Current through Register Vol. 35, No. 18, September 24, 2024
A. HCA
is responsible for timely and accurate issuance of benefits to eligible
households. All applications for assistance will be processed as soon as
possible. Applicants who complete the application process will have their
eligibility determined and be given an opportunity to participate within the
time limits mandated for expedited or normal application processing. ISD will
explain the time limits to the applicant and inform them of the date by which
the application will be processed. With the exception of those manual
provisions that specify "working days," time limits begin on the first calendar
day following the action that triggered the time limit.
B. Household cooperation: To determine
eligibility an application form must be completed and signed, a household or
its authorized representative interviewed, and certain information on the
application verified.
(1) At application: If a
household refuses to cooperate in completing the process, the application will
be denied at the time of refusal. For a determination of refusal to be made, a
household must be able to cooperate, but clearly demonstrates that it will not
take action that it can take and that is required to complete the application
process. If there is any question that a household has failed to cooperate as
opposed to refused to cooperate, it will not be denied. Once denied for refusal
to cooperate, a household may reapply but will not be determined eligible until
it cooperates with ISD.
(2)
Subsequent reviews: A household will be determined ineligible if it refuses to
cooperate in a subsequent review of eligibility. Such reviews include those
because of reported changes and at application for recertification. Once
terminated for refusal to cooperate, a household may reapply, but will not be
determined eligible until it cooperates with ISD.
(3) Outside sources: A household will not be
determined ineligible when an individual outside the household fails to
cooperate with a request for verification. Individuals identified as ineligible
household members in
8.139.400.12 NMAC will not be
considered as individuals outside the household.
(4) Cooperation with quality control (QC): A
household will be determined ineligible if it fails or refuses to cooperate in
a QC review of eligibility and benefit amount.
(a) Period of ineligibility:
(i) A household that refuses to cooperate
with a state QC review will be determined ineligible effective the month
following the month the adverse action notice time limit expires. Ineligibility
will continue until 125 days from the end of the annual QC review period
(February 4) during which non-cooperation is found. The annual QC review period
begins October 1 and ends September 30.
(ii) A household that refuses to cooperate
with a federal QC review will be ineligible effective the month following the
month the adverse action notice time limit expires. Ineligibility will continue
until nine months from the end of the annual review period (May 1) during which
non-cooperation is found. The annual QC review period begins October 1 and ends
September 30.
(b)
Re-establishing eligibility:
(i) A household
may reapply during the period of ineligibility but will not be determined
eligible until it cooperates with the QC review and is otherwise
eligible.
(ii) A household which
reapplies at the end of the period of ineligibility will not be determined
ineligible because of its failure or refusal to cooperate with a state or
federal QC review. The household must provide verification necessary to
determine eligibility at reapplication in accordance with Subsection H of
8.139.110.11NMAC.
C. Verification standards: Verification is
use of third-party information or documentation to establish the accuracy of
statements on the application, or information provided by the applicant or
recipient.
(1) Initial certification:
Verification is mandatory for the following information prior to initial
certification for both new and reopened cases.
(a) Financial information:
(i) gross nonexempt income, and
(ii) resources.
(b) Any of the following if the expense would
result in a deduction:
(i) utility
expenses;
(ii) continuing shelter
expenses;
(iii) dependent care
expenses;
(iv) deductible medical
expenses including the amount of reimbursements;
(v) legally obligated child support expenses,
and amount actually paid;
(vi) if
any of the above expenses will not result in a deduction, verification shall
not be required (for example, less than $35 in medical expenses, or shelter
expenses that do not exceed fifty percent of income after all other
deductions).
(c)
Nonfinancial information:
(i)
residence;
(ii) citizenship, if
questionable, and non-citizen status of household members who are individually
applying for benefits only;
(iii)
identity of the applicant and authorized representative, if
designated;
(iv) household size and
composition;
(v) disability, if
necessary;
(vi) social security
numbers, except that eligibility or issuance of benefits shall not be delayed
solely to verify the social security number of a household member,
and
(vii) any questionable
information that must be verified to determine eligibility.
(2) Verification
subsequent to initial certification: Verification of the following is mandatory
in accordance with the individual's reporting requirements found at 8.139.120.9
through 12 NMAC:
(a) a change in income if the
source has changed or the amount has changed by more than $50;
(b) a change in utility expenses if the
source has changed;
(c) previously
unreported medical expenses, and total recurring medical expenses which have
changed by more than $25;
(d) new
social security numbers, for individuals who are applying for benefits, that
shall be verified as detailed in
8.139.410.8 NMAC;
(e) any other information which has changed
or is questionable;
(f) unchanged
information shall not be re-verified unless it is incomplete, inaccurate,
inconsistent, or outdated.
(g)
satisfactory compliance with time limits for individuals subject to the time
limit in accordance with
8.139.410.14 NMAC.
(3) Providing verification:
(a) If electronic verification is not
available, the household has primary responsibility for providing documentary
evidence to support statements on the application and to resolve any
questionable information.
(b) ISD
shall assist a household in obtaining verification, provided the household is
cooperating in the application process.
(c) A household or their authorized
representative may supply documentary evidence in person, by mail, fax,
electronic device or through the YES NM web portal.
(d) A household shall not be required to
supply verification in person at the ISD office or to schedule an appointment
to provide such verification.
(e)
ISD shall accept any reasonable documentary evidence provided by the household
and must be primarily concerned with how adequately the verification proves the
statements on the application.
(4) Documentation: A case file shall be
documented to support eligibility, ineligibility, and benefit amount
determination. Documentation shall be in sufficient detail to permit a reviewer
to determine the reasonableness and accuracy of the determination.