TITLE 8 SOCIAL SERVICES

CHAPTER 231 MEDICAID ELIGIBILITY - INFANTS OF MOTHERS WHO ARE MEDICAID OR MEDICAL ASSISTANCE PROGRAM ELIGIBLE

PART 600 BENEFIT DESCRIPTION

8.231.600.1 ISSUING AGENCY: New Mexico Health Care Authority.

[8.231.600.1 NMAC - Rp, 8.231.600.1 NMAC, 1/1/2019; A, 7/1/2024]

8.231.600.2 SCOPE: The rule applies to the general public.

[8.231.600.2 NMAC - Rp, 8.231.600.2 NMAC, 1/1/2019]

8.231.600.3 STATUTORY AUTHORITY: The New Mexico medicaid program and other health care programs are administered pursuant to regulations promulgated by the federal department of health and human services under Title XIX of the Social Security Act as amended or by state statute. See Section 27-1-12 et seq., NMSA 1978. 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.

[8.231.600.3 NMAC - Rp, 8.231.600.3 NMAC, 1/1/2019; A, 7/1/2024]

8.231.600.4 DURATION: Permanent.

[8.231.600.4 NMAC - Rp, 8.231.600.4 NMAC, 1/1/2019]

8.231.600.5 EFFECTIVE DATE: January 1, 2019, or upon a later approval date by the federal centers for medicare and medicaid services (CMS), unless a later date is cited at the end of the section.

[8.231.600.5 NMAC - Rp, 8.231.600.5 NMAC, 1/1/2019]

8.231.600.6 OBJECTIVE: The objective of this rule is to provide specific instructions when determining eligibility for the medicaid program and other health care programs. Processes for establishing and maintaining this category of eligibility are found in the affordable care general provision chapters located at 8.291.400 NMAC through 8.291.430 NMAC.

[8.231.600.6 NMAC - Rp, 8.231.600.6 NMAC, 1/1/2019]

8.231.600.7 DEFINITIONS: [RESERVED]

8.231.600.8 MISSION: 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.

[8.231.600.8 NMAC - Rp, 8.231.600.8 NMAC, 1/1/2019; A, 1/1/2022]

8.231.600.9 BENEFIT DESCRIPTION: An applicant or recipient who is eligible for medicaid under this category is eligible to receive the full range of medicaid services.

[8.231.600.9 NMAC - Rp, 8.231.600.9 NMAC, 1/1/2019]

8.231.600.10 BENEFIT DETERMINATION:

A. Medical service providers must give the name and case number of the New Mexico medicaid eligible mother and the name, birth date, sex of the newborn, and the name of the hospital where the birth occurred to local county income support division (ISD) office. Within three days after receipt of this information, the income support specialist (ISS):

(1) determines if the mother was eligible for New Mexico medicaid at the time of birth or if the birth and delivery was covered by emergency medical services to undocumented non-citizens (EMSNC);

(2) registers the newborn for medicaid on the system; a signed application is not required;

(3) provides eligibility information to the hospital; and

(4) notifies the mother that a signed application is necessary to establish the newborn’s eligibility for temporary assistance for needy families (TANF), if applicable.

B. Processing time limit: All applications must be processed within 45 days from the date of application. The time limit begins on the day the signed application is received. Applications must be acted upon and notice of approval, denial or delay sent out within the required time limit. The ISS explains the time limit and that the applicant may request an administrative hearing if the application pends longer than the time limit allows.

[8.231.600.10 NMAC - Rp, 8.231.600.10 NMAC, 1/1/2019; A, 1/1/2022]

8.231.600.11 ONGOING BENEFITS: A newborn remains eligible for assistance under Category 031 from birth through the month of the child’s first birthday as long as the newborn remains in New Mexico.

[8.231.600.11 NMAC - Rp, 8.231.600.12 NMAC, 1/1/2019]

8.231.600.12 RETROACTIVE BENEFIT COVERAGE: Retroactive medicaid coverage is provided in accordance with Subsection H of 8.200.400.14 NMAC.

[8.231.600.12 NMAC - Rp, 8.231.600.13 NMAC, 1/1/2019]

8.231.600.13 CHANGE IN ELIGIBILITY: If the newborn is placed on MAD Category 400 or 420 and then loses eligibility for either of these categories, the newborn can still be eligible for Category 031 if he meets Category 031 requirements for the remainder of the 12 month period. A new application is not required

[8.231.600.13 NMAC - Rp, 8.231.600.14 NMAC, 1/1/2019]

8.231.600.14 PERIODIC REDETERMINATIONS OF ELIGIBILITY (42 CFR 435.117(d)): A redetermination of eligibility must be completed on behalf of the children described in this provision in accordance with 8.291.410.19 NMAC.

[8.231.600.14 NMAC - Rp, 8.231.600.14 NMAC, 1/1/2019]

8.231.600.15 ENUMERATION AND CITIZENSHIP:

A. HSD requires, as a condition of eligibility, that each individual (including children) seeking medicaid furnish each of his or her social security numbers (SSN) per paragraph (a) of 42 CFR 435.910 and 8.200.410.10 NMAC. HSD will request an SSN at renewal if not already provided.

B. Newborns who were initially eligible for medicaid as deemed newborns are considered to have provided satisfactory documentation of citizenship, identity, and age.

[8.231.600.15 NMAC - Rp, 8.231.600.15 NMAC, 1/1/2019]

HISTORY OF 8.231.600 NMAC:

Pre-NMAC History: The material in this part was derived from that previously filed with the State Records Center:

ISD 290.1000, Medical Assistance for Woman and Children, filed 11/13/1984.

ISD FA 830, Medical Assistance for Woman and Children and AFDC Related Groups, filed 2/10/1988.

MAD Rule 830, Medical Assistance for Women and Children and AFDC - Related Groups, filed 8/11/1988.

MAD Rule 830, Medical Assistance for Women and Children and AFDC - Related Groups, filed 9/8/1988.

MAD Rule 830, Medical Assistance for Women and Children and AFDC - Related Groups, filed 9/30/1988.

MAD Rule 830, Medical Assistance for Women and Children and AFDC - Related Groups, filed 12/1/1988.

MAD Rule 830, Medical Assistance for Women and Children and AFDC - Related Groups, filed 3/31/1989.

MAD Rule 830, Medical Assistance for Women and Children and AFDC - Related Groups, filed 6/8/1989.

MAD Rule 830, Medical Assistance for Women and Children and AFDC - Related Groups, filed 12/28/1989.

MAD Rule 830, Medical Assistance for Women and Children and AFDC - Related Groups, filed 12/29/1989.

MAD Rule 830, Medical Assistance for Women and Children and AFDC - Related Groups, filed 3/1/1991.

MAD Rule 830, Medical Assistance for Women and Children and AFDC - Related Groups, filed 6/5/1992.

History of Repealed Material:

MAD Rule 830, Medical Assistance for Women and Children and AFDC - Related Groups, filed 6/5/1992 - Repealed effective 2/1/1995.

8.231.600 NMAC, Benefit Description, filed 12/10/2007 - Repealed 1/1/2014.

8.231.600 NMAC, Benefit Description, filed 12/2/2013 - Repealed effective 10/1/2017.

8.231.600 NMAC, Benefit Description, filed 9/14/2017 - Repealed effective 1/1/2019.

NMAC History:

8.231.600 NMAC, Benefit Description, filed 12/2/2013 was replaced by 8.231.600 NMAC, Benefit Description, effective 10/1/2017.

8.231.600 NMAC, Benefit Description, filed 9/14/2017 was replaced by 8.231.600 NMAC, Benefit Description, effective 1/1/2019.