New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 281 - MEDICAID ELIGIBILITY - INSTITUTIONAL CARE (CATEGORIES 081, 083 AND 084)
Part 600 - BENEFIT DESCRIPTION
Section 8.281.600.12 - ONGOING BENEFITS
Universal Citation: 8 NM Admin Code 8.281.600.12
Current through Register Vol. 35, No. 18, September 24, 2024
A complete redetermination of eligibility must be performed by the ISD worker for each open case at least annually.
A. Regular reviews: For each regular yearly review, the ISD worker must determine:
(1) whether medical care credit payments are
up to date; an overdue balance may indicate a change in circumstances that is
unreported, particularly where rental property is involved; and
(2) whether the deposit to the recipient's
personal fund is consistently no more than the applicable personal needs
allowance amount per month; a larger deposit may indicate an increase in income
that is unreported or a previously unidentified source of income.
B. Level of care reviews are required to be completed at least annually. Level of care determinations are made by the utilization review contractor or a member's selected or assigned managed care organization.
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