New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 291 - MEDICAID ELIGIBILITY - AFFORDABLE CARE
Part 430 - FINANCIAL RESPONSIBILITY REQUIREMENTS
Section 8.291.430.13 - LIVING ARRANGEMENT

Universal Citation: 8 NM Admin Code 8.291.430.13

Current through Register Vol. 35, No. 18, September 24, 2024

All individuals listed on the MAP application are evaluated according to their living arrangement to determine if they can be included in an assistance group or budget group.

A. Extended living in the home: An individual physically absent from the home is a member of the assistance unit or budget group. Extended living in the home includes:

(1) attending college or boarding school;

(2) receiving treatment in a title XIX MAD enrolled facility (including institutionalized when meeting a nursing facility (NF) level of care (LOC) and intermediate care facilities for the mentally retarded (ICF-MRs);

(3) emergency absences: an applicant or recipient absent from the home due to an emergency, who is expected to return to the household, continues to be a member of the household;

(4) foster care placements: a minor applicant or minor recipient removed from the home by a child protective services agency (tribal, bureau of Indian affairs, or children, youth and families department) will be considered to be living in the home until the adjudicatory hearing; if the adjudicatory hearing results in custody being granted to some other entity, the minor applicant or minor recipient will be removed from the assistance unit and budget group;

(5) inmate of a public institution:
(a) see 8.200.410.15 NMAC for the definition of a public institution and an inmate of a public institution;

(b) an inmate of a public institution is included in the household with other mandatory household members if they are expected to file a tax return or be claimed as a tax dependent; see 8.291.430.14 NMAC;

(c) an inmate of a public institution is not included in the household if they neither file a tax return nor is claimed as a tax dependent which requires that mandatory household members be living together; see 8.291.430.14 NMAC.

B. Extended living in the home also includes:

(1) residential treatment centers;

(2) group homes; and

(3) free-standing psychiatric hospitals.

C. Living in the home with a parent caretaker: To be included in the assistance unit, a minor applicant or minor recipient must be living, or considered to be living, in the home of:

(1) a biological or adoptive or step parent (there is a presumption that a child born to a married woman is the child of the husband); or

(2) a specified relative who:
(a) is related within the fifth degree of relationship by blood, marriage or adoption, as determined by New Mexico statute Chapter 45 - Uniform Probate Code; a relationship based upon marriage, such as "in-law" or "step" relationships, continues to exist following the dissolution of the marriage by divorce or death; and

(b) assumes responsibility for the day-to-day care and control of the minor applicant or minor recipient; the determination of whether an individual functions as the specified relative shall be made by the specified relative unless other information known to the worker clearly indicates otherwise;

(3) a minor applicant or minor recipient considered to be living in the home: a minor applicant or minor recipient is considered to be part of the assistance unit and budget group as evidenced by the minor applicant's or minor recipient's customary physical presence in the home; if they are living in more than one household, the following applies:
(a) the custodial parent is the parent with whom the minor applicant or minor recipient lives the greater number of nights; or

(b) if the minor applicant or minor recipient spends equal amounts of time with each household, the minor applicant or minor recipient shall be considered to be living in the household of the parent with the higher modified adjusted gross income (MAGI).

D. For individuals for whom the state must complete a determination of income either based on MAGI or for MAGI-excepted groups:

(1) MAD recognizes same-sex couples as spouses, if they are legally married under the laws of the state, territory, or foreign jurisdiction in which the marriage was celebrated; and

(2) for an applicant or recipient whose MAP category of eligibility is based on the eligibility for any other HCA benefit program and for which income is not used in the eligibility determination, the applicant's or recipient's marital status will not be used in making the eligibility determination; the applicant's or recipient's MAP category of eligibility will continue to be based on the determination of eligibility of the other HCA applicable benefits.

Disclaimer: These regulations may not be the most recent version. New Mexico may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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