Current through Register Vol. 35, No. 18, September 24, 2024
A. HSD
must make eligibility for medicaid effective no later than the first or up to
the third month before the month of application if the individual:
(1) Requested coverage for months prior to
the application month;
(2) received
medicaid services, at any time during that period, of a type covered under the
plan and;
(3) would have been
eligible for medicaid at the time he or she received the services, if he or she
had applied (or an authorized representative has applied for him or her)
regardless of whether the individual is alive when application for medicaid is
made.
B. Eligibility for
medicaid is effective on the first day of the month if an individual was
eligible at any time during that month.
C. Eligibility for each retroactive month is
determined separately. Retroactive medicaid must be requested within 180 days
of the date of the medicaid application.
D. Retroactive medicaid is allowed for up to
three months prior to the application month for the following medicaid
categories:
(1) other adults (COE
100);
(2) parent caretaker (COE
200);
(3) pregnant women (COE
300);
(4) pregnancy-related
services (COE 301);
(5) children
under age 19 (COEs 400, 401, 402, 403, 420, and 421);
(6) family planning (COE 029);
(7) children, youth and families department
(CYFD COEs 017, 037, 046, 047, 066, and 086);
(8) supplemental security income (SSI COEs
001, 003, and 004);
(9) SSI (COEs
001, 003, and 004, e.g. 503s, disabled adult children, ping pongs, and early
widowers);
(10) working disabled
individuals (COE 074);
(11) breast
and cervical cancer (BCC COE 052);
(12) specified low income beneficiaries
(SLIMB COE 045);
(13) qualified
individuals (QI1 COE 042);
(14)
qualified disabled working individuals (COE 050);
(15) refugees (COE 049); and
(16) institutional care medicaid (COEs 081,
083, and 084) excluding the program for all-inclusive care for the elderly
(PACE).
E. The following
categories do not have retroactive medicaid:
(1) emergency medical services for
non-citizens ( EMSNC COE 085). EMSNC provides coverage for emergency services,
which may be provided prior to the application month, but is not considered
retroactive medicaid. Eligibility is determined in accordance with 8.285.400,
8.285.500, and 8.285.600 NMAC;
(2)
home and community based-services waivers (COEs 091, 093, 094, 095, and
096);
(3) PACE (COEs 081, 083, and
084);
(4) qualified medicare
beneficiaries (COEs 041 and 044); and
(5) transitional medicaid (COEs 027 and
028).
F. Newborns (COE
031) are deemed to have applied and been found eligible for the newborn
category of eligibility from birth through the month of the child's first
birthday. This applies in instances where the labor and delivery services were
furnished prior to the date of the application and covered by medicaid based on
the mother applying for up to three months of retroactive
eligibility.
