New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT POLICIES
Part 410 - GENERAL RECIPIENT REQUIREMENTS
Section 8.200.410.15 - NON-CONCURRENT RECEIPT OF ASSISTANCE
Universal Citation: 8 NM Admin Code 8.200.410.15
Current through Register Vol. 35, No. 18, September 24, 2024
A. An applicant or an eligible recipient receiving medicaid in another state is not medical assistance program eligible in New Mexico except when:
(1) institutional
care medicaid begins on a specific date within the month rather than
automatically reverting to the first day of the month, if an applicant for
institutional care medicaid (Category 081, 083 or 084) moves to New Mexico from
another state and it can be verified that the other state will terminate the
individual's medicaid eligibility under that state program prior to the initial
eligibility date in New Mexico, the application may be approved even though the
individual receives medicaid from the other state for part of the month;
coverage in New Mexico begins after the end date of services from the other
state;
(2) an individual is court
ordered into full or partial responsibility CYFD; when CYFD places a child in a
new state of residence, the new state of residence is responsible for the
provision of medicaid; however, New Mexico must provide limited medicaid
coverage for medicaid services that are part of New Mexico's medicaid benefit
package and not available in the new state of residence.
B. An individual who is eligible for a full-coverage medicaid program may also be eligible for one of the medicare cost sharing medical assistance program categories. See 8.200.400 NMAC.
C. When a supplemental security income (SSI) recipient enters into a nursing home or hospital (institutionalized), SSA will re-evaluate SSI and related medicaid eligibility.
(1) When SSA determines that the individual
remains eligible for SSI while institutionalized, the SSI benefit is adjusted
as follows:
(a) if institutionalized for more
than 90 calendar days - the SSI benefit is limited to thirty ($30) a month;
or
(b) if institutionalized for 90
calendar days or less - the SSI benefit continues at the regular
amount.
(2) When SSA
determines that the individual is not eligible for SSI, the individual or his
or her authorized representative should file an application at HSD for
institutional care medicaid. If the individual meets all factors of
eligibility, approval of the institutional care medicaid application should be
coordinated with the SSI closure date. If eligible, there will not be a break
in eligibility and the individual shall not receive both SSI and institutional
care medicaid in the same month pursuant to
8.281.400.10
NMAC.
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.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.