New Mexico Medicaid Application Information
New Mexico Medicaid is a national public health insurance program funded jointly by the state of New Mexico and the U.S. federal government. Payments are strictly made to medical service providers, not to the eligible Medicaid beneficiary. Each state in the US has a different Medicaid program.
New Mexico's Medicaid program has a number of strict financial and other eligibility requirements. It provides payment for medical services such as therapy, surgery and resources such as wheelchairs for special needs children under the age of 19 and the elderly over the age of 65. The program offers a range of services to qualifying individuals depending on residency, income, household size, age and medical history.
There are approximately 40 ways to qualify for New Mexico Medicaid, which make it possible for many people to receive assistance. In New Mexico, the following individuals or groups are eligible for Medicaid if they meet specific criteria within one of the eligibility categories.
General Eligibility Criteria
- Families with children below 18 years who meet AFDC related eligibility criteria
- Pregnant women who meet AFDC income and resource standards
- Infants born to mothers who were eligible for and receiving New Mexico Medicaid benefits during the time of birth
- Children who are under 19 years of age living in families with incomes below 185% of the FPL guidelines
- Pregnant women whose family income is below 185% of FDL regardless of whether they meet resource guidelines
- Senior residents who receive SSI and are aged, blind, or disabled, senior citizens who do not qualify for SSI due to income or resource limitations may still qualify for New Mexico Medicaid
- Women diagnosed with breast or cervical cancer that are below age 65years old and uninsured
- Children living in foster homes or in adoption subsidy situations or otherwise under the care of the Children Youth and Families Department (CYFD)
Eligibility based on Residency
New Mexico Medicaid Assistance is available to U.S. citizens and legal immigrants who reside in New Mexico. Illegal or unregistered immigrants qualify to receive emergency Medicaid services if they meet other eligibility guidelines. Low-income refugees are eligible to receive up to eight months of Medicaid from the day they enter the United States. Applicants must show proof of identity, residency and income to receive Medicaid in New Mexico.
Eligibility based on Income
Residents of New Mexico receive full or partial Medicaid benefits based on their income and household size. Most applicants qualify for full benefits only if their income falls below 185 percent of the Federal Poverty Level Guidelines. Families that do not meet income guidelines for full coverage are not left out. They may be qualifying for partial or full services requiring a co-payment or premium.
In case of couples, combined income before taxes and other deductions is compared to the Federal Poverty Guidelines listed in the table below. Different Medicaid categories use different percentages of the Federal Poverty Guidelines. See Coverage Types for the percentage of the Federal Poverty Guidelines that applies to you here:
Your household's monthly income must not exceed the amount shown in the table below. If your income is paid on a weekly basis, then multiply your weekly income by 4.333 to see your monthly income.
|Family Size||100% of FPL||133% of FPL||150% of FPL||185% of FPL||200% of FPL||235% of FPL||250% of FPL|
New Mexico Medicaid program considers members of your immediate family living together, including children under 19 years of age, their children, and parents. Children who are away at school are included in the family group. In case of pregnant women, the unborn child is also counted as part of the family.
For those children within the custody of the Children, Youth and Families Department (CYFD), or are homeless, or are living with relatives for more than 60 days, there are counted as an assistance unit of 1 family, and the income of the family is not taken into consideration. Children who are in foster homes, home treatment centers, group homes, treatment foster homes, and free-standing psychiatric hospitals are eligible to receive Medicaid the starting the first day of the month following admittance without taking into account the family income.
If married with no children, your family includes you and your spouse if living together. For single adults without children, your family includes just you.
The following income is counted in order for your eligibility to be determined:
- Income earned monthly
- Income received for services or duties performed (before deductions) - Income received from self-employment (minus expenses)
- Unearned monthly income
- Social Security benefits
- Railroad Retirement benefits
- Federal veterans' benefits (minus allowed exclusions)
- Interest and dividend income
- Rental income (minus expenses)
New Mexico Medicaid categories may differ in the income that is counted and not counted when determining eligibility. Also, various income exclusions may apply depending on varying individual's situation. Income not counted may include:
- SSI Income
- Veteran's benefits supporting dependents
- Tax refunds
- Non-cash payments
- Any other income considered by federal laws other than the Social Security Act
Changes in assets, income, health insurance, immigration status, household size, disability status and address must be reported to New Mexico Medicaid to avoid affecting your eligibility negatively.
Undocumented immigrants may qualify for New Mexico Medicaid under these two categories:
1. Emergency medical services for undocumented aliens:
Individuals in this category must be qualifying for Medicaid criteria for their alien status. The individual must have received emergency services and be referred to the local Income Support Division (ISD) office by the provider. If found eligible for NM Medicaid, the alien must notify emergency services provider so a claim may be filed.
2. Medical assistance for refugees:
Low-income refugees meeting the AFDC income guidelines may qualify for Medicaid benefits for a period of eight months from the day they entered the U.S. under four scenarios:
- Applicant must meet AFDC standard of need when earned income disregard is applied
- Applicant should meet all criteria for refugee cash assistance but wishes to receive only refugee medical assistance
- Refugee is in need of four month medical assistance extension when cash assistance is lost
Households receiving NM Medicaid may qualify for up to a year of transitional health coverage even when they no longer lie within the income guidelines for traditional coverage. For children below the age of 19 years, they may be eligible for coverage under the Children's Health Insurance Program (CHIP) but only if they do not have health coverage and their income is between 185 and 235 percent of the Federal Poverty Guidelines.
It is possible to receive Medicaid if you already have insurance, as long as you meet the Medicaid eligibility requirements. For example, you can have Medicare or health insurance through your employer, and still qualify for NM Medicaid. However, you will need to show your provider all insurance ID cards when you receive services. Your medical provider bills your insurance carrier or Medicare first, and then NM Medicaid is billed for the remaining services. Remember to adhere to all the rules governing NM Medicaid usage so that may Medicaid to honor your medical bills effectively.
New Mexico Medicaid program provides a school-based program that offers services for children with special needs in the school system. Services provided include:
- Mental health services
- Physical therapy
- Social services
- Occupational therapy
- Audi-logical therapy
- Case management
- Speech therapy
- Nursing services
NM Medicaid eligibility lasts for only 12 consecutive months. You must renew your application at the end of the 12-month period. This is done by reporting to the office listed on the renewal notice mailed to you. Any changes in your income, household size etc must be and disclosed to the agency.
Medicaid Application Instructions
Families interested in applying for the New Mexico Medicaid program have several options listed below. Detailed application details are available at:
www.hsd.state.nm.us/mad/CApplications.html & www.hsd.state.nm.us/mad
Applying in Person
You may apply at the Human Services Department's Medical Assistance Division (MAD) in your local County. The county representative may require the following documents to complete your application.
- Current Bank Statements
- Current Payroll Stubs
- List of assets - such as real estate and vehicles
- Identification documents for individuals applying for Medicaid such as genuine birth certificates and proof of citizenship or immigration status.
- Social Security Card
- Copies of any other insurance or medical policy
- Recent statements from any other source of income: e.g. child support, pensions and retirement benefits
You are not mandated to bring an application form with you. However, printing and filling out as much of the application as you can prior to your visit may expedite the process. Application form can be downloaded at:
Mail in Application
You can also apply via mail by downloading and printing the application details at:
Fill the details requested and mail the form to your local MAD office.
Please note applications received via internet or faxed are not considered.
The Human Services Department's Medical Assistance Division (MAD) is the office that administers the New Mexico Medicaid program; you can contact the office at:
NM Human Services Department's Medical Assistance Division
P.O. Box 2348
Santa Fe, NM 87504-2348
Phone: (505) 827-3100 (local Santa Fe)
Toll free: 1-888-997-2583
Fax: (505) 827-3185