N.M. Admin. Code § 8.200.430.9 - RECIPIENT RIGHTS AND RESPONSIBILITIES
A. An individual
has the right to apply for medicaid and other health care programs HCA
administers regardless of whether it appears they may be eligible.
(1) Income support division (ISD) determines
eligibility for the medical assistance division's medical assistance programs
(MAP), unless otherwise determined by another entity as stated in 8.200.400
NMAC. A decision shall be made promptly on applications in accordance with the
timeliness standards set forth in 8.100.130 NMAC.
(2) Individuals who might be eligible for
supplemental security income (SSI) are referred to the social security
administration (SSA) office to apply.
B. Application: A paper or electronic
application is required from the applicant, an authorized representative, or,
if the applicant is incompetent or incapacitated, someone acting responsibly
for the applicant. The applicant may complete a joint MAP, cash assistance,
supplemental nutrition assistance program (SNAP) and low income home energy
assistance (LIHEAP) application or a MAP-only application.
(1) The following do not require an
application unless a re-determination is due in that month or the following
month, as applicable:
(a) switching from one
of the medical assistance for women, children (MAWC) and families MAP
categories to another;
(b)
switching between medicaid and refugee medical assistance; and
(c) switching to or from one of the long term
care medicaid categories.
(2) Medicare savings programs (MSP):
(a) A MAP eligible recipient receiving full
benefits is automatically deemed eligible for MSP when they receive free
medicare Part-A hospital insurance; the eligible recipient does not have to
apply for medicare MSP;
(b) When an
individual is not eligible for free medicare Part A hospital insurance, a
separate application for the MAP qualified medicare beneficiary (QMB)
eligibility category 040 is required. Individuals must apply for medicare Part
A with the SSA. This is called, "conditional Part A" because they will receive
medicare Part A on the condition that the MAP QMB category of eligibility is
approved. When QMB is approved, the cost of the premium for Part A will be
covered by MAD.
C. Responsibility in the application or
recertification process: The applicant or the re-determining eligible recipient
is responsible for providing verification of eligibility. Refer to 8.100.130
NMAC.
(1) An applicant or an eligible
recipient's failure to provide necessary verification results in MAP
ineligibility.
(2) An applicant or
a re-determining eligible recipient must give HCA permission to contact other
individuals, agencies, or sources of information which are necessary to
establish eligibility.
Notes
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