LOOKING FOR INFORMATION

Medical Assistance Division

NMAC Program Rule Manual

Program Rules (New Mexico Administrative Codes and Rules)

Medical Assistance Division: NMAC Eligibility Rule Manual

Individuals become eligible for Centennial Care, New Mexico’s Medicaid Program, when they meet the specific criteria for one of the Medicaid eligibility categories. The links below give basic information about these eligibility categories. The actual process of determining eligibility is complex because numerous financial and non-financial factors are considered.

Regulations for Centennial Care are promulgated by the Human Services Department and Medical Assistance Division. The Department’s Income Support Division offices make eligibility determinations for Medicaid, except for those categories administered by the Children, Youth and Families Department, the Social Security Administration, and the Premium Assistance programs.

For more information on eligibility please read Eligibility Pamphlet

The NMAC rule numbers can also be looked up on the NM Administrative Code website

Affordable Care Act – Medicaid Eligibility Manual

NM Administrative Code (NMAC)

Rule Number

Category Policy Topic

8.291.400

8.291.410

8.291.420

8.291.430

Affordable Care

8.292.400

8.292.500

8.292.600

200 Parent Caretaker

8.293.400

8.293.500

8.293.600

300 Pregnant Women

8.294.400

8.294.500

8.294.600

301 Pregnancy-Related Services

8.295.400

8.295.500

8.295.600

400

401

402

403

420

421

Children Under 19

8.296.400

8.296.500

8.296.600

100 Other Adults

8.297.400

8.297.500

8.297.600

027 Loss of Parent Caretaker due to Spousal Support

8.298.400

8.298.500

8.298.600

028 Loss of Parent Caretaker due to Earnings from Employment

8.299.400

8.299.500

8.299.600

029 Family Planning Services

 

Medicaid Eligibility Manual

Rule Number

NM Administrative Code (NMAC)

Category Program Program Description

8.171.400

8.171.500

8.171.600

071/2 PAC Premium Assistance for Children

8.200.400

8.200.410

8.200.420

8.200.430

8.200.450

8.200.510

8.200.520

N/A MAD Medicaid Eligibility – General Recipient Policies

8.201.400

8.201.500

8.201.600

001

003

004

EXT Medicaid Extension

8.202.400

8.202.500

8.202.600

072 JUL JUL Medicaid Eligibility

8.206.400

8.206.500

8.206.600

017

037

046

047

060

061

066

086

CYM

Medicaid for Recipient Under Eighteen

Years of Age for Whom the CYFD has

Full or Partial Financial Responsibility

8.215.400

8.215.500

8.215.600

SSI Related SSI Supplemental Security Income Methodology

8.227.400

8.227.500

8.227.600

027 CSM

Transitional Medicaid Eligibility:

Loss of JUL Family Medicaid due to

Spousal Support

8.228.400

8.228.500

8.228.600

028 TME

Transitional Medicaid:

Loss of JUL Family Medicaid

8.230.400

8.230.500

8.230.600

030 PWN Pregnant Women who meet AFDC

8.231.400

8.231.500

8.231.600

031 NBN Infants of Mothers who are Medicaid Eligible

8.232.400

8.232.500

8.232.600

032 KID

Children Under 19

185% of Federal Poverty Guidelines

8.233.400

8.233.500

8.233.600

033 IAF

Medicaid Coverage when deemed Income or

Resources Results in AFDC Ineligiblity

8.234.400

8.234.500

8.234.600

034 ISS

Social Security Income Ineligibility due to

Income or Resources from an Alien Sponsor

8.235.400

8.235.500

8.235.600

035 PSO Pregnancy and /or Family Planning Services

8.240.400

8.240.500

8.240.600

041

044

QMB Qualified Medicare Beneficiary

8.242.400

8.242.500

8.242.600

050 QDS Qualified Disabled Working Individuals

8.243.400

8.243.500

8.243.600

074 WDI Working Disabled Individuals

8.245.400

8.245.500

8.245.600

045 SMB

Specified Low Income Medicare Beneficiaries

(SLIMB)

8.248.400

8.248.500

8.248.600

048 LIS

Medicare Drug Coverage:

Low Income subsidy (LIS)

8.249.400

8.249.500

8.249.600

049 RMO Refugee Medical Assistance

8.250.400

8.250.500

8.250.600

042 QIS

Qualified Individuals (QIS) whose

Income Exceeds QMB & SLIMB

8.252.400

8.252.500

8.252.600

052 BCC Breast and Cervical Cancer Program

8.259.400

8.259.500

8.259.600

059 RSD

Refugee Medical Assistance with

Spend Down Provision Only

8.280.400

8.280.500

8.280.600

N/A PACE

Program of All-Inclusive Care for the Elderly

(PACE)

8.281.400

8.281.500

8.281.510

8.281.600

081

083

084

ICM Institutional Care Medicaid

8.285.400

8.285.500

8.285.600

085 ESA ESA Emergency Medical Services for Aliens

8.290.400

8.290.500

8.290.600

090

091

093

094

095

096

WAV   Home and Community-Based Waiver Services

 

Current 8.200 MAD Rules

MAD 8.200.420

MAD 8.200.520 NMAC 8/1/19 to 8/10/20

MAD 8.200.520 5/17/18 to 7/31/19

Current 8.206 CYM Rules

CYM 8.206.400

Current 8.231 NBN Rules

NBN 8.231.600

Current 8.249 RMO Rules

RMO 8.249.500

Archived 8.200 MAD Rules

MAD 8.200.520 NMAC 12/15/20 to 3/31/21

MAD 8.200.510 NMAC 12/15/20 to 3/31/21

MAD 8.200.520 NMAC 8/1/19 to 8/10/20

MAD 8.200.510 NMAC 8/11/20 to 12/14/20

MAD 8.200.510 NMAC 8/1/19 to 8/10/20

MAD 8.200.510 12/11/18 to 7/31/19

MAD 8.200.510

MAD 8.200.430 10/1/17 to 1/31/20

MAD 8.200.400

MAD 8.200.410

MAD 8.200.430

MAD 8.200.410 8/1/18 to 7/31/19

MAD 8.200.410 1/18/18 to 7/31/18

MAD 8.200.410 10/1/17 to 1/17/18

MAD 8.200.520 1/1/17 to 5/16/18

MAD 8.200.510 2/27/18 to 12/10/18

MAD 8.200.400 1/1/19 to 1/31/20

MAD 8.200.400 10/1/17 to 12/31/18

MAD 8.200.520 5/17/18 to 7/31/19

MAD 8.200.510 1/16/20 to 4/30/20

MAD 8.200.520 NMAC 8/11/20 to 12/14/20

Archived 8.215 SSI Rules

SSI 8.215.500 2/27/18 to 12/31/20

SSI 8.215.500

SSI 8.215.400 9/16/13 to 12/31/18

SSI8.215.600 9/16/13 to 12/31/18

Archived 8.232 KID Rules

KID 8.232.500

KID 8.232.600

Archived 8.234 ISS Rules

ISS 8.234.400

ISS 8.234.500

ISS 8.234.600

Archived 8.235 PSO Rules

PSO 8.235.400

PSO 8.235.500

Archived 8.240 QMB Rules

QMB 8.240.500 2/27/18 to 12/31/20

QMB 8.240.500

Archived 8.242 QDS Rules

QDS 8.242.400

QDS 8.242.500

QDS 8.242.600

QDS 8.242.500 1/1/14 to 12/31/20

QDS 8.242.600 1/1/14 to 12/31/18

Archived 8.243 WDI Rules

WDI 8.243.400 6/1/04 to 12/31/18

WDI 8.243.600 10/15/14 to 12/31/18

Archived 8.245 SMB Rules

SMB 8.245.500 10/1/12 to 12/31/20

SMB 8.245.600 12/1/09 to 12/31/18

Archived 8.249 RMO Rules

RMO 8.249.600

RMO 8.249.600 1/1/14 to 12/31/18

Archived 8.250 QIS Rules

QIS 8.250.400

QIS 8.250.500

QIS 8.250.600

QIS 8.250.500 1/1/14 to 12/31/20

QIS 8.250.600 12/1/09 to 12/31/18

Archived 8.252 BCC Rules

BCC 8.252.400

BCC 8.252.500

BCC 8.252.600

BCC 8.252.600 1/1/14 to 12/31/18

Archived 8.259 RSD Rules

RSD 8.259.400

RSD 8.259.500

RSD 8.259.600

Archived 8.262 SCI Rules

SCI 8.262.500

SCI 8.262.400

SCI 8.262.500

SCI 8.262.600

Archived 8.280 PACE Rules

PACE 8.280.400 1/1/19/ to 1/31/21

PACE 8.280.400 12/1/06 to 12/31/18

PACE 8.280.600 12/1/06 to 12/31/18

Archived 8.281 ICM Rules

ICM 8.281.500

ICM 8.281.400

ICM 8.281.400 2/27/18 tp 12/31/18

ICM 8.281.600 4/1/09 to 12/31/18

Archived 8.285 ESA Rules

ESA 8.285.400 1/1/2014 to 5/4/2020

ESA 8.285.400

ESA 8.285.500

ESA 8.285.600 12/1/2008 to 4/30/2020

ESA 8.285.600

Archived 8.290 WAV Rules

WAV 8.290.400

WAV 8.290.400 2/27/18 to 12/31/18

WAV 8.290.600 11/1/12 to 12/31/18

Archived 8.291 ACA Rules

ACA 8.291.430 12/1/20 to 3/31/21

ACA 8.291.410

ACA 8.291.420

ACA 8.291.430

ACA 8.291.410

ACA 8.291.400

ACA 8.3291.430 8/1/19 to 11/30/20

ACA 8.291.430 4/1/2016 – 5/16/2018

ACA 8.291.430 5/17/18 to 7/31/19

Archived 8.292 Parent Caretaker Rules

PC 8.292.400

PC 8.292.500

PC 8.292.600

PC 8.292.600 1/1/14 to 12/31/18

Archived 8.293 Pregnant Women Rules

PW 8.293.400

PW 8.293.600 1/1/14 to 12/31/18

Archived 8.294 Pregnancy-Related Rules

PR 8.294.400

PR 8.294.600 1/1/14 to 12/31/18

Archived 8.295 Children Under 19

8.295.600 1/1/14 to 12/31/18

Archived 8.296 Other Adults

8.296.400 1/1/19 to 1/31/20

8.296.400 1/1/14 to 12/31/18

8.296.600 1/1/14 to 12/31/18

Archived 8.297 Loss of Parent Caretaker due to Spousal Support

8.297.400 1/1/14 to 12/31/18

8.297.600 1/1/14 to 12/31/18

Archived 8.298 Loss of Parent Caretake due to Earning from Employment

8.298.400 1/1/14 to 12/31/18

8.298.600 1/1/14 to 12/31/18

Archived 8.299 Family Planning Services

8.299.400 10/1/17/ to 12/31/18

8.299.600 10/1/17 to 12/31/18

Archived 8.201 EXT Rules

EXT 8.201.400 7/1/03 to 12/31/18

EXT 8.201.600 10/1/09 to 12/31/18

Archived 8.231 NBN Rules

NBN 8.231.600 10/1/17 to 12/31/18