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 health care authority 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.
C. Section 9-8-1 et seq. NMSA 1978 establishes the health
care authority (HCA) as a single, unified department to administer laws and
exercise functions relating to health care facility licensure and health care
purchasing and regulation.
[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]
[8.100.180.7
NMAC - Rp 8.100.180.7 NMAC, 7/1/2024]
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 HCA 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 an
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 overissuance 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 him/her 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 the client 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 themselves,
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.
(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 the client’s 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 HCA 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, and posters in county offices.
C. Appeal rights:
Notice
of the change will include the recipient’s right to appeal. A hearing is not available, and benefits are
not continued, when automatic benefit adjustments are required by federal or
state law unless the specific, express basis for the hearing request is
incorrect benefit computation. 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: 8.100.180 NMAC - General Operating Policies - External Communications (filed
3/26/2001) - Replaced by 8.100.180 NMAC - General Operating Policies - External Communications effective 7/1/2024.