01]
8.206.500.13 RESOURCE EXCLUSIONS:
Certain resources are excluded from the resource computation.
A. Vehicle
exclusion: The equity value of one
vehicle belonging to the applicant/recipient or in his/her name, is not
considered a countable resource if the value of the vehicle is $1,500 or
less. Any excess over $1,500 is a
countable resource. The value of any
apparatus for the handicapped which is installed on the vehicle is also
excluded.
B. Income
exclusion: Any income which is
excluded under income provisions is also excluded from consideration as a
resource. Excluded income which is saved
must be kept separate from non-excluded savings.
C. Settlement
fund payment exclusion: Payments
received from the Radiation Exposure Compensation Act is excluded. Payments made under the Agent Orange
Settlement Act is also excluded.
Payments by the remembrance, responsibility and the future foundation to
individual survivors forced into slave labor by the Nazis are excluded.
D. Earned income tax credit payment exclusion: Earned income tax credit payments are not
considered resources until the third month after receipt of the payment.
E. Funeral
agreement exclusion: The equity
value of funeral agreement(s) owned by the applicant/recipients which do not
exceed $1,500 are excluded.
F. Contingent
and unliquidated claim exclusion:
"Contingent and unliquidated claim" is defined as a yet
unnamed right of the applicant/recipient to receive, at some future time, a
resource such as an interest in an unprobated estate or damages/compensation
from an accident or injury. These claims
are excluded if the applicant/recipient can demonstrate that he/she has
consulted an attorney or that under the circumstances it is reasonable not to
have consulted an attorney but that he/she is making effort to prosecute
his/her claim or to proceed with the probate.
If the applicant/recipient can demonstrate that his/her share in an
unprobated estate would be less than the expense of the proceeding to probate
the estate, the value is not considered a resource.
G. Chafee medicaid: All resources belonging to recipients of
Chafee medicaid who are between eighteen (18) and twenty-one (21) years of age
are excluded.
[10-1-94;
8.206.500.13 NMAC - Rn, 8 NMAC 4.CYM.500, 3-1-01; A, 5-1-01; A/E, 12-1-06]
8.206.500.14 RESOURCE TRANSFERS: To be
eligible for CYFD Medicaid, the applicant/recipient must not have transferred
resources within two (2) years prior to application for the purpose of
qualifying for CYFD medicaid. An
applicant/recipient under eighteen (18) years of age cannot transfer property,
except through a guardian. Normally,
such applicants/recipients do not own property in his/her own right. If facts indicate the existences of a trust,
inheritance, or prior gift, the CYFD representative completing the application
must determine if a transfer has taken place within the two (2) year period.
A. Transfers
made for the purpose of qualifying for medicaid: A transfer is considered to have been made
for the purpose of becoming eligible if:
(1) the transfer was made without a reasonable
return; and
(2) the applicant/recipient had no reasonable
plan for support at the time of the transfer other than receiving CYFD
medicaid.
(3) if the value of the applicant/recipient's
equity in the transferred property plus all other countable resources is less
than $1,000, the transfer is not considered to be for the purpose of becoming
eligible.
B. Definitions:
(1) "Transfer" includes the sale,
transfer by gift, or conveyance by deed or any other method of transferring the
title to the property. The transfer can
be for either the title to real property or any other interest or rights in
real property, such as mineral rights.
(2) "Reasonable return" is
considered to have been received when the applicant/recipient received
compensation in cash or in kind equals the value of the property at the time of
transfer. This determination is based on
the applicant/recipient's equity interest in the property at the time of
transfer.
C. Attempts to obtain reasonable return: If the property was transferred for the
purpose of becoming eligible but the applicant/recipient subsequently makes and
continues to make efforts to obtain a reasonable return or regain the title,
the applicant/recipient is not ineligible because of the improper transfer of
resources.
D. Period
of ineligibility: If a transfer
without fair return was made for the purpose of becoming eligible for CYFD
Medicaid, the applicant/recipient is ineligible for a period of twenty-four
(24) months beginning with the month the resources were transferred.
[10-1-94;
8.206.500.14 NMAC - Rn, 8 NMAC 4.CYM.515, 3-1-01]
8.206.500.15 TRUSTS: If an
applicant/recipient is the beneficiary of a trust fund, a copy of the trust
document and any other documents pertaining to the creation of the trust must
be submitted to the eligibility unit of the medical assistance division for
coordination of the trust analysis with the human services department's office
of general counsel.
[10-1-94;
8.206.500.15 NMAC - Rn, 8 NMAC 4.CYM.517, 3-1-01]
8.206.500.16 INCOME STANDARDS:
A. To be eligible for CYFD medicaid, the
applicant/recipient's income must be less than the maximum aid to families with
dependent children (AFDC) standard for one person. See 8.200.520.10 NMAC, Income Standards. Any earned
and unearned income that belongs to the applicant/recipient must be totaled and
compared to the standard.
B. The authorized representative of CYFD who completes the
medicaid application on behalf of the applicant/recipient must take all
necessary steps to apply for or obtain any other income which the
applicant/recipient may qualify for when the individual becomes aware of the
income. If income becomes available to
the applicant/recipient, his/her eligibility for CYFD medicaid must be
re-evaluated.
C. Sources of potential income includes social security,
veterans benefits, supplement security income, trust funds, and contingent
claims.
[10-1-94;
8.206.500.16 NMAC - Rn, 8 NMAC 4.CYM.520, 3-1-01]
8.206.500.17 EARNED INCOME:
A. If a applicant/recipient of CYFD medicaid has earned
income and is not a full-time student in elementary school, high school, or a
course of vocational or technical training, his/her earnings are considered in
the earned income calculation.
B. Earned
income exclusions:
(1) Exclusion for full-time students: If an applicant/recipient of CYFD medicaid
has earned income and is a full-time student in elementary school, high school,
or in a course of vocational or technical training, his/her earnings are
totally excluded.
(2) Job Training Partnership Act (JTPA)
earnings and earned income tax credit exclusion: JTPA earning/reimbursement and earned income
tax credit payments are excluded from consideration as income regardless of
whether the applicant/recipient is a full-time student.
(3) Work-related expense disregard: An applicant/recipient of CYFD medicaid with
earned income from employment is entitled to a deduction of ninety dollars
($90) from gross monthly earnings for work-related expenses.
(4) Census bureau employment: Wages paid by the census bureau for temporary
employment related to the census are excluded from consideration as income in
the eligibility determination process.
(5) Recipients
of Chafee medicaid: All earned
income of an applicant/recipient between eighteen (18) and twenty-one (21)
years of age is excluded while receiving Chafee independent living assistance
from CYFD.
[10-1-94,
8.206.500.17 NMAC - Rn, 8 NMAC 4.CYM.521 & A, 3-1-01; A/E, 12-1-06]
8.206.500.18 UNEARNED INCOME:
Unearned incomes includes but is not limited to social security benefits,
child support, gifts, contributions, and all other cash income which does not
meet the definition of earned income.
Unearned income is counted in the gross amount received.
A. Unearned
income exclusions and disregards:
Certain amounts of unearned income are excluded from the computation of
unearned income.
(1) Educational assistance exclusions: Bona fide loans from private individuals or
commercial institutions for education assistance are excluded from unearned
income. Income from work study whose
purpose is to assist with educational expenses are excluded from unearned
income. Educational grants and
scholarships whose purpose is to assist with education expenses are excluded
regardless of the actual utilization of the funds.
(2) Child nutrition and school lunch
benefit exclusion: Child nutritional
and school lunch benefits provided in the form of money payments, vouchers, or
foodstuffs authorized under the Child Nutritional Act and the National School
Lunch Act are excluded.
(3) Income tax return income exclusion: State and federal income tax refunds are
excluded from consideration as income. Tax refunds are considered resources.
(4) Native American payment exclusion: Certain payments to Native Americans can be
excluded which include:
(a) per capita payment of tribal funds
authorized by the tribe or by the secretary of the United States department of
the interior; payments received and distributed by the bureau of Indian affairs
(BIA) as a trustee for an individual members of a tribe, refer to as individual
Indian monies (IAMB) are not considered as per capita payments;
(b) interest derived from retrained per capita
payments is disregarded if the retained per capita payments have not been
commingled with other savings; and
(c) BIA general assistance payments made to
disabled tribal members by the BIA;
(d) any tax exempt payment made under the
Alaska Native Claims Act are excluded from consideration as unearned income.
(5) Settlement fund payment exclusions: Payments received from the agent orange
settlement fund or from any other fund established pursuant to the agent orange
product liability litigation settlement are excluded from unearned income. Payments received from the Radiation Exposure
Compensation Act are excluded from unearned income. Payments by the remembrance, responsibility
and the future foundation to individual survivors forced into slave labor by
the Nazis are excluded from unearned income.
(6) Payments made by division of vocational
rehabilitation: Any payment made by
the division of vocation rehabilitation to an applicant/recipient in training
to help him/her meet additional training costs are disregarded. The entire payment is disregarded unless
specific portion is designated for basic maintenance and the
applicant/recipient is maintaining only one resident. The portion designated for basic maintenance
is considered income.
(7) Child support disregard: The first fifty dollars ($ 50) of child
support payments received in a month from an absent parent which represents
payment on a support obligation for the month is disregarded in the eligibility
determination and redetermination process.
(a) If multiple child support payments are
received such as cases where more than one parent is paying or a parent makes
weekly or biweekly payments, the disregard is allowed only once during the
month.
(b) If a payment included both current support
and arrearage, the disregard is allowed only on the current support.
(8) Disregard for payments made by CYFD: Payment made by CYFD to a third party on
behalf of an applicant/recipient are not considered income to the
applicant/recipient.
(9) Chafee independent living assistance
recipients: All unearned income of
an applicant/recipient between eighteen (18) and twenty-one (21) years of age
is excluded.
[10-1-94;
8.206.500.18 NMAC - Rn, 8 NMAC 4.CYM.500, 3-1-01; A, 5-1-01; A/E, 12-1-06]
8.206.500.19 DEEMED INCOME:
Income is not deemed to an applicant/recipient from his/her parents if
the applicant/recipient is the full or partial financial responsibility of
CYFD. Any voluntary contributions made
by the applicant/recipient's parent(s) is considered as unearned income.
[10-1-94;
8.206.500.19 NMAC - Rn, 8 NMAC 4.CYM.523, 3-1-01]
8.206.500.20 TOTAL INCOME: The
combination of the applicant/recipient's earned income and unearned income
minus any applicable exclusions and disregards is compared to the maximum
income standard for one person to determine if the applicant/recipient is
eligible for CYFD medicaid.
[10-1-94;
8.206.500.20 NMAC - Rn, 8 NMAC 4.CYM.524, 3-1-01]
8.206.500.21 LUMP SUM PAYMENTS: Lump
sums are considered as income in the month received and resources (if retained)
as of the first moment of the first day of the following month.
[10-1-94;
8.206.500.21 NMAC - Rn, 8 NMAC 4.CYM.527, 3-1-01]
HISTORY OF
8.206.500 NMAC: [RESERVED]
History of Repealed Material:
[RESERVED]