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 Human Services Department.
[8.248.400.1 NMAC -
N, 2-1-06]
8.248.400.2 SCOPE: The rule
applies to the general public.
[8.248.400.2 NMAC -
N, 2-1-06]
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 human services department
pursuant to state statute. See NMSA
1978, 27-2-12 et. seq. ( 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.
[8.248.400.3 NMAC -
N, 2-1-06]
8.248.400.4 DURATION:
Permanent.
[8.248.400.4 NMAC -
N, 2-1-06]
8.248.400.5 EFFECTIVE DATE:
February 1, 2006, unless a later date is cited at the end of a section.
[8.248.400.5 NMAC -
N, 2-1-06]
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.
[8.248.400.6 NMAC -
N, 2-1-06]
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.
[8.248.400.9 NMAC -
N, 2-1-06]
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.
[8.248.400.10 NMAC -
N, 2-1-06]
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.
[8.248.400.11 NMAC -
N, 2-1-06]
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.
[8.248.400.12 NMAC -
N, 2-1-06]
8.248.400.13 RECIPIENT RIGHTS AND RESPONSIBILITIES: An
applicant/recipient is responsible for establishing his 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 human services
department (HSD) 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 his right to apply for assistance in the future.
[8.248.400.13 NMAC -
N, 2-1-06]
8.248.400.14 REPORTING REQUIREMENTS: A LIS
recipient must report to the local ISD office any change in his circumstances
that might affect eligibility within ten (10) days of the change.
[8.248.400.14 NMAC -
N, 2-1-06]
HISTORY OF 8.248.400
NMAC: [RESERVED]