TITLE 8 SOCIAL SERVICES

CHAPTER 285 MEDICAL ASSISTANCE PROGRAM ELIGIBILITY – EMERGENCY MEDICAL

SERVICES FOR NON-CITIZENS

PART 400 RECIPIENT REQUIREMENTS

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

[8.285.400.1 NMAC - Rp, 8.285.400.1 NMAC, 1/1/2014]

8.285.400.2 SCOPE: The rule applies to the general public.

[8.285.400.2 NMAC - Rp, 8.285.400.2 NMAC, 1/1/2014]

8.285.400.3 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 NMSA 1978, Section 27-1-12.

[8.285.400.3 NMAC - Rp, 8.285.400.3 NMAC, 1/1/2014]

8.285.400.4 DURATION: Permanent.

[8.285.400.4 NMAC - Rp, 8.285.400.4 NMAC, 1/1/2014]

8.285.400.5 EFFECTIVE DATE: January 1, 2014, unless a later date is cited at the end of a section.

[8.285.400.5 NMAC - Rp, 8.285.400.5 NMAC, 1/1/2014]

8.285.400.6 OBJECTIVE: The objective of this rule is to provide specific instructions when determining eligibility for the medicaid program and other health care programs.

[8.285.400.6 NMAC - Rp, 8.285.400.6 NMAC, 1/1/2014]

8.285.400.7 DEFINITIONS: [RESERVED]

8.285.400.8 MISSION: To transform lives. Working with our partners, we design and deliver innovative, high quality health and human services that improve the security and promote independence for New Mexicans in their communities.

[8.285.400.8 NMAC - N, 1/1/2014; A, 5/1/2020]

8.285.400.9 EMERGENCY MEDICAL SERVICES FOR NON-CITIZENS - CATEGORY 085: Certain non-citizens who are undocumented or who do not meet the qualifying immigration criteria specified in 8.200.410 NMAC, but who meet all eligibility criteria for the following medical assistance categories of eligibility (COEs): other adults (COE 100), parent/caretaker (COE 200), pregnant women (COE 300), pregnancy-related services (COE 301), children under age 19 (COEs 400, 401, 402, 403, 420, and 421) or supplemental security income (COEs 001, 003, and 004) can receive coverage for emergency services. See 42 CFR Section 440.225.

[8.285.400.9 NMAC - Rp, 8.285.400.9 NMAC, 1/1/2014; A, 5/1/2020; A, 1/1/2022]

8.285.400.10 BASIS FOR DEFINING THE GROUP: The definition of an emergency medical condition is found at 8.325.10.13 NMAC.

[8.285.400.10 NMAC - Rp, 8.285.400.10 NMAC, 1/1/2014; A, 5/1/2020]

8.285.400.11 [RESERVED]

8.285.400.12 ENUMERATION: A non-citizen applicant is exempt from the requirement to provide a social security number (SSN). If the applicant is found eligible for coverage of emergency services, the claims are paid using an eligibility system generated identification number.

[8.285.400.12 NMAC - Rp, 8.285.400.12 NMAC, 1/1/2014; A, 5/1/2020]

8.285.400.13 CITIZENSHIP: An applicant must be a non-citizen who is undocumented or who does not meet the qualifying immigration criteria specified in 8.200.410 NMAC. Per 42 CFR 440.255(c), effective January 1, 1987, non-citizens who are not lawfully admitted for permanent residence in the United States or permanently residing in the United States under the color of law must receive the services necessary to treat the condition defined at 8.325.10.13 NMAC.

[8.285.400.13 NMAC - Rp, 8.285.400.13 NMAC, 1/1/2014; A, 5/1/2020]

8.285.400.14 RESIDENCE: An applicant must be a resident of the state of New Mexico in accordance with 8.200.410.14 and 8.291.410.15 NMAC.

[8.285.400.14 NMAC - Rp, 8.285.400.14 NMAC, 1/1/2014; A, 5/1/2020]

8.285.400.15 EMPLOYMENT, TRAINING, AND WORK REGISTRATION: Registration for employment or training is not a factor of eligibility.

[8.285.400.15 NMAC - Rp, 8.285.400.15 NMAC, 1/1/2014]

8.285.400.16 [RESERVED]

8.285.400.17 SSI STATUS: Applicants who apply under supplemental security income (SSI) coverage must meet the income and resource limits. Eligibility is determined using the SSI methodology contained in 8.215 NMAC. Disability is determined by disability determination services.

[8.285.400.17 NMAC - Rp, 8.285.400.17 NMAC, 1/1/2014]

8.285.400.18 RECIPIENT RIGHTS AND RESPONSIBILITIES: It is the responsibility of the applicant to provide the required information, documents or undertake the actions necessary for HSD to establish eligibility. The applicant must grant HSD permission to contact other persons, agencies or sources of information which are necessary in the establishment of eligibility. Failure of the applicant to provide or take action will result in a HSD action to deny eligibility.

[8.285.400.18 NMAC - Rp, 8.285.400.18 NMAC, 1/1/2014]

8.285.400.19 ASSIGNMENT OF SUPPORT: See 8.200.430 NMAC.

[8.285.400.19 NMAC - Rp, 8.285.400.19 NMAC, 1/1/2014]

HISTORY OF 8.285.400 NMAC:

History of Repealed Material:

8.285.400 NMAC, Recipient Policies, filed 11-17-08 - Repealed effective 1/1/2014.