TITLE 8 SOCIAL SERVICES

CHAPTER 242 MEDICAL ASSISTANCE PROGRAM ELIGIBILITY - QUALIFIED DISABLED INDIVIDUALS WHOSE INCOME EXCEEDS QMB AND SLIMB

PART 600 BENEFIT DESCRIPTION

8.242.600.1 ISSUING AGENCY: New Mexico Human Services Department (HSD).

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8.242.600.2 SCOPE: The rule applies to the general public.

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8.242.600.3 STATUTORY AUTHORITY: 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 et seq., NMSA 1978.

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8.242.600.4 DURATION: Permanent.

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8.242.600.5 EFFECTIVE DATE: 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.

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8.242.600.6 OBJECTIVE: The objective of this rule is to provide specific instructions when determining eligibility for the medicaid program and other health care programs. Generally, applicable eligibility rules are detailed in the medical assistance division (MAD) eligibility policy manual, specifically 8.200.400 NMAC, General Medicaid Eligibility. Processes for establishing and maintaining MAD eligibility are detailed in the income support division (ISD) general provisions 8.100 NMAC, General Provisions for Public Assistance Programs.

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8.242.600.7 DEFINITIONS: [RESERVED]

8.242.600.8 [RESERVED]

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8.242.600.9 BENEFIT DESCRIPTION: For Category 050, medicaid coverage is limited to payment of the medicare Part A premium. No medicaid card is issued.

[8.242.600.9 NMAC - Rp, 8.242.600.9 NMAC, 1/1/2019]

8.242.600.10 BENEFIT DETERMINATION: Application for Category 050 is made on the assistance application form. Applications must be acted on and notice of action taken must be sent to the applicant within 45 days of receipt of the application.

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8.242.600.11 INITIAL BENEFITS: The effective date of eligibility for qualified disabled working individuals (QD) is based on the date of application and the date on which all eligibility criteria, including enrollment for medicare Part A, are met. Verification of the effective date of medicare Part A enrollment must be obtained from the social security administration (SSA). When the eligibility determination is made, notice of the approval or denial is sent to the applicant. If denied, this notice includes the reason for the denial and an explanation of rights to a hearing.

[8.242.600.11 NMAC - Rp, 8.242.600.11 NMAC, 1/1/2019]

8.242.600.12 ONGOING BENEFITS: A redetermination of eligibility must be made every 12 months.

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8.242.600.13 RETROACTIVE BENEFIT COVERAGE: Retroactive medicaid coverage is provided in accordance with 8.200.400.14 NMAC.

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8.242.600.14 CHANGES IN ELIGIBILITY: The case is closed when an eligible recipient becomes ineligible and is notified of the ineligibility in an advance notice. The case is closed in the month following the death of an eligible recipient.

[8.242.600.14 NMAC - Rp, 8.242.600.14 NMAC, 1/1/2019]

HISTORY OF 8.242.600 NMAC:

Pre-NMAC History: The material in this part was derived from that previously filed with the State Records Center:

MAD Rule 842.00, Qualified Disabled Working Individuals, filed 10/11/1990.

MAD Rule 842, Qualified Disabled Working Individuals, filed 6/30/1992.

MAD Rule 842, Qualified Disabled Working Individuals, filed 9/26/1994.

History of Repealed Material:

MAD Rule 842, Qualified Disabled Working Individuals, filed 9/26/1994 - Repealed effective 2/1/1995.

8.242.600 NMAC, Benefit Description, filed 9/3/2013 - Repealed effective 1/1/2014.

8.242.600 NMAC, Benefit Description, filed 12/2/2013 - Repealed effective 1/1/2019.