TITLE 8 SOCIAL SERVICES
CHAPTER 243 MEDICAID ELIGIBILITY - WORKING DISABLED
INDIVIDUALS (WDI) (CATEGORY 043)
PART 600 BENEFIT DESCRIPTION
8.243.600.1 ISSUING AGENCY: New Mexico
Health Care Authority(HCA).
[8.243.600.1 NMAC - Rp, 8.243.600.1
NMAC, 1/1/2019;
A, 7/1/2024]
8.243.600.2 SCOPE: This rule
applies to the general public.
[8.243.600.2 NMAC - Rp,
8.243.600.2 NMAC, 1/1/2019]
8.243.600.3 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.
[8.243.600.3 NMAC - Rp,
8.243.600.3 NMAC, 1/1/2019; A, 7/1/2024]
8.243.600.4 DURATION: Permanent.
[8.243.600.4 NMAC - Rp,
8.243.600.4 NMAC, 1/1/2019]
8.243.600.5 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.
[8.243.600.5 NMAC - Rp,
8.243.600.5 NMAC, 1/1/2019]
8.243.600.6 OBJECTIVE: The objective
of these rules is to provide eligibility policy and procedures for the medical assistance
programs.
[8.243.600.6 NMAC - Rp,
8.243.600.6 NMAC, 1/1/2019]
8.243.600.7 DEFINITIONS: [RESERVED]
8.243.600.8 [RESERVED]
[8.243.600.8
NMAC - Rp, 8.243.600.8 NMAC, 1/1/2019]
8.243.600.9 GENERAL BENEFIT DESCRIPTION: An individual
who meets a medical assistance programs (MAP) category of eligibility for the
working disabled individual program (WDI) is eligible to receive full state
plan benefits.
[8.243.600.9 NMAC - Rp,
8.243.600.9 NMAC, 1/1/2019]
8.243.600.10 BENEFIT DETERMINATION: Completed
applications must be acted upon and notice of approval, denial, or delay sent
out within 60 days of the date of application.
Individuals will have time limits explained, and
be informed of the date by which the application should be processed.
[8.243.600.10 NMAC - Rp,
8.243.600.10 NMAC, 1/1/2019]
8.243.600.11 INITIAL BENEFITS: Eligibility
begins the month of approval. When an
eligibility determination is made, notice of the approval or denial is sent to
the individual. If the application is
denied, this notice includes the individual’s right to request a hearing.
[8.243.600.11 NMAC - Rp,
8.243.600.11 NMAC, 1/1/2019]
8.243.600.12 ONGOING BENEFITS: A
re-determination of MAP eligibility is made every 12 months or at such time the
MAP eligible recipient begins receiving medicare
benefits.
[8.243.600.12 NMAC - Rp,
8.243.600.12 NMAC, 1/1/2019]
8.243.600.13 RETROACTIVE BENEFIT COVERAGE: Retroactive medicaid coverage is provided in accordance with
8.200.400.14 NMAC.
[8.243.600.13 NMAC - Rp,
8.243.600.13 NMAC, 1/1/2019]
8.243.600.14 CHANGES IN ELIGIBILITY: A case is
closed, with provision of advance notice, when the MAP eligible recipient
becomes ineligible. If a MAP eligible recipient
dies, the case is closed the following month.
[8.243.600.14 NMAC - Rp,
8.243.600.14 NMAC, 1/1/2019]
HISTORY OF 8.243.600 NMAC: [RESERVED]
History of Repealed
Material:
8.243.600
NMAC - Medicaid Eligibility - Working Disabled Individuals (WDI) (Category 043)
- Benefit Description, filed 12/13/2000 Repealed effective 1/1/2019.