New Mexico Register / Volume XXXV, Issue 14 / July 30, 2024

 

 

This is an amendment to 8.200.520 NMAC, Sections 1, 8, 11, 12, 13, 15, 16 and 20 effective 8/1/2024.

 

8.200.520.1          ISSUING AGENCY:  New Mexico [Human Services Department (HSD)] Health Care Authority (HCA).

[8.200.520.1 NMAC - Rp, 8.200.520.1 NMAC, 8/28/2015; A, 8/1/2024]

 

8.200.520.8          MISSION STATEMENT:  [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.] We ensure that New Mexicans attain their highest level of health by providing whole-person, cost-effective, accessible, and high-quality health care and safety-net services.

[8.200.520.8 NMAC - Rp, 8.200.520.8 NMAC, 8/28/2015; Repealed/E, 4/1/2016; A/E, 8/11/2020; A, 8/1/2024]

 

8.200.520.11       FEDERAL POVERTY INCOME GUIDELINES:

               A.           One hundred percent federal poverty limits (FPL):

                              Size of budget group                                       FPL per month

                                             [1                                                                       $1,215*

                                             2                                                                         $1,644*

                                             3                                                                         $2,072

                                             4                                                                         $2,500

                                             5                                                                         $2,929

                                             6                                                                         $3,357

                                             7                                                                         $3,785

                                             8                                                                         $4,214]

                                             1                                                                         $1,255*

                                             2                                                                         $1,704*

                                             3                                                                         $2,152

                                             4                                                                         $2,600

                                             5                                                                         $3,049

                                             6                                                                         $3,497

                                             7                                                                         $3,945

                                             8                                                                         $4,394

                                             Add [$429] $449 for each additional person in the budget group.

                                             *FPL must be below 100% for an individual or couple for qualified medicare beneficiary (QMB) program.

               B.           One hundred twenty percent FPL:  This income level is used only in the determination of the maximum income limit for specified low income medicare beneficiaries (SLIMB) applicants or eligible recipients.

                              Applicant or eligible recipient                        Amount

                                             1             Individual            At least [$1,215] $1,255 per month but no more than [$1,458] $1,506 per month.

                                             2             Couple                 At least [$1,644] $1,704 per month but no more than [$1,972] $2,044 per month.

                                             For purposes of this eligibility calculation, “couple” means an applicant couple or an applicant with an ineligible spouse when income is deemed.

               C.           One hundred thirty-three percent FPL:

                              Size of budget group                                       FPL per month

                                             [1                                                                       $1,616

                                             2                                                                         $2,186

                                             3                                                                         $2,756

                                             4                                                                         $3,325

                                             5                                                                         $3,895

                                             6                                                                         $4,465

                                             7                                                                         $5,035

                                             8                                                                         $5,604]

                                             1                                                                         $1,670

                                             2                                                                         $2,266

                                             3                                                                         $2,862

                                             4                                                                         $3,458

                                             5                                                                         $4,055

                                             6                                                                         $4,651

                                             7                                                                         $5,247

                                             8                                                                         $5,844

                              Add [$569] $597 for each additional person in the budget group.

               D.           One hundred thirty-five percent FPL:  This income level is used only in the determination of the maximum income limit for a qualified individual 1 (QI1) applicant or eligible recipient.  For purposes of this eligibility calculation, “couple” means an applicant couple or an applicant with an ineligible spouse when income is deemed.  The following income levels apply:

                              Applicant or eligible recipient                        Amount

                                             1             Individual            At least [$1,458] $1,506 per month but no more than [$1,641] $1,695 per month.

                                             2             Couple                 At least [$1,972] $2,044 per month but no more than [$2,219] $2,300 per month.

               E.           One hundred eighty-five percent FPL:

                              Size of budget group                                       FPL per month

                                             [1                                                                       $2,248

                                             2                                                                         $3,041

                                             3                                                                         $3,833

                                             4                                                                         $4,625

                                             5                                                                         $5,418

                                             6                                                                         $6,210

                                             7                                                                         $7,003

                                             8                                                                         $7,795]

                                             1                                                                         $2,322

                                             2                                                                         $3,152

                                             3                                                                         $3,981

                                             4                                                                         $4,810

                                             5                                                                         $5,640

                                             6                                                                         $6,469

                                             7                                                                         $7,299

                                             8                                                                         $8,128

                              Add [$792] $829 for each additional person in the budget group.

               F.            Two hundred percent FPL:

                              Size of budget group                                       FPL per month

                                             [1                                                                       $2,430

                                             2                                                                         $3,287

                                             3                                                                         $4,144

                                             4                                                                         $5,000

                                             5                                                                         $5,857

                                             6                                                                         $6,714

                                             7                                                                         $7,570

                                             8                                                                         $8,427]

                                             1                                                                         $2,510

                                             2                                                                         $3,407

                                             3                                                                         $4,304

                                             4                                                                         $5,200

                                             5                                                                         $6,097

                                             6                                                                         $6,994

                                             7                                                                         $7,890

                                             8                                                                         $8,787

                              Add [$857] $897 for each additional person in the budget group.

               G.           Two hundred thirty-five percent FPL:

                              Size of budget group                                       FPL per month

                                             [1                                                                       $2,856

                                             2                                                                         $3,862

                                             3                                                                         $4,869

                                             4                                                                         $5,875

                                             5                                                                         $6,882

                                             6                                                                         $7,889

                                             7                                                                         $8,895

                                             8                                                                         $9,902]

                                             1                                                                         $2,950

                                             2                                                                         $4,003

                                             3                                                                         $5,057

                                             4                                                                         $6,110

                                             5                                                                         $7,164

                                             6                                                                         $8,218

                                             7                                                                         $9,271

                                             8                                                                         $10,325

                              Add [$1,007] $1,054 for each additional person in the budget group.

               H.           Two hundred fifty percent FPL:

                              Size of budget group                                       FPL per month

                                             [1                                                                       $3,038

                                             2                                                                         $4,109

                                             3                                                                         $5,180

                                             4                                                                         $6,250

                                             5                                                                         $7,321

                                             6                                                                         $8,392

                                             7                                                                         $9,463

                                             8                                                                         $10,534]

                                             1                                                                         $3,138

                                             2                                                                         $4,259

                                             3                                                                         $5,380

                                             4                                                                         $6,500

                                             5                                                                         $7,621

                                             6                                                                         $8,742

                                             7                                                                         $9,863

                                             8                                                                         $10,984

                              Add [$1,071] $1,121 for each additional person in the budget group.

[8.200.520.11 NMAC - Rp, 8.200.520.11 NMAC, 8/28/2015; A/E, 4/1/2016; A/E, 9/14/2017; A, 2/1/2018; A/E, 5/17/2018; A, 9/11/2018; A/E, 4/11/2019; A, 7/30/2019, A/E, 8/11/2020; A, 12/15/2020; A/E, 4/1/2021; A, 9/1/2021; A/E, 4/1/2022; A, 8/9/2022; A/E, 4/1/2023; A/E, 4/1/2024; A, 8/1/2024]

 

8.200.520.12       COST OF LIVING ADJUSTMENT (COLA) DISREGARD COMPUTATION:  The countable social security benefit without the COLA is calculated using the COLA increase table as follows:

               A.           divide the current gross social security benefit by the COLA increase in the most current year; the result is the social security benefit before the COLA increase;

               B.           divide the result from Subsection A above by the COLA increase from the previous period or year; the result is the social security benefit before the increase for that period or year; and

               C.           repeat Subsection B above for each year, through the year that the applicant or eligible recipient received both social security benefits and supplemental security income (SSI); the final result is the countable social security benefit.

COLA Increase and disregard table

 

Period and year

COLA increase

= benefit before

1

2024 Jan - Dec

3.2

Jan 24

[1] 2

2023 Jan - Dec

8.7

Jan 23

[2] 3

2022 Jan - Dec

5.9

Jan 22

[3] 4

2021 Jan - Dec

1.3

Jan 21

[4] 5

2020 Jan - Dec

1.6

Jan 20

[5] 6

2019 Jan - Dec

2.8

Jan 19

[6] 7

2018 Jan - Dec

2.0

Jan 18

[7] 8

2017 Jan - Dec

0.3

Jan 17

[8] 9

2016 Jan - Dec

0

Jan 16

[9] 10

2015 Jan - Dec

1.017

Jan 15

[10] 11

2014 Jan - Dec

1.015

Jan 14

[11] 12

2013 Jan - Dec

1.017

Jan 13

[12] 13

2012 Jan - Dec

1.037

Jan 12

[13] 14

2011 Jan - Dec

0

Jan 11

[14] 15

2010 Jan - Dec

1

Jan 10

[15] 16

2009 Jan - Dec

1

Jan 09

[16] 17

2008 Jan - Dec

1.058

Jan 08

[17] 18

2007 Jan - Dec

1.023

Jan 07

[18] 19

2006 Jan - Dec

1.033

Jan 06

[19] 20

2005 Jan - Dec

1.041

Jan 05

[20] 21

2004 Jan - Dec

1.027

Jan 04

[21] 22

2003 Jan - Dec

1.021

Jan 03

[22] 23

2002 Jan - Dec

1.014

Jan 02

[23] 24

2001 Jan - Dec

1.026

Jan 01

[24] 25

2000 Jan - Dec

1.035

Jan 00

[25] 26

1999 Jan - Dec

1.025

Jan 99

[26] 27

1998 Jan - Dec

1.013

Jan 98

[27] 28

1997 Jan - Dec

1.021

Jan 97

[28] 29

1996 Jan - Dec

1.029

Jan 96

[29] 30

1995 Jan - Dec

1.026

Jan 95

[30] 31

1994 Jan - Dec

1.028

Jan 94

[31] 32

1993 Jan - Dec

1.026

Jan 93

[32] 33

1992 Jan - Dec

1.03

Jan 92

[33] 34

1991 Jan - Dec

1.037

Jan 91

[34] 35

1990 Jan - Dec

1.054

Jan 90

[35] 36

1989 Jan - Dec

1.047

Jan 89

[36] 37

1988 Jan - Dec

1.04

Jan 88

[37] 38

1987 Jan - Dec

1.042

Jan 87

[38] 39

1986 Jan - Dec

1.013

Jan 86

[39] 40

1985 Jan - Dec

1.031

Jan 85

[40] 41

1984 Jan - Dec

1.035

Jan 84

[41] 42

1982 Jul - 1983 Dec

1.035

Jul 82

[42] 43

1981 Jul - 1982 Jun

1.074

Jul 81

[43] 44

1980 Jul - 1981 Jun

1.112

Jul 80

[44] 45

1979 Jul - 1980 Jun

1.143

Jul 79

[45] 46

1978 Jul - 1979 Jun

1.099

Jul 78

[46] 47

1977 Jul - 1978 Jun

1.065

Jul 77

[47] 48

1977 Apr - 1977 Jun

1.059

Apr 77

[8.200.520.12 NMAC - Rp, 8.200.520.12 NMAC, 8/28/2015; A/E, 1/1/2016; A/E, 3/1/2017; A/E, 5/17/2018; A, 9/11/2018; A, 4/11/2019; A, 7/30/2019; A/E, 8/11/2020; A, 12/15/2020; A/E, 4/1/2021; A, 9/1/2021; A/E, 4/1/2022; A, 8/9/2022; A/E, 4/1/2023; A/E, 4/1/2024; A, 8/1/2024]

 

8.200.520.13       FEDERAL BENEFIT RATES (FBR) AND VALUE OF ONE-THIRD REDUCTION (VTR):

Year

Individual

Institution

Individual

Couple

Institution

Couple

 

FBR

FBR

VTR

FBR

FBR

VTR

1/89 to 1/90

$368

$30

$122.66

$553

$60

$184.33

1/90 to 1/91

$386

$30

$128.66

$579

$60

$193.00

1/91 to 1/92

$407

$30

$135.66

$610

$60

$203.33

1/92 to 1/93

$422

$30

$140.66

$633

$60

$211.00

1/93 to 1/94

$434

$30

$144.66

$652

$60

$217.33

1/94 to 1/95

$446

$30

$148.66

$669

$60

$223.00

1/95 to 1/96

$458

$30

$152.66

$687

$60

$229.00

1/96 to 1/97

$470

$30

$156.66

$705

$60

$235.00

1/97 to 1/98

$484

$30

$161.33

$726

$60

$242.00

1/98 to 1/99

$494

$30

$164.66

$741

$60

$247.00

1/99 to 1/00

$500

$30

$166.66

$751

$60

$250.33

1/00 to 1/01

$512

$30

$170.66

$769

$60

$256.33

1/01 to 1/02

$530

$30

$176.66

$796

$60

$265.33

1/02 to 1/03

$545

$30

$181.66

$817

$60

$272.33

1/03 to 1/04

$552

$30

$184.00

$829

$60

$276.33

1/04 to 1/05

$564

$30

$188

$846

$60

$282.00

1/05 to 1/06

$579

$30

$193

$869

$60

$289.66

1/06 to 1/07

$603

$30

$201

$904

$60

$301.33

1/07 to 1/08

$623

$30

$207.66

$934

$60

$311.33

1/08 to 1/09

$637

$30

$212.33

$956

$60

$318.66

1/09 to 1/10

$674

$30

$224.66

$1,011

$60

$337

1/10 to 1/11

$674

$30

$224.66

$1,011

$60

$337

1/11 to 1/12

$674

$30

$224.66

$1,011

$60

$337

1/12 to 1/13

$698

$30

$232.66

$1,048

$60

$349.33

1/13 to 1/14

$710

$30

$237

$1,066

$60

$355

1/14 to 1/15

$721

$30

$240

$1,082

$60

$361

1/15 to 12/15

$733

$30

$244

$1,100

$60

$367

1/16 to 12/16

$733

$30

$244

$1,100

$60

$367

1/17 to 12/17

$735

$30

$245

$1,103

$60

$368

1/18 to 12/18

$750

$30

$250

$1,125

$60

$375

1/19 to 12/19

$771

$30

$257

$1,157

$60

$386

1/20 to 12/20

$783

$30

$261

$1,175

$60

$392

1/21 to 12/21

$794

$30

$264.66

$1,191

$60

$397

1/22 to 12/22

$841

$30

$280.33

$1,261

$60

$420.50

1/23 to 12/23

$914

$30

$304.66

$1,371

$60

$456.99

1/24 to 12/24

$943

$30

$314.33

$1,415

$60

$471.66

               A.           Ineligible child deeming allocation is [$457] $472.

               B.           Part B premium is [$164.90] $174.70 per month.

               C.           VTR (value of one third reduction) is used when an individual or a couple lives in the household of another and receives food and shelter from the household or when the individual or the couple is living on [his or her] their own household but receiving support and maintenance from others.

               D.           The SSI resource standard is $2000 for an individual and $3000 for a couple.

[8.200.520.13 NMAC - Rp, 8.200.520.13 NMAC, 8/28/2015; A/E, 1/1/2016; A/E, 3/1/2017; A/E, 5/17/2018; A, 9/11/2018; A/E, 4/11/2019; A, 7/30/2019; A/E, 8/11/2020; A, 12/15/2020; A/E, 4/1/2021; A, 9/1/2021; A/E, 4/1/2022; A, 8/9/2022; A/E, 4/1/2023; A/E, 4/1/2024; A, 8/1/2024]

 

8.200.520.15       SUPPLEMENTAL SECURITY INCOME (SSI) LIVING ARRANGEMENTS:

               A.           Individual living in [his or her] their own household who own or rent:

                                             Payment amount:               [$914] $943         Individual

                                                                                          [$1,371] $1,415   Couple

               B.           Individual receiving support and maintenance payments:  For an individual or couple living in [his or her] their own household, but receiving support and maintenance from others (such as food, shelter or clothing), subtract the value of one third reduction (VTR).

                                             Payment amount:

[$914 - $304.66 = $609.34 Individual

                                                                                          $1,371 - $456.99 = $914.01 Couple]

                                                                                          $943 - $314.33 = $628.67 Individual

                                                                                          $1,415 - $471.66 = $943.34 Couple

               C.           Individual or couple living household of another:  For an individual or couple living in another person's household and not contributing [his or her] their pro-rata share of household expenses, subtract the VTR.

                                             Payment amount:               [$914 - $304.66 = $609.34 Individual

                                                                                          $1,371 - $456.99 = $914.01 Couple]

                                                                                          $943 - $314.33 = $628.67 Individual

                                                                                          $1,415 - $471.66 = $943.34 Couple

               D.           Child living in home with [his or her] their parent:

                                             Payment amount:               [$914] $943

               E.           Individual in institution:

                                             Payment amount:               $30.00

[8.200.520.15 NMAC - Rp, 8.200.520.15 NMAC, 8/28/2015; A/E, 3/1/2017; A/E, 5/17/2018; A, 9/11/2018; A/E, 4/11/2019; A, 7/30/2019; A/E, 8/11/2020; A, 12/15/2020; A/E, 4/1/2021; A, 9/1/2021; A/E, 4/1/2022; A, 8/9/2022; A/E, 4/1/2023; A/E, 4/1/2024; A, 8/1/2024]

 

8.200.520.16       MAXIMUM COUNTABLE INCOME FOR INSTITUTIONAL CARE MEDICAID AND HOME AND COMMUNITY BASED WAIVER SERVICES (HCBS) CATEGORIES:  Effective [January 1, 2022] January 1, 2024, the maximum countable monthly income standard for institutional care medicaid and the home and community based waiver categories is [$2,742] $2,829.

[8.200.520.16 NMAC - Rp, 8.200.520.16 NMAC, 8/28/2015; A/E, 3/1/2017; A/E, 5/17/2018; A, 9/11/2018; A/E, 4/11/2019; A, 7/30/2019; A/E, 8/11/2020; A, 12/15/2020; A/E, 4/1/2021; A, 9/1/2021; A/E, 4/1/2022; A, 8/9/2022; A/E, 4/1/2023; A/E, 4/1/2024; A, 8/1/2024]

 

8.200.520.20       COVERED QUARTER INCOME STANDARD:

                              Date                                                                   Calendar Quarter Amount

               Jan. 2024 - Dec. 2024                                                     $1,730 per calendar quarter

               Jan. 2023 - Dec. 2023                                                     $1,640 per calendar quarter

               Jan. 2022 - Dec. 2022                                                     $1,510 per calendar quarter

               Jan. 2021 - Dec. 2021                                                     $1,470 per calendar quarter

               Jan. 2020 - Dec. 2020                                                     $1,410 per calendar quarter

               Jan. 2019 - Dec. 2019                                                     $1,360 per calendar quarter

               Jan. 2018 - Dec. 2018                                                     $1,320 per calendar quarter

               Jan. 2017 - Dec. 2017                                                     $1,300 per calendar quarter

               Jan. 2016 - Dec. 2016                                                     $1,260 per calendar quarter

               Jan. 2015 - Dec. 2015                                                     $1,220 per calendar quarter

               Jan. 2014 - Dec. 2014                                                     $1,200 per calendar quarter

               Jan. 2013 - Dec. 2013                                                     $1,160 per calendar quarter

               Jan. 2012 - Dec. 2012                                                     $1,130 per calendar quarter

               Jan. 2011 - Dec. 2011                                                     $1,120 per calendar quarter

               Jan. 2010 - Dec. 2010                                                     $1,120 per calendar quarter

               Jan. 2009 - Dec. 2009                                                     $1,090 per calendar quarter

               Jan. 2008 - Dec. 2008                                                     $1,050 per calendar quarter

               Jan. 2007 - Dec. 2007                                                     $1,000 per calendar quarter

               Jan. 2006 - Dec. 2006                                                     $970 per calendar quarter

               Jan. 2005 - Dec. 2005                                                     $920 per calendar quarter

               Jan. 2004 - Dec. 2004                                                     $900 per calendar quarter

               Jan. 2003 - Dec. 2003                                                     $890 per calendar quarter

               Jan. 2002 - Dec. 2002                                                     $870 per calendar quarter

[8.200.520.20 NMAC - Rp, 8.200.520.20 NMAC, 8/28/2015; A/E, 1/1/2016; A/E, 03/01/2017; A/E, 5/17/2018; A, 9/11/2018; A/E, 4/11/2019; A, 7/30/2019; A/E, 8/11/2020; A, 12/15/2020; A/E, 4/1/2021; A, 9/1/2021; A/E, 4/1/2022; A, 8/9/2022; A/E, 4/1/2023; A/E, 4/1/2024; A, 8/1/2024]