TITLE 8 SOCIAL SERVICES
CHAPTER
291 MEDICAID ELIGIBILITY - AFFORDABLE
CARE
PART 420 RECIPIENT RIGHTS AND
RESPONSIBILITIES
8.291.420.1 ISSUING
AGENCY: New Mexico Human Services Department (HSD).
[8.291.420.1 NMAC - Rp, 8.291.420.1 NMAC, 1-1-14]
8.291.420.2 SCOPE: The
rule applies to the general public.
[8.291.420.2 NMAC - Rp, 8.291.420.2 NMAC, 1-1-14]
8.291.420.3 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 or by state statute. See
NMSA 1978, Section 27-1-12 et seq.
[8.291.420.3 NMAC - Rp, 8.291.420.3 NMAC, 1-1-14]
8.291.420.4 DURATION:
Permanent.
[8.291.420.4 NMAC - Rp, 8.291.420.4 NMAC, 1-1-14]
8.291.420.5 EFFECTIVE
DATE: January 1, 2014, unless a later date is cited
at the end of a section.
[8.291.420.5 NMAC - Rp, 8.291.420.5 NMAC, 1-1-14]
8.291.420.6 OBJECTIVE: The
objective of this rule is to provide eligibility guidelines when determining
eligibility for the medical assistance
division (MAD) medicaid program and other
health care programs it administers.
Processes for establishing and maintaining this category of eligibility
are found in the affordable care general provision chapter located at 8.291.400
NMAC through 8.291.430 NMAC.
[8.291.420.6 NMAC - Rp, 8.291.420.6 NMAC, 1-1-14]
8.291.420.7 DEFINITIONS: Refer
to 8.291.400.7 NMAC.
[8.291.420.7 NMAC - Rp, 8.291.420.7 NMAC, 1-1-14]
8.291.420.8 RIGHT TO APPLY:
A. An
individual has the right to apply for medicaid and
other health care programs MAD administers regardless of whether it appears he
or she may be eligible.
(1) The income support division (ISD)
determines eligibility for medicaid, unless otherwise
determined by another entity as stated in another NMAC rule. A decision shall be made promptly on
applications in accordance with the timeliness standards set forth in 8.291.410
NMAC.
(2) Individuals who might be eligible for
supplemental security income (SSI) are referred to the social security
administration (SSA) office to apply.
B. Application: A signed electronic or paper application, as
defined in 8.291.410 NMAC, is required from the applicant, an authorized
representative, or, if the applicant is incompetent or incapacitated, someone
acting responsibly for the applicant.
The applicant may complete a joint application for all benefits that HSD
administers. A recipient will not be
required to submit an application if there is a need to switch from one medicaid benefit to another unless a redetermination is due
in that month or the following month.
Additional information may be requested if the new benefit requires
additional information and verification of eligibility.
[8.291.420.8 NMAC - Rp, 8.291.420.8 NMAC, 1-1-14]
8.291.420.9 FREEDOM OF CHOICE OF PROVIDER: Refer
to 8.200.430.10 NMAC.
[8.291.420.9 NMAC - Rp, 8.291.420.9 NMAC, 1-1-14]
8.291.420.10 RELEASE OF INFORMATION/CONFIDENTIALITY: Refer
to 8.200.430.11 NMAC.
[8.291.420.10 NMAC -
Rp, 8.291.420.10 NMAC, 1-1-14]
8.291.420.11 RIGHT TO ADEQUATE NOTICE AND
ADMINISTRATIVE HEARING: Refer to 8.200.430.12 NMAC.
[8.291.420.11 NMAC -
Rp, 8.291.420.11 NMAC, 1-1-14]
8.291.420.12 ASSIGNMENT OF MEDICAL SUPPORT
RIGHTS: Refer to 8.200.430.13 NMAC.
[8.291.420.12 NMAC -
Rp, 8.291.420.12 NMAC, 1-1-14]
8.291.420.13 ELIGIBLE RECIPIENT RESPONSIBILITY TO COOPERATE WITH ASSIGNMENT OF SUPPORT RIGHTS: Refer to 8.200.430.14 NMAC.
[8.291.420.13 NMAC -
Rp, 8.291.420.13 NMAC, 1-1-14]
8.291.420.14 ELIGIBLE RECIPIENT RESPONSIBILITY TO GIVE PROVIDER PROPER IDENTIFICATION AND
NOTICE OF ELIGIBILITY CHANGES: Refer to 8.200.430.15 NMAC.
[8.291.420.14 NMAC -
Rp, 8.291.420.14 NMAC, 1-1-14]
8.291.420.15 ELIGIBLE RECIPIENT FINANCIAL
RESPONSIBILITIES: Refer to 8.200.430.16 NMAC.
[8.291.420.15 NMAC -
Rp, 8.291.420.15 NMAC, 1-1-14]
8.291.420.16 RESTITUTION: Refer to 8.200.430.17 NMAC.
[8.291.420.16 NMAC -
Rp, 8.291.420.16 NMAC, 1-1-14]
8.291.420.17 THIRD PARTY LIABILITY: Refer to 8.200.420.12 NMAC.
[8.291.420.17 NMAC -
Rp, 8.291.420.17 NMAC, 1-1-14]
8.291.420.18 MAD ESTATE RECOVERY: Refer to 8.200.420.13 NMAC.
[8.291.420.18 NMAC -
Rp, 8.291.420.18 NMAC, 1-1-14]
HISTORY OF
8.291.420 NMAC:
History of Repealed Material:
8.291.420 NMAC, Recipient Rights and Responsibilities, filed 9-17-13 -
Duration expired 12-31-13.