TITLE 8 SOCIAL SERVICES
CHAPTER 295 MEDICAID ELIGIBILITY - CHILDREN UNDER 19
PART 400 RECIPIENT REQUIREMENTS
8.295.400.1 ISSUING AGENCY: New Mexico Human Services Department (HSD).
[8.295.400.1 NMAC - Rp,
8.295.400.1 NMAC, 1-1-14]
8.295.400.2 SCOPE: The rule applies to the general public.
[8.295.400.2 NMAC - Rp,
8.295.400.2 NMAC, 1-1-14]
8.295.400.3 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 and XXI of the Social Security Act as amended or by
state statute. See NMSA 1978, Section
27-1-12 et seq.
[8.295.400.3 NMAC - Rp,
8.295.400.3 NMAC, 1-1-14]
8.295.400.4 DURATION: Permanent.
[8.295.400.4 NMAC - Rp,
8.295.400.4 NMAC, 1-1-14]
8.295.400.5 EFFECTIVE DATE: January 1, 2014, unless a later date is cited at the end of a section.
[8.295.400.5 NMAC - Rp,
8.295.400.5 NMAC, 1-1-14]
8.295.400.6 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.
[8.295.400.6 NMAC - Rp,
8.295.400.6 NMAC, 1-1-14]
8.295.400.7 DEFINITIONS: Refer to 8.291.400.7 NMAC.
[8.295.400.7 NMAC - Rp, 8.295.400.7
NMAC, 1-1-14]
8.295.400.8 MISSION: To reduce the impact of poverty on
people living in New Mexico by providing support services that help families
break the cycle of dependency on public assistance.
[8.295.400.8 NMAC - Rp,
8.295.400.8 NMAC, 1-1-14]
8.295.400.9 WHO CAN BE A RECIPIENT: To be eligible, an applicant must meet specific medical assistance
programs (MAP) requirements:
A. an individual
under 19 years of age; and
B. an
individual who meets Affordable Care Act (ACA) eligibility requirements
pursuant to 8.291.400 through 2.291.430 NMAC.
[8.295.400.9 NMAC - Rp,
8.295.400.9 NMAC, 1-1-14; A, 5-1-15]
8.295.400.10 BASIS FOR DEFINING THE ASSISTANCE UNIT AND
BUDGET GROUP: To be considered in a
child assistance unit, an individual must apply and be determined
eligible. Individuals living with the
applicant who meet criteria in 8.291.430 NMAC are included in the budget group.
[8.295.400.10 NMAC - Rp,
8.295.400.10 NMAC, 1-1-14; A, 5-1-15]
8.295.400.11 CHILDRENS HEALTH
INSURANCE PROGRAM (CHIP):
A. A budget group
that includes the applicant and has countable income between the following
federal income poverty limits (FPL) is considered to be eligible for the CHIP:
(1) if the applicant in the assistance
unit is under the age of six and the assistance unit and budget group’s
countable income is between 240 and 300 percent of FPL for the countable
household size; or
(2) if the
assistance unit consists of the applicant age six or over and the assistance
unit’s and budget group’s countable income is between 190 and 240 percent of
FPL for the countable household size.
B. In order to be eligible for CHIP, the applicant in the assistance unit
cannot have other qualified health plan (QHP) coverage. Individuals who have voluntarily dropped a
QHP will be eligible for inclusion in the assistance unit in the month the
individual no longer has a QHP.
[8.295.400.11 NMAC - Rp,
8.295.400.11 NMAC, 1-1-14; A, 5-1-15]
HISTORY OF 8.295.400 NMAC:
History of Repealed Material:
8.295.400 NMAC, Recipient Requirements, filed 9-17-13 - Duration expired 12-31-13.