N.M. Admin. Code § 8.325.10.12

Current through Register Vol. 35, No. 24, December 23, 2024

Section 8.325.10.12 - ELIGIBLE INDIVIDUALS

A. An applicant must be a noncitizen who is undocumented or who does not meet the qualifying immigration criteria specified in 8.200.410 NMAC, General Recipient Requirements, and in 8.285.400 NMAC, Medicaid Eligibility Emergency Medical Services for Non-Citizens-Category 085.

B. Eligibility determinations are made by local county income support division (ISD) offices after the receipt of emergency services. The individual is responsible for completing an application at the local county ISD office and for providing all necessary documentation to prove that they meet the applicable eligibility criteria.

(1) An individual must apply for coverage at the ISD office no later than the last day of the third month following the month in which the alleged emergency services were received.

(2) A noncitizen recipient is responsible for notifying providers of the approval or denial of an application.

(3) If an application is denied or an application for coverage is not filed by the last day of the third month following the month in which the alleged emergency services were received, the non-citizen recipient is responsible for payment of the provider bill.

(4) If reimbursement for services is denied by MAD, the individual is responsible for payment and can be billed directly for payment by the provider.

N.M. Admin. Code § 8.325.10.12

2/1/95; 8.325.10.12 NMAC - Rn, 8 NMAC 4.MAD.769.3 & A, 12/1/03; A, 10/15/08; A, 11/15/10, Amended by New Mexico Register, Volume XXXI, Issue 08, April 21, 2020, eff. 5/1/2020, Amended by New Mexico Register, Volume XXXII, Issue 24, December 28, 2021, eff. 1/1/2022, Adopted by New Mexico Register, Volume XXXV, Issue 12, June 25, 2024, eff. 7/1/2024