Current through Register Vol. 35, No. 6, March 26, 2024
A. To
be included in the assistance unit and budget group, an individual must be
living, or considered to be living, in the budget group's home.
B.
A child considered to be living in
the home: A child is considered to be part of the budget group as
evidenced by the child's customary physical presence in the home. If a child is
living with more than one household, the following applies:
(1) when the child is actually spending more
time with one household than the other, the child would be determined to be
living with the household with whom the child spends the most time;
or
(2) when the child is actually
spending equal amounts of time with each household, the child shall be
considered to be living with the household who first applies for medicaid
enrollment.
C.
Extended living in the home: An individual may be physically
absent from the home for longer or shorter periods of time and be a member of
the assistance unit and budget group.
(1)
Extended living in the home includes:
(a) when
an individual is attending college or boarding school; or
(b) when an individual is receiving treatment
in a Title XIX medicaid facility, including institutionalized when meeting a
nursing facility (NF) level of care (LOC) and intermediate care facilities for
individuals with an intellectual disability (ICF-IID) LOC.
(2) When an individual has been a member of
the assistance unit, eligibility for another medicaid eligibility category,
such as long term care medicaid, should be evaluated; until a determination of
eligibility for another category can be made, the individual is considered to
be living with the budget group.
D.
Temporary absence such as extended
living in the home: An individual may be physically absent from the home
and be a member of the assistance unit and budget group. These other temporary
absences include:
(1) an individual not living
in the home due to an emergency, who is expected to return to the household
within 60 calendar days, continues to be a member of the household;
(2) a child removed from the home of a parent
or a specified relative by a child protective services agency (tribal, bureau
of Indian affairs, or children, youth and families department), until an
adjudicatory custody hearing takes place; if the adjudicatory hearing results
in custody being granted to some other entity, the child will be removed from
the assistance unit; or
(3) a child
residing in a detention center:
(a) continues
to be a member of the household if he or she resides fewer than 60 calendar
days, regardless of adjudication as an inmate of a public institution;
or
(b) is not eligible for medicaid
enrollment if he or she resides 60 calendar days or more as an adjudicated
inmate of a public institution pursuant to 8.200.410 NMAC.
