TITLE 8               SOCIAL SERVICES

CHAPTER 106  STATE FUNDED ASSISTANCE PROGRAMS

PART 500            ELIGIBILITY POLICY - GENERAL INFORMATION

 

8.106.500.1          ISSUING AGENCY:  New Mexico Health Care Authority.

[8.106.500.1 NMAC - N, 07/01/2004; A, 7/1/2024]

 

8.106.500.2          SCOPE:  The rule applies to the general public.

[8.106.500.2 NMAC - N, 07/01/2004]

 

8.106.500.3          STATUTORY AUTHORITY:  New Mexico Statutes Annotated 1978 (Chapter 27, Articles 1 and 2) authorize the state to administer the aid to families with dependent children (AFDC), general assistance (GA), shelter care supplement, the burial assistance programs and such other public welfare functions as may be assumed by the state.  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.

[8.106.500.3 NMAC - N, 07/01/2004; A, 7/1/2024]

 

8.106.500.4          DURATION:  Permanent.

[8.106.500.4 NMAC - N, 07/01/2004]

 

8.106.500.5          EFFECTIVE DATE:  July 1, 2004, unless a later date is cited at the end of a section.

[8.106.500.5 NMAC - N, 07/01/2004]

 

8.106.500.6          OBJECTIVE:

                A.            The objective of general assistance is to provide financial assistance to dependent needy children and disabled adults who are not eligible for assistance under a federally matched financial assistance program such as New Mexico works (NMW) or the federal program of supplemental security income (SSI).  The general assistance program is not intended to be an unemployment or general relief program.

                B.            The objective of the supplement for residential care program is to provide a cash assistance supplement to SSI recipients who reside in licensed adult residential care homes.

                C.            The objective of the burial assistance program is to assist in payment of burial expenses for an individual who was a low-income individual at the time of death.

[8.106.500.6 NMAC - N, 07/01/2004]

 

8.106.500.7          DEFINITIONS:  [RESERVED]

[8.106.500.7 NMAC - N, 07/01/2004]

 

8.106.500.8          GA - GENERAL REQUIREMENTS:

                A.            Limited state funds may result in a suspension or reduction in general assistance benefits without eligibility and need considered.

                B.            Need determination process:  Eligibility for the GA program based on need requires a finding that the:

                                (1)           countable resources owned by and available to the benefit group do not exceed either the $1,500 liquid or $2,000 non-liquid resource limit;

                                (2)           benefit group's countable gross earned and unearned income does not equal or exceed eighty-five percent of the federal poverty guideline for the size of the benefit group; and

                                (3)           benefit group’s countable net income does not equal or exceed the standard of need for the size of the benefit group.

                C.            GA payment determination:  The benefit group’s cash assistance payment is determined after subtracting from the standard of need the benefit group's countable income and any payment sanctions or recoupments.

                D.            Gross income test:  The total countable gross earned and unearned income of the benefit group cannot exceed eighty-five percent of the federal poverty guidelines for the size of the benefit group.

                                (1)           Income eligibility limits are revised and adjusted each year in October.

                                (2)           The gross income limit for the size of the benefit group is as follows:

                                                (a)           one person            $1,067

                                                (b)           two persons           $1,448

                                                (c)           three persons        $1,829

                                                (d)           four persons          $2,210

                                                (e)           five persons          $2,592

                                                (f)            six persons            $2,972

                                                (g)           seven persons       $3,353

                                                (h)           eight persons        $3,735

                                                (i)            add $382 for each additional person.

                E.            Standard of need:

                                (1)           As published monthly by the department, the standard of need is an amount provided to each GA cash assistance benefit group on a monthly basis and is based on availability of state funds, the number of individuals included in the benefit group, number of cases, number of applications processed and approved, application approval rate, number of case closures, IAR caseload number and expenditures, and number of pending applications.

                                (2)           Basic needs include food, clothing, shelter, utilities, personal requirements and an individual benefit group member’s share of supplies.

                                (3)           Notice: The department shall issue prior public notice identifying any change(s) to the standard of need amounts for the next quarter, as discussed at 8.106.630.11 NMAC.

                F.            Net income test: The total countable earned and unearned income of the benefit group after all allowable deductions cannot equal or exceed the standard of need for the size of the GA benefit group.  After the countable net income is determined it is rounded down prior to the comparison of the household's income to the standard of need to determine the households monthly benefit amount.

                G.            Special clothing allowance for school-age dependent children: A special clothing allowance may be issued to assist in preparing a child for school, subject to the availability of state or federal funds and a specific allocation of the available funds for this allowance.

                                (1)           For purposes of determining eligibility for the clothing allowance, a child is considered to be of school age as defined by PED.

                                (2)           The clothing allowance shall be allowed for each school-age child who is included in the GA cash assistance benefit group, subject to the availability of state or federal funds.

                                (3)           The clothing allowance is not counted in determining eligibility for GA cash assistance.

                H.            Supplemental issuance: A one-time supplemental issuance may be distributed to recipients of GA for disabled adults based on the sole discretion of the secretary of the human services department and the availability of state funds.

                                (1)           The one time supplemental issuance may be no more than the standard GA payment made during the month the GA payment was issued.

                                (2)           To be eligible to receive the one time supplement, a GA application must be active and determined eligible no later than the last day of the month in the month the one time supplement is issued.

                I.             Minimum Benefit Amount:  Benefits less than ten dollars ($10.00) will not be issued for the initial month or subsequent months.  ISD shall certify household beginning the month of application.

[8.106.500.8 NMAC - N, 07/01/2004; A/E, 10/01/2004; A/E, 10/01/2005; A, 7/17/2006; A/E, 10/01/2006; A/E, 10/01/2007; A, 01/01/2008; A, 06/16/2008; A/E, 10/01/2008; A, 07/01/2009; A/E, 10/01/2009; A, 10/30/2009; A, 12/01/2009; A, 01/01/2011; A, 07/29/2011; A/E, 10/01/2011; A/E, 10/01/2012; A, 07/01/2013; A/E, 10/01/2013; A/E, 10/01/2014; A, 10/01/2015; A, 10/01/2016; A/E, 10/01/2017; A, 2/01/2018; A/E, 10/01/2018; A, 3/1/2019; A/E, 10/01/2019; A, 3/1/2020 A/E, 10/01/2020; A, 3/1/2021; A/E, 10/01/2021; A, 04/01/2022; A/E, 10/01/2022; A, 04/01/2023, A/E 10/1/2023; A, 03/1/2024; A/E 10/1/2024]

 

8.106.500.9          PROSPECTIVE BUDGETING:

                A.            Initial eligibility:  Eligibility for cash assistance programs shall be determined prospectively.  The benefit group must meet all eligibility criteria in the month following the month of application.  Eligibility and amount of payment shall be determined prospectively for each month in the certification period.

                B.            Changes in benefit group composition:  A person added to the benefit group shall have eligibility determined prospectively, beginning in the month following the month the report is made.

                C.            Anticipating income:  In determining the benefit group's eligibility and benefit amount, the income already received and any income the benefit group expects to receive during the certification period shall be counted.

                                (1)           Income anticipated during the certification period shall be counted only in the month it is expected to be received, unless the income is averaged.

                                (2)           Actual income shall be calculated by using the income already received and any other income that can reasonably be anticipated in the calendar month.

                                (3)           If the amount of income or date of receipt is uncertain, the portion of the income that is uncertain shall not be counted.

                                (4)           In cases where the receipt of income is reasonably certain but the amount may fluctuate, the income shall be averaged.

                                (5)           Averaging is used to determine a monthly calculation, when there is fluctuating income within the weekly, biweekly or monthly pay period and to achieve a uniform amount for projecting future income.

                D.            Counting income in the certification period:

                                (1)           For the purposes of cash assistance eligibility and determination of benefit amount, income is money received by or available to the benefit group in each month of the certification period.

                                (2)           Only income which is actually received, or can reasonably be expected to be received, is counted for financial eligibility and benefit calculation.

                                (3)           The benefit group must take appropriate steps to apply for and receive income from any other source to which the group may potentially be entitled.

                                (4)           A benefit group may be found ineligible for failing or refusing to apply for or pursue potential income or assets from other sources.

                                (5)           A benefit group member who is 62 years of age or older must apply for and take all necessary steps to receive a reduced OASDI benefit from the SSA.

                E.            Income availability:

                                (1)           The availability of income to the benefit group is determined by who must be included in the benefit group and whether income must be deemed available to the benefit group.

                                (2)           The earned and unearned income of an individual who is not a mandatory benefit group member shall not be considered available to the benefit group.

                                (3)           Income belongs to the person who gains it, either through the person's own efforts, as in the case of earnings, or as a benefit, as in the case of a beneficiary of SSA benefits.

                                (4)           Unearned income, such as child support or social security survivor's benefits and other similar payments for a child, are considered as belonging to the benefit group in which the child is included.

                                (5)           Alien sponsors:  The gross income belonging to an individual who is the sponsor of an alien included in the cash assistance benefit group, and the income belonging to the sponsor's spouse, shall be counted in its entirety to determine the eligibility and benefit amount if the sponsor has executed an affidavit of support pursuant to Subsection 213-A of the Immigration and Nationality Act.  The income of the alien sponsor and spouse shall be counted until the sponsored alien achieves citizenship or can be credited with 40 qualifying quarters under title II of the federal Social Security Act.

                F.            Unavailable income:  In some situations, individuals who are included in the benefit group, either in applicant or recipient status, have a legal right to income but do not have access to it.  Such income is not counted as available income for purposes of cash assistance eligibility and benefit calculation.

                G.            Ineligible alien:  The countable income belonging to an ineligible alien who is a mandatory benefit group member is deemed available to the benefit group.  The countable income shall be prorated according to the size of the benefit group to determine the eligibility and benefit amount for the benefit group.

                H.            Income received less frequently than monthly:  The amount of gross income that is received less frequently than monthly is determined by dividing the total gross income by the number of months the income is intended to cover.  This includes, but is not limited to, income from sharecropping, farming and self-employment.  It also includes contract income as well as income of a tenured teacher who may not actually have a contract.

                I.             Contract income:  A benefit group that derives its annual income in a period of less than one year shall have that income averaged over a twelve-month period, provided that the income is not earned on an hourly or piecework basis.

                J.             Using exact income:  Exact income, rather than averaged income, shall be used if:

                                (1)           the benefit group has chosen not to average income;

                                (2)           income is from a source terminated in the month of application;

                                (3)           employment began in the application month and the income represents a partial month; or

                                (4)           income is received more frequently than weekly.

                K.            Income projection for earned income:

                                (1)           Income from the four-week period prior to the date of initial interview is used to project monthly income, provided that the income is expected to continue.  If a determination is made that the prior income is not indicative of income anticipated to be received during the certification period, then income from a longer period of past time may be used.  If the longer period is not indicative of income anticipated to be received, then verification of anticipated income shall be obtained from the income source.

                                (2)           The methods described above may not give the most accurate estimate of monthly earnings due to unique circumstances that may occur.  In such cases, the caseworker shall use whichever method provides the most accurate estimate of earnings.

                                (3)           An income projection shall be considered valid for the certification period unless changes are made that affect eligibility or benefit amount.

                L.            Unearned income:  For purposes of anticipating future income, unearned income from the four-week period prior to the date of interview shall be used, provided that the income is expected to continue.

                M.           Use of conversion factors:  Whenever a full month's income is anticipated and is received on a weekly or biweekly basis, the income shall be converted to monthly amount as follows:

                                (1)           income received on a weekly basis is averaged and multiplied by 4.0;

                                (2)           income received on a biweekly basis is averaged and multiplied by 2.0;

                                (3)           averaged income shall be rounded to the nearest whole dollar prior to application of the conversion factor; amounts resulting in $0.50 or more are rounded up; amounts resulting in $0.49 or lower are rounded down.

[8.106.500.9 NMAC - N, 07/01/2004; A, 04/01/2010]

 

8.106.500.10        PAYMENTS TO ADULTS IN RESIDENTIAL CARE:

                A.            Conditions:  Subject to the availability of state funding for the program, a payment may be made to an individual who resides in a shelter care home.  The individual must be a recipient of supplemental security income (SSI) under title XVI of the Social Security Act.

                B.            Licensing of the shelter care home:  The shelter care home must be licensed pursuant to regulations of the New Mexico department of health.

                C.            Payment:  A cash payment may be made to an SSI recipient when the recipient resides in a licensed shelter care home because the recipient needs help with personal care, such as bathing, dressing, eating or taking prescribed medication.

                                (1)           The payment shall be allowed only if the SSI recipient resides in a residential shelter care facility that is licensed by the New Mexico department of health.

                                (2)           The payment made to an SSI recipient living in a licensed residential shelter care facility is $100 per month.

[8.106.500.10 NMAC - N, 07/01/2004]

 

8.106.500.11        [RESERVED]

[8.106.500.11 NMAC - N, 07/01/2004; A, 12/01/2009]

 

HISTORY OF 8.106.500 NMAC:  [RESERVED]