N.M. Admin. Code § 8.200.400.15

Current through Register Vol. 35, No. 23, December 10, 2024

Section 8.200.400.15 - AUTOMATIC ENROLLMENT OF SSI RECIPIENTS IN THE QMB GROUP

A. SSI recipients entitled to premium-free part A: Effective October 1, 2024, the HCA shall automatically deem SSI recipients into QMB the first month they are eligible for SSI Medicaid and entitled to premium-free part A. The start of the part B buy-in coverage is the first month of entitlement to premium-free part A and the QMB eligibility group coverage is the first day of the following month.

B. SSI recipients enrolled in part B only: Effective upon the centers for medicare and medicaid services (CMS) and HCA systems' capacity, the HCA shall automatically deem individuals enrolled in SSI medicaid eligible for the QMB eligibility group the first month they are both enrolled in part B and eligible for a medicare enrollment period, bypassing the need for actual or conditional part A enrolment at the social security administration.

C. Effective January 1, 2024, the HCA's liability for retroactive part B premiums for full-benefit medicaid beneficiaries, including individuals receiving SSI medicaid, is limited to a period of no greater than 36 months prior to the date of the medicare enrollment determination.

D. For SSI medicaid recipients deemed eligible for the QMB group, renewal for QMB is required only to the extent to verify that an individual continues to receive SSI medicaid and has continued medicare part A coverage. The regular renewal process for QMB applies when an individual loses their SSI medicaid.

N.M. Admin. Code § 8.200.400.15

8.200.400.15 NMAC - N, 1-1-14, Reserved by New Mexico Register, Volume XXVIII, Issue 18, September 26, 2017, eff. 10/1/2017, Reserved by New Mexico Register, Volume XXIX, Issue 24, December 27, 2018, eff. 1/1/2019, Adopted by New Mexico Register, Volume XXXV, Issue 20, October 22, 2024, eff. 10/1/2024