Current through Register Vol. 35, No. 18, September 24, 2024
A. Renewal of
individuals whose medicaid eligibility is based on MAGI.
(1) Except as provided in Subsection D of
8.291.410.19 NMAC, the eligibility of medicaid beneficiaries whose financial
eligibility is determined using MAGI-based income must be renewed once every 12
months, and no more frequently than once every 12 months.
(2) Renewal on basis of information available
to HSD. HSD will make a redetermination of eligibility without requiring
information from the individual if able to do so based on reliable information
contained in the individual's account or other more current information
available to HSD, including but not limited to information accessed through any
data bases accessed by HSD under
42 CFR
435.948,
435.949
and
435.956.
If the HSD is able to renew eligibility based on such information, HSD will
notify the individual:
(a) Of the eligibility
determination, and basis; and
(b)
That the individual must inform the HSD, through any of the modes permitted for
submission of applications under
42
CFR 435.907(a) and
Subsection A of
8.291.410.18
NMAC, if any of the information contained in such notice is inaccurate, but
that the individual is not required to sign and return such notice if all
information provided on such notice is accurate.
(3) Use of a pre-populated renewal form. If
HSD cannot renew eligibility in accordance with Paragraph (2) of Subsection A
of 8.291.410.19 NMAC, HSD will:
(a) Provide
the individual with:
(i) A renewal form
containing information available to HSD that is needed to renew
eligibility.
(ii) At least 30 days
from the date of the renewal form to respond and provide any necessary
information through any of the modes of submission specified in
42
CFR 435.907(a) and
8.291.410.18
(A) NMAC and to sign the renewal form in a manner consistent with
42
CFR 435.907(f) and
Subsection F of 8.291.410.18 NMAC.
(iii) Notice of the HSD decision concerning
the renewal of eligibility.
(b) Verify any information provided by the
beneficiary in accordance with
42 CFR
435.945 through
435.956.
(c) Reconsider in a timely manner the
eligibility of an individual who is terminated for failure to submit the
renewal form or necessary information, if the individual subsequently submits
the renewal form within 90 days after the date of termination without requiring
a new application;
(d) Not require
an individual to complete an in-person interview as part of the renewal
process.
B.
Redetermination of individuals whose medicaid eligibility is determined
on a basis other than modified adjusted gross income: HSD will
redetermine the eligibility of medicaid beneficiaries excepted from modified
adjusted gross income per
42 CFR
435.603, for circumstances that may change,
at least every 12 months. HSD will make a redetermination of eligibility in
accordance with the provisions of Paragraph (2) of Subsection A of 8.291.410.19
NMAC, if sufficient information is available to do so. HSD adopts the
procedures described at
42 CFR
435.916(a)(3) for
individuals whose eligibility cannot be renewed in accordance with Paragraph
(3) of Subsection A of 8.291.410.19 NMAC.
(1)
HSD will consider blindness as continuing until the reviewing physician under
42 CFR
435.531 determines that a beneficiary's
vision has improved beyond the definition of blindness contained in the plan;
and
(2) HSD will consider
disability as continuing until the review team, under
42 CFR
435.541, determines that a beneficiary's
disability no longer meets the definition of disability contained in the
plan.
C.
Procedures for reporting changes: HSD has procedures designed to
ensure that beneficiaries make timely and accurate reports of any change in
circumstances that may affect their eligibility and that such changes may be
reported through any of the modes for submission of applications described in
43 CFR 435.907(a) and Subsection A of
8.291.410.18
NMAC.
D.
HSD action on
information about changes: Consistent with the requirements of
42
CFR 435.952, HSD will promptly redetermine
eligibility between regular renewals of eligibility described in Subsections B
and C of 8.291.410.19 NMAC whenever it receives information about a change in a
beneficiary's circumstances that may affect eligibility. Auto renewal is only
applicable to the following medicaid categories: working disabled individuals,
qualified medicare beneficiaries, specified low income medicare beneficiary,
qualified individuals, parent caretaker, pregnant women, children's medicaid,
children's health insurance program (CHIP), pregnancy related services, other
adult and family planning.
(1) For renewals
of medicaid beneficiaries whose financial eligibility is determined using
MAGI-based income, the agency must limit any requests for additional
information from the individual to information relating to such change in
circumstance.
(2) If HSD has enough
information available to it to renew eligibility with respect to all
eligibility criteria, the HSD will begin a new 12-month renewal
period.
(3) If HSD has information
about anticipated changes in a beneficiary's circumstances that may affect his
or her eligibility, HSD will redetermine eligibility at the appropriate time
based on such changes.
E. HSD will request from beneficiaries only
the information needed to renew eligibility. Requests for non-applicant
information must be conducted in accordance with
42
CFR 435.907.
F. Determination of ineligibility and
transmission of data pertaining to individuals no longer eligible for medicaid.
(1) Prior to making a determination of
ineligibility, HSD will consider all bases of eligibility, consistent with
42 CFR
435.911.
(2) For individuals determined ineligible for
medicaid, the agency must determine potential eligibility for other insurance
affordability programs and comply with the procedures set forth in
42
CFR 435.1200.
G. Any renewal form or notice will be
accessible to persons who are limited english proficient and persons with
disabilities, consistent with
42 CFR
435.905.
