TITLE 8 SOCIAL SERVICES
CHAPTER 248 MEDICAID ELIGIBILITY - MEDICARE DRUG COVERAGE
(CATEGORY 048)
PART 400 RECIPIENT POLICIES
8.248.400.1 ISSUING AGENCY: New
Mexico Health Care Authority.
[8.248.400.1 NMAC - Rp, 8.248.400.1 NMAC, 7/1/2024]
8.248.400.2 SCOPE: The
rule applies to the general public.
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8.248.400.3 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 health care authority pursuant to state statute. See 27-2-12 et. seq. NMSA 1978 (Repl. Pamp. 1991). The legal basis for the low-income subsidy (LIS) program is the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), Public Law 108-173. Section 9-8-1 et seq. NMSA 1978 establishes the health care authority (HCA) as a single, unified department to administer laws and exercise functions relating to health care facility licensure and health care purchasing and regulation.
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8.248.400.4 DURATION:
Permanent.
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8.248.400.5 EFFECTIVE DATE: July
1, 2024, unless a later date is cited at the end of a section.
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8.248.400.6 OBJECTIVE: The
objective of these regulations is to provide eligibility policy and procedures
for the medicare part D - low-income subsidy program.
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8.248.400.7 DEFINITIONS: [RESERVED]
8.248.400.8 [RESERVED]
8.248.400.9 LOW-INCOME SUBSIDY FOR MEDICARE PART D
ELIGIBLES: Applicants/recipients who meet certain income
and other non-financial requirements can be eligible for the low-income subsidy
(LIS) under medicare part D.
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8.248.400.10 BASIS FOR DEFINING THE GROUP:
A. Medicare recipients who are eligible for part D medicare coverage under the MMA of 2003 may be eligible for
the low-income subsidy program.
Eligibility is based on financial criteria, both income and resources,
of applicant and spouse (if any) for the appropriate family size.
B. Family size: The
following persons are included in the family size:
(1) the applicant;
(2) the applicant's spouse, if living with
the applicant; and
(3) any persons who are related by blood,
marriage, or adoption, who are living with the applicant and spouse and who are
dependent on the applicant or spouse for at least one half of their financial
support.
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8.248.400.11 GENERAL RECIPIENT REQUIREMENTS:
A. Medicare: Applicants must be eligible for and receiving
part A or part B medicare benefits.
B. Residence: To be
eligible for the low-income subsidy, an applicant/recipient must be physically
present in New Mexico on the date of application or final determination of
eligibility and must have demonstrated intent to remain in the state. Eligibility for the low-income subsidy (LIS)
will transfer to New Mexico if determined by the social security administration
(SSA) in another state. If eligibility
was determined by another state (not SSA), eligibility must be re-determined in
New Mexico.
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8.248.400.12 SPECIAL RECIPIENT REQUIREMENTS: Applicants/recipients
must be enrolled in a part D prescription drug plan (PDP) or a medicare advantage prescription drug (MA-PD) plan.
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8.248.400.13 RECIPIENT RIGHTS AND RESPONSIBILITIES: An
applicant/recipient is responsible for establishing their eligibility for the
LIS.
A. As part of this responsibility, the applicant/recipient
must provide required information and documents or take the actions necessary
to establish eligibility. Failure to do
so must result in a decision that eligibility does not exist.
B. An applicant/recipient must also grant the HCA permission
to contact other persons, agencies or sources of information that are necessary
to establish eligibility.
C. An applicant can voluntarily withdraw an application any
time prior to the determination of eligibility.
The ISD office advises an applicant that withdrawing an application has
no effect upon their right to apply for assistance in the future.
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8.248.400.14 REPORTING REQUIREMENTS: A LIS
recipient must report to the local ISD office any change in their circumstances
that might affect eligibility within 10 days of the change.
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HISTORY OF
8.248.400 NMAC: 8.248.400 NMAC - Recipient Policies (filed 1/13/2006) Repealed
effective 7/1/2024.
Other: 8.248.400 NMAC - Recipient Policies (filed
1/13/2006) Replaced by 8.248.400 NMAC - Recipient Policies effective 7/1/2024.