Current through Register Vol. 35, No. 18, September 24, 2024
An applicant/ recipient is always allowed the complete time
processing deadline for the program to provide necessary verification. The
minimum amount of time allowed is specific to the program. This requirement
pertains to requests for verification for initial applications as well as for
verification for ongoing eligibility. Below are the time frames for provision
of verification by type of assistance. ISD shall make an eligibility decision
within three work days of the receipt of all necessary verification.
A. Food assistance and NMW/EWP cash
assistance programs: The application disposition deadline for SNAP and cash
assistance programs is 30 calendar days.
(1)
Expedited (emergency) SNAP: If applicant is eligible for expedited SNAP
processing, issue benefits no later than the sixth day following the date of
application to be available to the applicant/recipient on the seventh day or
the preceding work day if the sixth day falls on a weekend or
holiday.
(2) Day 1: Calendar day
following date of application.
(3)
Approvals: If verification provided establishes eligibility and the 30th
calendar day after the application is:
(a)
Monday by the preceding Friday, the 27th day;
(b) Tuesday by the preceding Monday, the 29th
day;
(c) Wednesday by the preceding
Tuesday, the 29th day;
(d) Thursday
by the preceding Wednesday, the 29th day;
(e) Friday by the preceding Thursday, the
29th day;
(f) Saturday by the
preceding Friday, the 29th day;
(g)
Sunday by the preceding Friday, the 28th day;
(h) Monday holiday by the preceding Friday,
the 27th day;
(i) if necessary
verification is not received by these deadlines but is received on or before
the end of the processing period, approve on the day that full verification is
provided.
(4) Needbased
determination: ISD must make a need-based eligibility determination for SNAP
within 30 days of the date of the application or by the preceding work day if
the 30th day falls on a weekend or holiday, if all mandatory verification has
been received, with the following specific provisions. If one or more household
members have failed to turn in mandatory individual verification that is not
required for all the mandatory members of a household, ISD will deny those
members missing verification, and will determine eligibility for the remaining
members.
(5) Procedural denials:
(a) Lack of verification: In cases where ISD
was able to conduct an interview and request all necessary verification on the
same day or any day before the 30th day after the
application was filed, and no subsequent requests for verification have been
made, ISD may deny the application on the 30th day.
Following the day of application, if ISD provided assistance to the household
in obtaining the verification in accordance with
7 CFR
273.2(f)(5), but the
household failed to provide the requested verification, ISD may deny the
application on the 30th day after the application
was filed.
(b) Missed interview: If
the household failed to appear for a scheduled interview and made no subsequent
contact with ISD to express interest in pursuing the application, the
application shall be denied on the 30th day following the day of application.
The household must file a new application if it wishes to participate in the
program.
(6) Extension of
time beyond the 30th day: If ISD does not determine a household's eligibility
and provide an opportunity to participate within 30 days following the date the
application was filed, ISD shall take action in accordance with
7 CFR
273.2(h).
(a) Household caused: If by the 30th day ISD
cannot take any further action due to the fault of the household, the household
shall lose its entitlement to benefits for the month of application and a
notice of denial shall be issued. The household will be given an additional 30
days to take the required action.
(i) If the
household takes the required action within 60 days following the date of
application, the case shall be reopened without requiring a new application. If
the household is found eligible during the second 30 day period, benefits shall
be provided only from the month following the month of application. The
household is not entitled to benefits for the month of application when the
delay was the fault of the household.
(ii) If the household is at fault for not
completing the application process within 60 days following the date of initial
application, ISD shall deny the application and require the household to file a
new application if it wishes to participate.
(b) ISD caused:
(i) Whenever a delay in the initial 30 day
period is the fault of ISD, immediate corrective action shall be taken. If the
household is found to be eligible during the second 30 day period, the
household shall be entitled to benefits retroactive to the date of application.
If, however, the household is found to be ineligible, ISD shall deny the
application.
(ii) If ISD is at
fault for not completing the application process by the end of the second
30-day period, and the case is otherwise complete, ISD shall continue to
process the original application until an eligibility determination is
reached.
(iii) If ISD is at fault
for not completing the application process by the end of the second 30-day
period, but the case is not complete enough to reach an eligibility
determination, ISD may continue to process the original application, If ISD was
also at fault for the delay in the initial 30 days, the amount of benefits lost
would be calculated from the month following the month of
application.
B. Medical assistance: As per
42 CFR
435.912(c)(3), the
determination of eligibility for any medicaid applicant may not exceed:
(1) 90 days for applicants who apply for
medicaid on the basis of disability; and
(2) 45 days for all other medicaid
applicants.
C. The 45-day
processing timeframe is the following:
(1)
Day 1: The date of application is the first day.
(2) No later than day 44 by the preceding
work day if day 44 falls on a weekend or holiday:
(a) if verification provided establishes
eligibility or ineligibility; or
(b) if the day following day 44 is not a work
day, then decision must be made earlier than day 44 to allow for mailing on or
before the deadline.
(3)
No later than day 45 by the next work day if day 45 falls on a weekend or
holiday, if needed verification is not provided until day 42 through
44.
(4) Day 45 by the next work day
if day 45 falls on a weekend or holiday, if needed verification is provided on
day 45, or is not provided.
(5)
After day 45:
(a) When an applicant/recipient
requests one or more 10-day extensions of time to provide needed verification.
An applicant/recipient is entitled to receive up to three 10-day extensions of
time upon request.
(b) The
eligibility decision must be made as soon as possible and within three work
days of receipt of all necessary verification.
(c) HCA provides a reasonable opportunity
period to individuals who have made a declaration of citizenship or
satisfactory immigration status in accordance with
8.200.410.13 NMAC.
D. The 90-day
processing timeframe is the following: An application for medicaid shall be
processed no later than 90 days from the date the application is filed.
(1) No later than day 89: by the previous
work day if day 89 falls on a weekend or holiday:
(a) if verification provided establishes
eligibility or ineligibility; or
(b) if day following day 89 is not a work
day, then decision must be made earlier than day 89 to allow for mailing on or
before deadline.
(2) No
later than day 90 by the next work day if day 90 falls on a weekend or holiday,
if needed verification is not provided until day 87 through 89.
(3) Day 90 by the next work day if day 90
falls on a weekend or holiday, if needed verification is provided on day 90, or
is not provided. The eligibility decision must be made as soon as possible and
within three-work days of receipt of all necessary verification.
E.
General
assistance: An application for general assistance shall be processed no
later than 90 days from the date the application is filed.
(1) No later than day 89: by the previous
work day if day 89 falls on a weekend or holiday:
(a) if verification provided establishes
eligibility or ineligibility; or
(b) if day following day 89 is not a work
day, then decision must be made earlier than day 89 to allow for mailing on or
before deadline.
(2) No
later than day 90 by the next work day if day 90 falls on a weekend or holiday,
if needed verification is not provided until day 87 through 89. The only
exceptions are days with system maintenance activities and network outage or
down time.
(3) Day 90 by the next
work day if day 90 falls on a weekend or holiday, if needed verification is
provided on day 90. The eligibility decision must be made as soon as possible
and within three-work days of receipt of all necessary verification.
(4) If needed verification is not provided,
case must be processed on day 90.
(5) Reconsideration: A reconsideration of a
disability determination may be requested, verbally or in writing, by a client
within 15 days of the date of the denial for not meeting conditions of
disability. The reconsideration period shall not exceed 30 days from the date
of denial. Disability will be evaluated based on additional medical evidence
provided by the client during the reconsideration period. Should no request be
made or the client does not provide additional medical evidence during the
reconsideration period the denial shall remain and the client may
reapply.
(6) Tracking the
application processing time limit: The application processing time limit begins
on the day after the signed application is received in the ISD county
office.
(7) Delayed determination:
If an eligibility determination is not made within the required application
processing time limit, the applicant/recipient shall be notified in writing of
the reason for the delay and that the applicant/ recipient has the right to
request a fair hearing regarding ISD's failure to act within the time limits.
Where applicable, NMAC subsections for specific programs detail how delays will
be notified.