HOUSE BILL 182

48th legislature - STATE OF NEW MEXICO - second session, 2008

INTRODUCED BY

Luciano "Lucky" Varela

FOR THE WELFARE REFORM OVERSIGHT COMMITTEE

AN ACT

RELATING TO MEDICAID; REQUIRING THE HUMAN SERVICES DEPARTMENT TO SIMPLIFY THE MEDICAID ELIGIBILITY AND ENROLLMENT PROCESS; REQUIRING HUMAN REVIEW OF MEDICAID ELIGIBILITY; MAKING AN APPROPRIATION.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     Section 1. Section 27-2B-15 NMSA 1978 (being Laws 1998, Chapter 8, Section 15 and Laws 1998, Chapter 9, Section 15, as amended by Laws 2001, Chapter 295, Section 8 and by Laws 2001, Chapter 326, Section 8) is amended to read:

     "27-2B-15. MEDICAID ELIGIBILITY--HUMAN REVIEW OF MEDICAID ELIGIBILITY STATUS REQUIRED.--

          A. The following are eligible for medicaid:

                (1) a participant who is in transition to self-sufficiency due to employment or child support;

                (2) a pregnant woman who meets the income and resource requirements for New Mexico's aid to families with dependent children as they existed on July 16, 1996;

                (3) a member of a benefit group who is eighteen years of age or younger if the benefit group's income is below one hundred eighty-five percent of the federal poverty guidelines;

                (4) a pregnant woman whose income is below one hundred eighty-five percent of the federal poverty guidelines;

                (5) participants receiving federal supplemental security income;

                (6) an aged, blind or disabled person in an institution who meets all the supplemental security income standards except for income;

                (7) a person who meets all standards for institutional care but is cared for at home and meets eligibility standards for medicaid;

                (8) a qualified medicare beneficiary, qualified disabled working person or specified low-income medicare beneficiary; and

                (9) a foster child in the custody of the state or of an Indian pueblo, tribe or nation who meets eligibility standards for medicare.

          B. Effective October 1, 2001, for the medicaid

category designated "JUL medicaid" by the department, the

income eligibility criteria shall be the same as the income

eligibility criteria set forth in the New Mexico Works Act.

          C. The department shall develop, implement and maintain a simplified eligibility and enrollment process that:

                (1) provides wide distribution of information to potential recipients of benefits available through Title 19 or Title 21 of the federal Social Security Act or other public health coverage programs administered by or through the state;

                (2) uses health care practitioners and facilities, community and social service organizations, electronic and print media and other information dissemination systems to make eligibility and enrollment process information available; and

                 (3) ensures that an applicant facing denial of benefits for having an incomplete application shall, prior to being denied, be notified in writing which additional documents are missing and be given at least ten days to provide that documentation.

          D. The department shall, to the extent permitted by federal law, annually recertify eligibility of participants and shall not deny eligibility unless a department employee:

                (1) determines, after review of the participant's file, that the participant is no longer financially eligible for benefits; provided that the review includes coordination of information from other programs, including child support, cash assistance, food stamps and low-income home energy assistance;

                (2) determines that a participant has received notification of requirements for recertification and failed to meet the requirements within thirty days of notification; provided that the notice is considered received when:

                     (a) a participant signs the notice;

                     (b) a medicaid provider certifies that the provider notified the participant in person; or

                     (c) a department employee certifies that the participant was notified via telephone in a language the participant understands; or

                (3) determines that all contact information for the participant is no longer correct and that the participant cannot be reached through the use of reverse postal look-up, re-mailing to the same address or to a forwarding address or by checking other applicable state data systems for a more recent address.

          E. When a participant's enrollment is terminated, a complete record of the reasons for termination, including documentation, shall be retained in the recipient's file for no less than three years.

          F. Nothing in the medicaid recertification process shall require the state to continue to provide medicaid or other public benefits for a participant if the participant is no longer eligible for such benefits."

     Section 2. APPROPRIATION.--Two hundred thousand dollars ($200,000) is appropriated from the general fund to the human services department for expenditure in fiscal year 2009 and subsequent fiscal years to develop a simplified eligibility and enrollment process pursuant to Section 27-2B-15 NMSA 1978 and to hire the staff necessary to implement the process. Any unexpended or unencumbered balance remaining at the end of a fiscal year shall not revert to the general fund.

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