Current through Register Vol. 35, No. 18, September 24, 2024
A.
Compliance with IAR
requirements: The state of New Mexico is a participant in the interim
assistance reimbursement (IAR) program administered by the social security
administration (SSA). The U.S. secretary of health and human services, through
the SSA, has agreed to reimburse the state through HSD for general assistance
payments made to an individual receiving GA disability during the period the
individual's application for SSI was pending. Upon approval of SSI, SSA sends
the first retroactive SSI payment due an individual to HSD as repayment for the
state-funded GA payments made to the individual. The repayment of GA benefits
from SSI is referred to as interim assistance reimbursement (IAR).
(1)
Interim assistance
authorization: An individual applying for disability based on set or
variable term disability must, as a condition of eligibility, authorize in
writing the reimbursement to HSD for the amount of GA benefits paid on the
individual's behalf for any month in which the SSA pays retroactive SSI
benefits to the individual.
(a)
Completing the IAR authorization: The IAR authorization shall be
completed and signed by the applicant and the Department representative at the
time the individual is interviewed. Refusal to sign an IAR authorization shall
result in immediate denial of a GA application.
(b) The department shall not approve an
application for GA without a completed and valid IAR.
(c) The completed and signed IAR
authorization form must be received by SSA within 30 days from the date of
signature in order to be valid.
(d)
Duration of authorization: The authorization for IAR shall remain
in effect from the date of signature until:
(i) SSA releases the SSI retroactive payment
to HSD and HSD recovers the full amount to which it is entitled; or
(ii) HSD and the individual agree to
terminate the authorization.
(2) Termination of GA benefits does not
constitute termination of the IAR authorization. HSD shall receive the first
retroactive SSI payment for an individual who has received GA in the past and
for whom an IAR authorization is in effect.
(3)
Validity of an IAR
authorization: In order for the IAR authorization to remain in effect,
an individual must have filed an application for SSI within 12 months of
signing the authorization.
(4)
Determination of repayment amount:
(a) The amount of repayment of GA benefits
from SSI shall be determined by comparing the months and amounts of GA paid to
the individual to the months and amounts of the SSI retroactive payment issued
by the SSA. The amount available for reimbursement to the department shall be
calculated from the first day the individual is eligible for SSI benefits and
shall end with (and include) the month the retroactive SSI payment is
made.
(b) For each month that GA
and SSI were both paid, the department shall recoup the amount of the GA
benefit, not to exceed the amount of SSI for that month.
(c) The department shall not recoup an SSI
payment for any month in which a GA payment was not issued.
(d) Emergency advance SSI payments shall not
be available for recoupment. Presumptive disability SSI payments shall not be
available for recoupment.
(5)
Issuance of balance of SSI
payment: When the amount of the total SSI payment exceeds the total GA
payment, the balance of the remaining SSI retroactive payment(s) shall be sent
to the individual within 10 calendar days of the date the department received
the SSI retroactive payment from SSA. The balance shall be paid in the form of
an HSD warrant. The individual shall be informed in writing of the retroactive
SSI payment amount, how the repayment amount was computed by the department,
and the balance being sent to the individual.
(6)
Returned checks: When the
department is issued an amount greater than the amount of GA benefits paid to
an individual, and the excess payment cannot be issued because the individual
is deceased or cannot be located, the balance of the SSI retroactive payment
shall be returned to SSA.
(7)
When the individual dies before eligibility is determined: The
department has the right to receive repayment for GA benefits paid to an
individual who dies before a determination of SSI eligibility is made. In such
a circumstance, SSA will make a determination of eligibility or ineligibility
for payment. Any excess payment after recovery by HSD will be returned to
SSA.
B.
Compliance with SSI status requirements:
(1) Any individual who is potentially
eligible for SSI on the basis of either age or disability must apply for and
accept SSI if approved by the social security administration.
(2) GA benefits shall be terminated when a
determination is made that an individual has failed or refused to follow
through with the initial SSI application interview, or failed or refused to
file a timely request for reconsideration or appeal of an SSI denial.
(3)
Ongoing SSI: An individual
receiving SSI, or who would be receiving SSI except for recovery of an
overpayment by the social security administration, is not eligible for
GA.
C.
SSI
application requirement for disabled individuals:
(1) An individual who is approved for GA
based on a set or variable term GA must file an application for SSI or OASDI
within 60 days following approval. The GA recipient must follow through with
the SSI application process and maintain an active SSI or OASDI
application.
(2) An individual
whose SSI or OASDI application has been denied or terminated must
request and pursue his right to a hearing and appeal through the administrative
law judge (ALJ) appeal level of the social security administration (SSA). If an
individual has allowed his or her hearing rights to expire, the individual must
file a new application with the SSA.
(3) An individual who has pursued his or her
hearing rights through the SSA and who has not been approved shall not be
required to pursue SSI or OASDI benefits any further.
(4) A GA recipient who has not applied for
SSI by the end of the month in which the 60th day
occurs shall be ineligible to continue receiving GA. In such a situation, a
notice of adverse action must be issued. If the individual files an application
for OASDI, SSI or both by the end of the month in which the notice of adverse
action expires, the individual's benefits will be reinstated.
(5) GA benefits shall be terminated when a
determination is made that an individual has failed or refused to follow
through with the initial SSI application interview or failed or refused to
timely request for consideration or appeal of an SSI denial, unless the
individual can demonstrate good cause.
D.
Contingency requirements: To
remain eligible for variable term disability assistance, an individual must
accept treatment available outside the GA program, unless a determination is
made that good cause exists for the individual's inability to comply. The
department shall make a determination of whether a contingency requirement is
warranted and must be met to maintain eligibility for GA.
(1) The GA recipient shall be informed of any
ongoing conditions or contingency requirements that must be met in order to
ensure ongoing eligibility.
(2) If
appropriate, the individual shall be referred to the division of vocational
rehabilitation (DVR). A recipient must accept vocational rehabilitation
services if offered by DVR.
(3) The
department shall not impose a time limit or deadline for a contingency
requirement to be met that cannot realistically be met in the community in
which the GA recipient resides.
(4)
Failure to comply: Failure to comply with out good cause shall
result in termination of GA benefits and ineligibility until contingency
requirements have been met or good cause can be established.
(5) If a recipient of GA fails or refuses a
referral, treatment or rehabilitation services, the case shall be reviewed by
the department to determine if the refusal was for good cause. A determination
that the failure or refusal to accept corrective treatment was for good cause
will not result in termination of benefits. A determination that the failure or
refusal was not for a good cause reason shall result in termination of GA
benefits.
E.
Good
cause: Good cause is determined on an individual basis. There may be
situations in which good cause exists for a GA recipient's inability to comply
with a contingency requirement, including but not limited to:
(1) the treatment is not available without
cost or minimal cost to the recipient;
(2) the treatment is totally unavailable or
not available at the frequency required due to lack of providers in the project
area in which the recipient resides;
(3) the failure of ISD to provide written
notice or sufficient information to the recipient about the contingency
requirement;
(4) the recipient's
inability to participate because of documented barriers, such as lack of
transportation, an inability to leave work, illness, or death in the immediate
family;
(5) the contingency
requirement was made in error;
(6)
a good cause reason approved by the department;
(7) treatment that involves more than
reasonable risk to correct the impairment;
(8) treatment that conflicts with the
individual's sincere religious beliefs;
(9) fear of additional treatment that could
interfere with or reduce the benefits of current treatment interventions;
or
(10) treatment that may cause
further limitations or loss of a function or organ and the recipient is not
willing to take the risk.