New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 171 - PREMIUM ASSISTANCE FOR CHILDREN (CATEGORY 071/2)
Part 400 - RECIPIENT POLICIES
Section 8.171.400.17 - SPECIAL RECIPIENT REQUIREMENTS

Universal Citation: 8 NM Admin Code 8.171.400.17

Current through Register Vol. 35, No. 6, March 26, 2024

To be eligible for premium assistance for kids, the applicant must meet the following criteria:

A. Age: For purposes of premium assistance for kidseligibility, the applicant must be less than 12 years of age, or less than the age of 18 if part of a sibling group that includes a child up to the age of 12.

B. Continuing eligibility on the basis of age: When an individual has been determined eligible based on age, he remains eligible on the condition of age until the upper age limit, as described above, is reached. An individual who exceeds the age limit during a given month is eligible for that month, unless the birthday is the first day of the month.

C. Uninsured: For purposes of premium assistance for kids eligibility, an applicant cannot be covered by a commercial health insurance product, medicare, or medicaid. The applicant must be ineligible for medicaid or SCHIP due to countable income, not on the basis of failure to recertify or failure to provide the necessary documentation to establish eligibility for medicaid or SCHIP. An individual with access to health care at Indian health services, veteran's administration, or through worker's compensation, is not considered to be insured by having such access.

D. Voluntary drop of insurance:

(1) An individual who has voluntarily dropped health insurance, or whose parent or stepparent has dropped health insurance on the child's behalf, will be ineligible for premium assistance for kids for six months, starting with the month that the health insurance was dropped (i.e., the first month of no coverage). It is not considered to be a voluntary drop if the drop was caused by: the loss of access to employer-sponsored insurance, the loss of employment, divorce, death of a spouse, geographic move, or loss of coverage as a dependent child.

(2) If the client share of the premium assistance for kids premium is not made on time and the client is disenrolled, there will be a 12 month period of ineligibility.

E. Ineligible for medicaid or SCHIP: To be eligible for premium assistance for kids, the applicant must either be denied for medicaid and SCHIP or be screened and found ineligible for medicaid and SCHIP.

Disclaimer: These regulations may not be the most recent version. New Mexico may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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