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TITLE 8 SOCIAL SERVICES
CHAPTER 243 MEDICAID ELIGIBILITY - WORKING DISABLED INDIVIDUALS (WDI) (CATEGORY 043)
PART 600 BENEFIT DESCRIPTION
8.243.600.1 ISSUING AGENCY: New Mexico Health Care Authority(HCA).
[8.243.600.1 NMAC - Rp, 8.243.600.1 NMAC, 1/1/2019 ; A, 7/1/2024]
8.243.600.2 SCOPE: This rule applies to the general public .
[8.243.600.2 NMAC - Rp, 8.243.600.2 NMAC, 1/1/2019]
8.243.600.3 STATUTORY AUTHORITY: The New Mexico medicaid program and other health care programs are administered pursuant to regulations promulgated by the federal department of health and human services under Title XIX of the Social Security Act as amended or by state statute. See Section 27-1-12 et seq ., NMSA 1978. Section 9-8-1 et seq. NMSA 1978 establishes the health care authority (HCA) as a single, unified department to administer laws and exercise functions relating to health care facility licensure and health care purchasing and regulation.
[8.243.600.3 NMAC - Rp, 8.243.600.3 NMAC, 1/1/2019 ; A, 7/1/2024]
8.243.600.4 DURATION: Permanent.
[8.243.600.4 NMAC - Rp, 8.243.600.4 NMAC, 1/1/2019]
8.243.600.5 EFFECTIVE DATE: January 1, 2019, or upon a later approval date by the federal centers for medicare and medicaid services (CMS), unless a later date is cited at the end of the section.
[8.243.600.5 NMAC - Rp, 8.243.600.5 NMAC, 1/1/2019]
8.243.600.6 OBJECTIVE: The objective of these rules is to provide eligibility policy and procedures for the medical assistance programs.
[8.243.600.6 NMAC - Rp, 8.243.600.6 NMAC, 1/1/2019]
8.243.600.7 DEFINITIONS: [ RESERVED ]
8.243.600.8 [RESERVED]
[8.243.600.8 NMAC - Rp, 8.243.600.8 NMAC, 1/1/2019]
8.243.600.9 GENERAL BENEFIT DESCRIPTION: An individual who meets a medical assistance programs (MAP) category of eligibility for the working disabled individual program (WDI) is eligible to receive full state plan benefits.
[8.243.600.9 NMAC - Rp, 8.243.600.9 NMAC, 1/1/2019]
8.243.600.10 BENEFIT DETERMINATION: Completed applications must be acted upon and notice of approval, denial, or delay sent out within 60 days of the date of application. Individuals will have time limits explained, and be informed of the date by which the application should be processed.
[8.243.600.10 NMAC - Rp, 8.243.600.10 NMAC, 1/1/2019]
8.243.600.11 INITIAL BENEFITS: Eligibility begins the month of approval. When an eligibility determination is made, notice of the approval or denial is sent to the individual. If the application is denied, this notice includes the individual’s right to request a hearing.
[8.243.600.11 NMAC - Rp, 8.243.600.11 NMAC, 1/1/2019]
8.243.600.12 ONGOING BENEFITS: A re-determination of MAP eligibility is made every 12 months or at such time the MAP eligible recipient begins receiving medicare benefits.
[8.243.600.12 NMAC - Rp, 8.243.600.12 NMAC, 1/1/2019]
8.243.600.13 RETROACTIVE BENEFIT COVERAGE: Retroactive medicaid coverage is provided in accordance with 8.200.400.14 NMAC.
[8.243.600.13 NMAC - Rp, 8.243.600.13 NMAC, 1/1/2019]
8.243.600.14 CHANGES IN ELIGIBILITY: A case is closed, with provision of advance notice, when the MAP eligible recipient becomes ineligible. If a MAP eligible recipient dies, the case is closed the following month.
[8.243.600.14 NMAC - Rp, 8.243.600.14 NMAC, 1/1/2019]
HISTORY OF 8.243.600 NMAC: [ RESERVED ]
History of Repealed Material:
8.243.600 NMAC - Medicaid Eligibility - Working Disabled Individuals (WDI) (Category 043) - Benefit Description, filed 12/13/2000 Repealed effective 1/1/2019.