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 Health Care Authority 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

NM Administrative Code (NMAC) Rule Number	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	EMSNC	Emergency Medical Services for Non-Citizens
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 4/1/23 to 7/31/24

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 8.200.510 NMAC 4/1/23 to 7/31/24

MAD 8.200.520 NMAC 4/1/23 to 7/31/24

MAD 8.200.520 NMAC 8/9/22 to 3/31/23

MAD 8.200.510 NMAC 8/9/22 to 3/31/23

MAD 8.200.400 NMAC 1/1/22 to 12/31/22

MAD 8.200.510 NMAC 4/1/2022 to 8/8/2022

MAD 8.200.520 NMAC 9/1/2021 to 3/31/2022

MAD 8.200.510 NMAC 9/1/2021 to 3/31/2022

MAD 8.200.520 NMAC 4/1/2021 to 8/31/2021

MAD 8.200.510 NMAC 4/1/21 to 8/31/21

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

MAD 8200.520 NMAC 4/1/2022 to 8/8/2022

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 NMAC 1/1/23-9/1/24

MAD 8.200.400 NMAC 2/1/20 to 12/31/2021

MAD 8.200.400

MAD 8.200.410 NMAC 8/1/19 to 12/31/21

8.200.410 NMAC 1/1/22 to 8/31/24

MAD 8.200.410

MAD 8.200.430 NMAC 2/1/20 to 10/31/24

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 8.231 NBN Rules

NBN 8.231.400 NMAC 10/1/17 to 12/31/21

NBN 8.231.600 NMAC 1/1/19 to 12/31/21

Archived 8.232 KID Rules

KID 8.232.500

KID 8.232.600

Archived 8.234 ISS Rules

ISS 8.234.400 NMAC 1/1/14 to 12/31/21

ISS 8.234.400

ISS 8.234.500 NMAC 1/1/14 to 12/31/21

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 NMAC 1/1/19 to 12/31/21

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 NMAC 1/1/19 to 12/31/22

RMO 8.249.400 NMAC 1/1/22 to 12/31/22

RMO 8.249.400 NMAC 1/1/14 to 12/31/21

RMO 8.249.500 NMAC 1/1/14 to 12/31/21

RMO 8.249.600

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

Archived 8.250 QIS Rules

QIS 8.250.400 NMAC 1/1/14 to 12/31/21

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 8.252.200 NMAC 7/1/02 to 12/31/21

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 8.280.500 12/1/06 to 11/30/22

PACE 8.280.400 NMAC 2/1/21 to 12/31/21

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 2/27/18 to 11/30/22

ICM 8.281.400 5/1/21 to 11/30/22

ICM 8.281.400  1/1/19 to 4/30/21

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 NMAC 5/1/20 to 12/31/21

ESA 8.285.400 1/1/14 to 5/4/20

ESA 8.285.400

ESA 8.285.500 NMAC 12/1/08 to 12/31/21

ESA 8.285.500

ESA 8.285.600 NMAC 5/1/20 to 12/31/21

ESA 8.285.600  12/1/08 to 4/30/20

ESA 8.285.600

Archived 8.290 WAV Rules

WAV 8.290.400  1/1/19 to 4/30/21

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 NMAC 4/1/23 to 7/31/24

ACA 8.291.430 8/9/22 to 3/31/23

8.291.400 NMAC 4/5/22 to 8/31/24

ACA 8.291.400  10/1/17 to 4/4/22

ACA 8.291.430  9/1/21 to 3/31/22

ACA 8.291.430  4/1/20 to 8/31/21

ACA 8.291.430  12/1/20 to 3/31/21

ACA 291.430 4/1/22 to  8/8/22

ACA 8.291.410 NMAC  10/1/17 to 12/31/21

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   1/1/14 to 6/30/21

PC 8.292.400

PC 8.292.500   1/1/14 to 12/31/21

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 8.293.500  5/1/15 to 12/31/21

PW 8.293.600  1/1/19 to 4/4/22

PW 8.293.600  1/1/14 to 12/31/18

Archived 8.294 Pregnancy-Related Rules

PR 8.294.400

PR 8.294.500   1/1/14 to 12/31/21

PR 8.294.600   1/1/19 to 4/4/22

PR 8.294.600   1/1/14 to 12/31/18

Archived 8.295 Children Under 19

8.295.500   1/1/14 to 12/31/21

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

8.296.500  1/1/16 yo 12/31/21

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

8.296.500  1/1/14 to 12/31/21

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