Current through Register Vol. 35, No. 18, September 24, 2024
A.
Extended eligibility for pregnant individuals: For a pregnant individual who
was eligible and enrolled for mandatory or optional coverage under the state
plan on the date their pregnancy ends (regardless of the reason the pregnancy
ends), HSD provides full medicaid coverage through the last day of the month in
which the 12-month postpartum period ends.
B. Continuous eligibility for pregnant
individuals: For a pregnant individual who was eligible and enrolled for
mandatory or optional coverage under the state plan and who, because of a
change in circumstance (e.g., income, household, composition, aging out etc.),
will not otherwise remain eligible, HSD provides full medicaid coverage through
the last day of the month in which the 12-month postpartum period ends.
(1) The following populations are provided
continuous eligibility effective April 1, 2022:
(a) Current medicaid recipients who are
pregnant as of April 1, 2022 or who enroll based on pregnancy or become
pregnant after April 1, 2022.
(b)
Current medicaid recipients who are receiving medicaid while pregnant and who
are no longer pregnant as of April 1, 2022, but who are still within a 12-month
postpartum period; and
(c)
Individuals who apply for medicaid after their pregnancy ends, who received
medicaid-covered services while pregnant on or after April 1, 2022 if such
services were received during an approved period of retroactive
eligibility.
(2) The
following applies to certain categories or individuals:
(a) An individual approved on the other adult
category who becomes pregnant may remain on the adult category and receive
services under the alternative benefit plan (ABP). The ABP is considered full
benefits for the purpose of the 12-month extended postpartum period. An
individual on the other adult category who becomes pregnant may also transition
to another full coverage medicaid category such as pregnant women or
parent/caretaker and will remain eligible until their 12-month postpartum
period expires.
(b) Children
turning age 19 aging out of a children's medicaid category will remain on a
children's medicaid category until their 12-month postpartum period
expires.
(c) An individual covered
on the parent/caretaker category during a 12-month postpartum period and who
has increased earnings or spousal support above the parent/caretaker category
limit will remain on the parent/caretaker category until their 12-month
postpartum period expires and then can transition to a four or 12-month
transitional medical assistance period.
(d) An individual who becomes pregnant during
the 12-month postpartum period is entitled to 12-months continuous coverage
through the end of the second pregnancy and the 12-month postpartum period
following.
(e) The extended
12-month postpartum period applies to individuals receiving medicaid who are
lawfully residing children under age 21 and pregnant individuals referred to as
"CHIPRA 214".
C. Renewals: Medicaid renewals are conducted
at the end of the individual's 12-month postpartum period. Individuals remain
enrolled in the eligibility group in which the individual was enrolled during
pregnancy through the end of the 12-month postpartum period as described in
Subsection C of 8.291.400.14 NMAC.
D. There is not extended or continuous
medicaid eligibility for a pregnant individual covered during a presumptive
eligibility period under section 1920 of the ACT.
E. An individual's eligibility may not be
terminated during a continuous eligibility period, regardless of any changes in
circumstances, unless:
(1) the individual or
their representative requests a voluntary termination of eligibility;
(2) the individual ceases to be a resident of
New Mexico;
(3) eligibility was
determined incorrectly at the most recent determination or redetermination of
eligibility because of HSD error or fraud, abuse, or perjury attributed to the
individual; or
(4) the individual
dies.
