TITLE
8 SOCIAL SERVICES
CHAPTER
242 MEDICAL ASSISTANCE PROGRAM
ELIGIBILITY - QUALIFIED DISABLED INDIVIDUALS WHOSE INCOME EXCEEDS QMB AND SLIMB
PART
400 RECIPIENT REQUIREMENTS
8.242.400.1 ISSUING AGENCY: New Mexico Health Care Authority.
[8.242.400.1
NMAC - Rp, 8.242.400.1 NMAC, 1/1/2014; A, 7/1/2024]
8.242.400.2 SCOPE: The
rule applies to the general public.
[8.242.400.2
NMAC - Rp, 8.242.400.2 NMAC, 1/1/2014]
8.242.400.3 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.
[8.242.400.3 NMAC - Rp,
8.242.400.3 NMAC, 1/1/2014; A, 7/1/2024]
8.242.400.4 Duration: Permanent.
[8.242.400.4
NMAC - Rp, 8.242.400.4 NMAC, 1/1/2014]
8.242.400.5 Effective
Date: January 1, 2014, unless a later date is cited
at the end of a section.
[8.242.400.5
NMAC - Rp, 8.242.400.5 NMAC, 1/1/2014]
8.242.400.6 Objective: The objective of this rule is to provide
specific instructions when determining eligibility for the medicaid
program and other health care programs.
Generally, applicable eligibility rules are detailed in the medical
assistance division (MAD) eligibility, 8.200 NMAC, Medicaid Eligibility - General Recipient Policies. Processes for establishing and maintaining medicaid eligibility are detailed in the income support
division (ISD) general provisions 8.100 NMAC, General Provisions for Public Assistance Programs.
[8.242.400.6
NMAC - Rp, 8.242.400.6 NMAC, 1/1/2014]
8.242.400.7 DEFINITIONS: [RESERVED]
8.242.400.8 MISSION: To reduce the impact of poverty on people
living in New Mexico by providing support services that help families break the
cycle of dependency on public assistance.
[8.242.400.8 NMAC - N, 1/1/2014]
8.242.400.9 QUALIFIED DISABLED WORKING INDIVIDUALS
(QD) - CATEGORY 050:
A. To qualify as a qualified disabled working individual (QD), an
applicant or re-determining recipient must meet the following requirements:
(1) lose entitlement to free medicare Part A due to substantial gainful employment;
(2) continue to meet the social security administration (SSA)
disability criteria; and
(3) be enrolled for premium Part A medicare.
B. The date of eligibility is based on the date of application
and the date that all eligibility standards, including enrollment for medicare Part A, are met.
[8.242.400.9
NMAC - Rp, 8.242.400.9 NMAC, 1/1/2014]
8.242.400.10 [RESERVED]
8.242.400.11 ENUMERATION: An applicant or a re-determining recipient
must have a social security number.
Refer to 8.200.410.10 NMAC.
[8.242.400.11
NMAC - Rp, 8.242.400.11 NMAC, 1/1/2014]
8.242.400.12 CITIZENSHIP: Refer to 8.200.410.11 NMAC.
[8.242.400.12
NMAC - Rp, 8.242.400.12 NMAC, 1/1/2014]
8.242.400.13 RESIDENCE: An individual must be either be physically
present in New Mexico on the date of his or her application or re-determination
or on the eligibility determination date and intend to remain in the
state. A temporary absence from the
state does not preclude eligibility. A
temporary absence is considered to exist when the eligible recipient leaves the
state for a specific purpose with a time-limited goal, after accomplishment of
which the eligible recipient intends to return to New Mexico. Refer to 8.200.410.12 NMAC.
[8.242.400.13
NMAC - Rp, 8.242.400.13 NMAC, 1/1/2014]
8.242.400.14 NONCONCURRENT RECEIPT OF ASSISTANCE: An applicant or re-determining recipient is
not eligible for category 050 if he or she is eligible under another medical
assistance division (MAD) category of eligibility or if receiving medicaid services from another state.
[8.242.400.14
NMAC - Rp, 8.242.400.14 NMAC, 1/1/2014]
8.242.400.15 [RESERVED]
8.242.400.16 AGE: A recipient must
be under 65 years of age. When a
recipient reaches 65 years of age he or she becomes
entitled to free medicare Part A.
[8.242.400.16
NMAC - Rp, 8.242.400.16 NMAC, 1/1/2014]
8.242.400.17 RECIPIENT RIGHTS AND RESPONSIBILITIES: It is the responsibility of the applicant or
re-determining recipient to provide the required information, documents or
undertake the actions necessary for HSD to establish eligibility. The applicant or re-determining recipient
must grant HSD permission to contact other persons, agencies or sources of
information which are necessary in the establishment of eligibility. Failure of the applicant or re-determining
recipient to provide or take action will result in an
HSD action to deny eligibility. Refer to
8.200.430 NMAC.
[8.242.400.17
NMAC - Rp, 8.242.400.17 NMAC, 1/1/2014]
8.242.400.18 ASSIGNMENT OF SUPPORT: Assignment of medical support rights is not a
factor of eligibility for this category, since medicaid
coverage is limited to medicare Part A premium.
[8.242.400.18
NMAC - Rp, 8.242.400.18 NMAC, 1/1/2014]
8.242.400.19 REPORTING REQUIREMENTS: An applicant, re-determining, or eligible
recipient must report any change in his or her circumstances which can affect
his or her eligibility within 10 calendar days after the change to his or her
local income support division (ISD) office.
Refer to 8.200.430.19 NMAC.
[8.242.400.19
NMAC - Rp, 8.242.400.19 NMAC, 1/1/2014]
HISTORY
OF 8.242.400 NMAC:
Pre-NMAC History: The material in this part was derived from
that previously filed with the State Records Center:
MAD
Rule 842.00, Qualified Disabled Working Individuals, filed 10/11/1990.
MAD
Rule 842, Qualified Disabled Working Individuals, filed 6/30/1992.
MAD
Rule 842, Qualified Disabled Working Individuals, filed 9/26/1994.
History of Repealed
Material:
MAD
Rule 842, Qualified Disabled Working Individuals, filed 9/26/1994 - Repealed
effective 2/1/1995.
8.242.400
NMAC, Recipient Requirements, filed 9/3/2013 - Repealed effective 1/1/2014.