Current through Register Vol. 35, No. 18, September 24, 2024
A.
Financial need: The budget group's eligibility is based on financial need. See
Section 1931 of the Social Security Act, the rules in this chapter and in
8.200.520 NMAC.
B. Financial
eligibility: Pursuant to Section 1931 of the Social Security Act, enacted by
Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), a new
medicaid financial eligibility standard was created. Refugee medical assistance
(RMA) uses this same standard.
(1) Income
eligibility criteria: The income eligibility criteria for Category 049 are
based on New Mexico's aid to families with dependent children (AFDC) program as
of July 16, 1996. This is defined as the standard of need (SON) used in AFDC as
of July 16, 1996. A refugee can be eligible for Category 059 if income would be
below AFDC after deducting medical expenses incurred and paid in that month.
Eligibility for Category 059 is determined on a month-to-month basis.
(2) Less restrictive income and resource
methodology: Pursuant to Section 1931 of the Social Security Act, as a state
option, New Mexico may use income and resource eligibility methodologies that
are less restrictive than the AFDC methodologies used as of July 16, 1996. This
chapter defines less restrictive methodologies to be used by New Mexico for
resources, countable and excluded earned or unearned income, available or
unavailable income and income deductions or disregards.
C. Gross and net income tests: Determining
financial need is a two-step process. When the countable gross or net income is
exactly equal to the income eligibility standards, eligibility does not exist.
(1) Gross income test: The first step is
determining the countable gross income of the budget group. Gross income
includes all countable income before taking into account taxes or deductions.
Only self employment deductions are allowed in the gross income test. The
calculated gross income must be less than one hundred and eighty-five percent
of the SON. If the budget group's income is more than one hundred and
eighty-five percent of the SON, the assistance unit is not eligible.
(2) Net income test: The second step is
determining the countable net income of the budget group. From the countable
gross income in step one, deduct all allowable work related expenses (WRE) and
unearned income deductions/disregards. The countable net income must be less
than the SON appropriate to the budget group size. If the budget group's income
is more than the SON, the assistance unit is not eligible.
