New Mexico Register / Volume XXXV, Issue 11 / June 11,
2024
TITLE 8 SOCIAL SERVICES
CHAPTER 100 GENERAL PROVISIONS FOR PUBLIC ASSISTANCE
PROGRAMS
PART 180 GENERAL OPERATING POLICIES -
EXTERNAL COMMUNICATIONS
8.100.180.1 ISSUING AGENCY: New Mexico Health
Care Authority.
[8.100.180.1
NMAC - Rp, 8.100.180.1 NMAC, 7/1/2024]
8.100.180.2 SCOPE: The rule applies to the general
public.
[8.100.180.2
NMAC - Rp, 8.100.180.2 NMAC, 7/1/2024]
8.100.180.3 STATUTORY AUTHORITY:
A. Section 27 NMSA 1978 (1992 Repl.)
provides for the department to "...adopt, amend and repeal bylaws, rules
and regulations..." It also provides for administration of public
assistance programs.
B. The income support division (ISD) of the Health Care
Authority (HCA) was created by the HCA secretary under authority granted by
Paragraph (3) of Subsection B of Section 9-8-6 NMSA 1978.
[8.100.180.3
NMAC - Rp, 8.100.180.3 NMAC, 7/1/2024]
8.100.180.4 DURATION: Permanent.
[8.100.180.4
NMAC - Rp, 8.100.180.4 NMAC, 7/1/2024]
8.100.180.5 EFFECTIVE DATE: July 1, 2024 unless
a later date is cited at the end of a section.
[8.100.180.5
NMAC - Rp, 8.100.180.5 NMAC, 7/1/2024]
8.100.180.6 OBJECTIVE: The objective of these regulations is to
provide general policy and procedures for income support division (ISD)
administered programs.
[8.100.180.6
NMAC - Rp, 8.100.180.6 NMAC, 7/1/2024]
8.100.180.7 DEFINITIONS: [RESERVED]
8.100.180.8 COMMUNICATION WITH RECIPIENT - General
communication: Both oral and written communications with
applicants/recipients must be courteous. ISD shall inform the client promptly
and in accord with state and federal regulations of actions relating to an
application or ongoing case.
[8.100.180.8
NMAC - Rp, 8.100.180.8 NMAC, 7/1/2024]
8.100.180.9 DENIAL/APPROVAL OF APPLICATION: Prompt notification of action on a specific
application is required. See specific
program sections in this manual.
[8.100.180.9
NMAC - Rp, 8.100.180.9 NMAC, 7/1/2024]
8.100.180.10 NOTICE OF AN ADVERSE ACTION: Before any action to withhold a cash
assistance payment or to reduce or terminate medical, food stamp or cash
assistance benefits, the department must issue timely and adequate advance
notice of an adverse action.
A. Adverse action defined:
Adverse action means an action taken by HCA that adversely affects
eligibility or the amount of benefits a household or benefit group receives,
including withholding, suspending, reducing or terminating benefits.
B. Timing: A
notice shall be issued to the household or benefit group before taking and adverse action.
Benefits will not be reduced until 13 days from the date on the adverse action notice. If the 13th day falls on a weekend
or holiday, the next working day is counted as the last day of the 13-day
adverse action notice period.
C. Contents:
(1) General: An adverse action notice shall contain, in
easily understood language:
(a) reason
for the proposed action, including the specific regulations supporting the
action and the information on which the proposed action is based;
(b) date
the action will take place;
(c) statement
of the right to request a fair hearing and how to request a fair hearing;
(d) phone
number of the caseworker in the event the client wants more information or
wants to request a fair hearing;
(e) date
by which the client must request a fair hearing to continue receiving
assistance at the current rate;
(f) liability
of the recipient for any over issuance or overpayment;
(g) right
to be represented by legal counsel, friend or other
spokesperson;
(h) notice
that free legal help may be available to the household;
(i) the current benefit amount and
proposed benefit amount after reduction for any reason.
(2) Specific:
(a) For a disqualification from participation in the food stamp
program, the notice must also include the disqualification period, as
appropriate, and the action the disqualified individual must take to end
ineligibility.
(b) For
sanctions from cash assistance, the notice must also include the conciliation
period, if applicable, and the sanction period, as appropriate, as well as the
action the sanctioned individual must take to end ineligibility.
(c) For
termination of cash assistance benefits due to reaching the TANF 60-month term
limit, the notice must also include the actions the participant must take to
apply for a hardship extension, found at 8.102.410.17 NMAC, and the
availability of support services in the event the benefit group is not eligible
for a hardship extension.
[8.100.180.10
NMAC - Rp, 8.100.180.10 NMAC, 7/1/2024]
8.100.180.11 CONCURRENT NOTICE: A concurrent notice is one which is mailed no
later than the date the benefit is or would have been received. It is also referred to as an adequate notice.
A. Food stamps: HCA notifies a household that its FS benefits
are reduced or terminated no later than the date the household receives, or
would have received, its allotment, in the following circumstances:
(1) the
household reports the information which results in the reduction or
termination;
(2) the
reported information is in writing and signed by an adult household member;
(3) HCA
can determine the household's allotment or ineligibility based solely upon the
household's written information;
(4) the
household retains its right to a fair hearing;
(5) the
household retains its right to continued benefits by requesting a fair hearing
within the time period provided by the adverse action
notice;
(6) HCA
continues (or supplements) the household's previous benefit level, if
necessary, within five working days of the household's request for a fair
hearing.
B. FA and medical:
HCA notifies a benefit group that its benefits are reduced or terminated
by no later than the date the group receives, or would have received, its
benefit in the following circumstances.
(1) Death:
Termination or reduction of assistance is necessary because of the death
of an FA benefit group member or a MA recipient whose death is documented.
(2) Admission to institution: Reduction of assistance is necessary because
the client enters a skilled nursing home or intermediate care facility, or
termination is necessary because of the client's admission to an institution
which makes them ineligible for payment.
(3) Client request: The client requests in writing that the FA or
MA assistance be reduced or terminated; the client gives information in a
signed statement that causes a termination or reduction of services
and the client indicates in writing that he/she understands this is the
consequence of supplying such information.
(4) Whereabouts unknown: Withholding FA or MA assistance is necessary
because of the unknown whereabouts of the client, as evidenced by agency mail
to the client's last known address having been returned to the ISD as
undeliverable.
(5) Other assistance: The client is accepted for FA or MA
assistance in another county or state, or under another jurisdiction (including
SSI) and the effective date of coverage has been established.
(6) Removal of child: Termination or reduction of FA is necessary
because of the removal of a recipient child from the home through judicial
determination or the voluntary placement of the child in foster care by the
legal guardian or specified relative.
(7) Change in medical care: A change in a client's level of medical care
is prescribed by their physician.
(8) Special allowance: A special allowance granted to a client for a
specific period of time is terminated and the client
has been informed at the time the allowance was granted that it would terminate
at a specific time.
(9) Fair Hearings: An adverse action has been suspended pending a
fair hearing and the fair hearing determination is not in the client’s favor.
(10) Recertification: A recertification is not completed by the time
the certification expires and a notice of suspension is issued, or the
non-certified case has been in payment suspension for a month, and the case is
being closed.
(11) Sanction: An FA payment is being reduced or terminated
because an individual is not cooperating with the child support enforcement
program or is failing to meet work program requirements.
(12) A
client is also informed of their right to request a hearing on the action, the
way to make such a request, and the conditions under which assistance will be
continued if a hearing is requested. In
any contact with the county office or in a hearing, the client may speak for themself or be represented by legal counsel or a friend or
other spokesperson.
[8.100.180.11
NMAC - Rp, 8.100.180.11 NMAC, 7/1/2024]
8.100.180.12 FOOD STAMP EXCEPTIONS: Adverse action notices are not required under
the following conditions.
A. Mass changes: The state initiates a mass change.
B. Death: The ISS determines, based on reliable
information, that all members of a household have died.
C. Move
from project area: The ISS
determines, based on reliable information, that the household has moved from
the project area, or will move before the next FS issue.
D. Completion of restoration of lost benefits: The client has been receiving an increased
allotment to restore benefits, the restoration is complete, and the client has
been previously notified in writing when the increased allotment would end.
E. Anticipated
changes in monthly benefit amount: A
household's allotment varies from month to month within the certification
period to take into account changes which are
anticipated at the time of certification, and the household was notified at the
time of certification of the allotment variations.
F. Benefit reduction upon approval of
household's FA application: The
household jointly applied for FA and FS benefits, and
has been receiving food stamps pending the approval of the FA grant, and was
notified at the time of certification that FS benefits would be reduced upon
approval of the FA grant.
G. Household
member disqualified for intentional program violation: The benefits of the remaining household members
are reduced or terminated to reflect the disqualification of a household
member.
H. Benefits
contingent upon providing postponed verification: The ISS has assigned a normal certification
period to a household certified on an expedited basis, for whom verification
was postponed, and the household was given a written notice that the receipt of
benefits beyond the month of application was contingent upon its providing the
required verification.
I. Conversion: Converting a
household from cash or FS benefit recovery to recoupment (benefit reduction)
because of failure to make agreed-upon repayment.
J. Loss of certification by drug or alcoholic treatment center or group
living arrangement.: The ISS terminates the eligibility of a
resident of a drug or alcoholic treatment center or a group living arrangement
because the facility loses either its certification from the New Mexico health
department or other appropriate state agency, or has
its status as an authorized representative suspended because FCS has
disqualified it as a retailer.
K. Transfer
between FSP and food distribution programs.
If a local office is notified by the appropriate Indian tribal organization
(ITO) that a participating household wishes to switch programs, the ISS:
(1) advises
the ITO of the earliest date that program transfer may occur without risk of
dual participation;
(2) closes
the FS case without advance notice; and
(3) follows
up with the appropriate ITO-provided form.
L. Household
requests termination.
[8.100.180.12
NMAC - Rp, 8.100.180.12 NMAC, 7/1/2024]
8.100.180.13 FRAUD:
If the agency obtains facts indicating that FA or MA should be
suspended, terminated or reduced because of probable fraud by the recipient
which has been verified, if possible, by collateral sources, notice of the action
being taken is mailed at least five days before the action is to become
effective.
[8.100.180.13
NMAC - Rp, 8.100.180.13 NMAC, 7/1/2024]
8.100.180.14 CONTINUATION OF BENEFITS: If a fair hearing request is filed, benefits
are continued, under the circumstances described below, until the fair hearing
determination is completed.
A. Timely requests:
(1) Advance notice: If a household requests a fair hearing within
the advance notice period provided by the advance adverse action notice, and
its certification period has not expired, the household's participation in the
program is continued on the same basis authorized immediately before the
adverse action notice, unless the household specifically waives a continuation
of benefits.
(2) All
fair hearing request forms contain a space for a household to indicate whether or not continuation of benefits is requested. If the form does not positively indicate that
the household has waived continuation of benefits, the ISS assumes that
continuation of benefits is desired and the benefits
are issued accordingly. Such benefits
are continued until the end of the certification period or the resolution of
the fair hearing, whichever is first.
B. Concurrent notice: If
a benefit group requests a fair hearing within 13 days of issuance of a
concurrent adverse action notice, and its certification period has not expired,
cash assistance, food stamps and medicaid benefits
are reinstated. Unless other intervening
changes occur, assistance is not reduced or terminated, nor may the manner or
form of payment be changed to a protective payment, during the period until the
hearing decision is rendered, except as provided in regulations at 8.100.180.10
and 8.100.180.15 NMAC.
(1) Additionally,
receipt of continued benefits ends if a determination is made at the hearing
that the sole issue is one of federal policy or law, or change in such policy
or law, and not one of incorrect grant computation.
(2) If
a later change affecting the client's grant occurs while the hearing decision
is pending and the client does not request a hearing regarding the change, the
payment which the client continues to receive during the hearing period is
adjusted only by the amount required by the change.
(3) If
assistance is to be continued, it is continued through the end of the month in
which a decision on the hearing is reached.
(4) If
hearing decisions are delayed, assistance is continued only if the delay is
caused by HCA or if a delay of five days or less is requested by the client
because of unusual circumstances beyond their control.
C. Late requests:
(1) If
a hearing request is not made within the period provided by the adverse action
notice, benefits are reduced or terminated as provided in the notice.
(2) If
a client demonstrates that failure to make the request within the advance
notice period was for good cause, benefits are reinstated to the previous
level. The hearing unit supervisor
decides if the failure was for good cause.
[8.100.180.14
NMAC - Rp, 8.100.180.14 NMAC, 7/1/2024]
8.100.180.15 MASS CHANGES:
A. General:
Certain changes initiated by the state or federal government may affect
the entire caseload or significant portions of it. These changes include, but are not limited
to, increases or decreases in eligibility or payment standards
changes in excluded or deducted items or amounts. Mass changes affecting income include annual
adjustments of Social Security, SSI, and other federal benefit programs, and
any other changes in eligibility criteria based on legislative or regulatory
actions.
B. Notice of mass changes:
Adverse action notices are required for mass changes resulting from
statutory or regulatory changes in eligibility or payment standards, benefit,
changes in excluded or deducted items or amounts for purposes of eligibility or
calculation of benefit levels. The
department will either provide concurrent notice to affected households of the
mass change no later than the date the household receives, or would have
received, its benefit issuance, or the affected cases will be notified through
the media, or posters in county offices.
C. Appeal rights: Notice of the change will include the
recipient’s right to appeal. If the
recipient requests a fair hearing within the advance notice period, benefits
will be continued at the former amount.
If the appeal results in a decision that the reduction or closure was
incorrect, the difference between what the recipient received pending the
appeal decision and the amount that should have been received will be restored
to the recipient.
[8.100.180.15
NMAC - Rp, 8.100.180.15 NMAC, 7/1/2024]
8.100.180.16 DISPUTED CONTINUATION OF BENEFITS: If a client and the ISS disagree about the
continuation of benefits, the client may request a fair hearing. Adverse action defined. "Adverse action" is action taken by
HCA which adversely affects the amount of benefits a client receives. Such actions include holding mailing of
assistance warrants, and suspension, reduction or termination of benefits.
[8.100.180.16
NMAC - Rp, 8.100.180.16 NMAC, 7/1/2024]
8.100.180.17 HOME
VISIT NOTICE: The worker shall give
advance notice to an applicant or recipient of any visit to the applicant’s or
recipient’s home.
A. Verbal
notice: The advance notice may be in
the form of a verbal communication between the worker
and the applicant or recipient. The time
and date of the visit must be mutually agreeable and should, in most cases, be
made at least one day in advance of the visit.
The worker shall provide an explanation of the need for the visit to the
applicant or recipient. The worker shall
document the discussion in the case narrative and provide a justification if
the period of advance notice is any less than one day.
B. Written
notice: The home visit notice may be
written. The written notice shall be
mailed at least 10 days in advance of the intended visit. The notice shall indicate the time, date, and
purpose of the visit. The notice shall
request the applicant or recipient to confirm the appointment date with the
worker. In the absence of a response
from the applicant or recipient, the visit shall take place and the applicant
or recipient is expected to be at home for the visit.
[8.100.180.17
NMAC - Rp, 8.100.180.17 NMAC, 7/1/2024]
History of
8.100.180 NMAC:
Pre-NMAC History: The material in this part was derived from
that previously filed with the State Records Center and Archives:
ISD
Rule 180, Notice Requirements, 2/9/1988.
History of
Repealed Material:
8 NMAC 3.ISD.180, General Operating
Policies, External Communications - Repealed, 7/1/1997.
8.100.180
NMAC, General Operating Policies - External Communications filed 3/26/2001
Repealed effective 7/1/2024.
Other: 8 NMAC 3.ISD.180, General Operating Policies,
External Communications filed 6/16/1997 Refiled and renumbered for NMAC2
codification. Also replaces 8 NMAC
3.ISD.000 (S# 17.0), filed 6/16/1997.
8.100.180
NMAC, General Operating Policies - External Communications filed 3/26/2001
Replaced 8.100.180 NMAC, General Operating Policies - External Communications
effective 7/1/2024.