TITLE 8 SOCIAL SERVICES
CHAPTER 291 MEDICAID ELIGIBILITY - AFFORDABLE CARE
PART 420 RECIPIENT RIGHTS AND RESPONSIBILITIES
8.291.420.1 ISSUING
AGENCY: New Mexico Health Care Authority.
[8.291.420.1 NMAC -
Rp, 8.291.420.1 NMAC, 1/1/2014; A, 7/1/2024]
8.291.420.2 SCOPE: The
rule applies to the general public.
[8.291.420.2 NMAC - Rp,
8.291.420.2 NMAC, 1/1/2014]
8.291.420.3 STATUTORY AUTHORITY: The New Mexico medicaid program is 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.
[8.291.420.3 NMAC - Rp, 8.291.420.3 NMAC, 1/1/2014; A, 7/1/2024]
8.291.420.4 DURATION: Permanent.
[8.291.420.4 NMAC - Rp,
8.291.420.4 NMAC, 1/1/2014]
8.291.420.5 EFFECTIVE
DATE: January 1, 2014, unless a later date is cited
at the end of a section.
[8.291.420.5 NMAC - Rp,
8.291.420.5 NMAC, 1/1/2014]
8.291.420.6 OBJECTIVE: The
objective of this rule is to provide eligibility guidelines when determining
eligibility for the medical assistance
division (MAD) medicaid program and other
health care programs it administers.
Processes for establishing and maintaining this category of eligibility
are found in the affordable care general provision chapter located at 8.291.400
NMAC through 8.291.430 NMAC.
[8.291.420.6 NMAC - Rp,
8.291.420.6 NMAC, 1/1/2014]
8.291.420.7 DEFINITIONS: Refer
to 8.291.400.7 NMAC.
[8.291.420.7 NMAC - Rp,
8.291.420.7 NMAC, 1/1/2014]
8.291.420.8 RIGHT TO APPLY:
A. An
individual has the right to apply for medicaid and
other health care programs MAD administers regardless of whether it appears he
or she may be eligible.
(1) The income support division (ISD) determines eligibility for medicaid, unless otherwise determined by another entity as stated in another NMAC rule. A decision shall be made promptly on applications in accordance with the timeliness standards set forth in 8.291.410 NMAC.
(2) Individuals
who might be eligible for supplemental security income (SSI) are referred to
the social security administration (SSA) office to apply.
B. Application: A signed electronic or paper application, as
defined in 8.291.410 NMAC, is required from the applicant, an authorized
representative, or, if the applicant is incompetent or incapacitated, someone
acting responsibly for the applicant. The
applicant may complete a joint application for all benefits that HSD administers.
A recipient will not be required to submit an application if there is a need to switch from one medicaid benefit to another unless a redetermination is due
in that month or the following month. Additional
information may be requested if the new benefit requires additional information
and verification of eligibility.
[8.291.420.8 NMAC - Rp,
8.291.420.8 NMAC, 1/1/2014]
8.291.420.9 FREEDOM OF CHOICE OF PROVIDER: Refer
to 8.200.430.10 NMAC.
[8.291.420.9 NMAC - Rp,
8.291.420.9 NMAC, 1/1/2014]
8.291.420.10 RELEASE OF INFORMATION/CONFIDENTIALITY: Refer
to 8.200.430.11 NMAC.
[8.291.420.10 NMAC -
Rp, 8.291.420.10 NMAC, 1/1/2014]
8.291.420.11 RIGHT TO ADEQUATE NOTICE AND
ADMINISTRATIVE HEARING: Refer to 8.200.430.12 NMAC.
[8.291.420.11 NMAC -
Rp, 8.291.420.11 NMAC, 1/1/2014]
8.291.420.12 ASSIGNMENT OF MEDICAL SUPPORT
RIGHTS: Refer to 8.200.430.13 NMAC.
[8.291.420.12 NMAC -
Rp, 8.291.420.12 NMAC, 1/1/2014]
8.291.420.13 ELIGIBLE RECIPIENT RESPONSIBILITY TO COOPERATE WITH ASSIGNMENT OF SUPPORT RIGHTS: Refer to 8.200.430.14 NMAC.
[8.291.420.13 NMAC -
Rp, 8.291.420.13 NMAC, 1/1/2014]
8.291.420.14 ELIGIBLE RECIPIENT RESPONSIBILITY TO GIVE PROVIDER PROPER IDENTIFICATION AND
NOTICE OF ELIGIBILITY CHANGES: Refer to 8.200.430.15 NMAC.
[8.291.420.14 NMAC -
Rp, 8.291.420.14 NMAC, 1/1/2014]
8.291.420.15 ELIGIBLE RECIPIENT FINANCIAL
RESPONSIBILITIES: Refer to 8.200.430.16 NMAC.
[8.291.420.15 NMAC -
Rp, 8.291.420.15 NMAC, 1/1/2014]
8.291.420.16 RESTITUTION: Refer to 8.200.430.17 NMAC.
[8.291.420.16 NMAC -
Rp, 8.291.420.16 NMAC, 1/1/2014]
8.291.420.17 THIRD PARTY LIABILITY: Refer to 8.200.420.12 NMAC.
[8.291.420.17 NMAC -
Rp, 8.291.420.17 NMAC, 1/1/2014]
8.291.420.18 MAD ESTATE RECOVERY: Refer to 8.200.420.13 NMAC.
[8.291.420.18 NMAC -
Rp, 8.291.420.18 NMAC, 1/1/2014]
HISTORY OF 8.291.420
NMAC:
History of Repealed Material:
8.291.420 NMAC, Recipient Rights and Responsibilities, filed 9/17/2013 -
Duration expired 12/31/2013.