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We ensure that New Mexicans attain their highest level of health by providing whole-person, cost-effective, accessible, and high-quality health care and safety-net services.
Medical Assistance Division
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 |
| — | Affordable Care | |
| 200 | Parent Caretaker | |
| 300 | Pregnant Women | |
| 301 | Pregnancy-Related Services | |
|
400 401 402 403 420 421 |
Children Under 19 | |
| 100 | Other Adults | |
| 027 | Loss of Parent Caretaker due to Spousal Support | |
| 028 | Loss of Parent Caretaker due to Earnings from Employment | |
| 029 | Family Planning Services |
Medicaid Eligibility Manual
| N/A | MAD | Medicaid Eligibility – General Recipient Policies | |
|
001 003 004 |
EXT | Medicaid Extension | |
|
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 |
|
| SSI Related | SSI | Supplemental Security Income Methodology | |
| 031 | NBN | Infants of Mothers who are Medicaid Eligible | |
| 034 | ISS |
Social Security Income Ineligibility due to Income or Resources from an Alien Sponsor |
|
|
041 044 |
QMB | Qualified Medicare Beneficiary | |
| 050 | QDS | Qualified Disabled Working Individuals | |
| 074 | WDI | Working Disabled Individuals | |
| 045 | SMB |
Specified Low Income Medicare Beneficiaries (SLIMB) |
|
| 048 | LIS |
Medicare Drug Coverage: Low Income subsidy (LIS) |
|
| 049 | RMO | Refugee Medical Assistance | |
| 042 | QIS |
Qualified Individuals (QIS) whose Income Exceeds QMB & SLIMB |
|
| 052 | BCC | Breast and Cervical Cancer Program | |
| 059 | RSD |
Refugee Medical Assistance with Spend Down Provision Only |
|
| N/A | PACE |
Program of All-Inclusive Care for the Elderly (PACE) |
|
|
081 083 084 |
ICM | Institutional Care Medicaid | |
| 085 | EMSNC | Emergency Medical Services for Non-Citizens | |
|
090 091 093 094 095 096 |
WAV | Home and Community-Based Waiver Services |
Archived 8.200 MAD Rules
MAD 8.200.400 NMAC 5/1/2025 – 7/31/2025
MAD 8.200.400 NMAC 2/1/25 to 4/30/25
MAD 8.200.400 NMAC 10/1/24 to 1/31/25
MAD 8.200.510 NMAC 4/1/2025 -7/31/2025
MAD 8.200.510 NMAC 8/1/24 to 3/31/2025
MAD 8.200.510 NMAC 4/1/23 to 7/31/24
MAD 8.200.520 NMAC 4/1/2025 – 7/31/2025
MAD 8.200.520 NMAC 8/1/24 to 3/31/2025
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 8.200.400 NMAC 1/1/23-9/1/24
MAD 8.200.400 NMAC 2/1/20 to 12/31/2021
MAD 8.200.410 NMAC 8/1/19 to 12/31/21
8.200.410 NMAC 1/1/22 to 8/31/24
MAD 8.200.430 NMAC 2/1/20 to 10/31/24
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 8.234 ISS Rules
ISS 8.234.400 NMAC 1/1/14 to 12/31/21
ISS 8.234.500 NMAC 1/1/14 to 12/31/21
Archived 8.243 WDI Rules
WDI 8.243.400 NMAC 1/1/19 to 12/31/21
Archived 8.249 RMO Rules
RMO 8.249.400 NMAC 5/1/2025 – 7/31/2025
RMO 8.249.600 NMAC 5/1/2025 -7/31/2025
RMO 8.249.600 NMAC 1/1/23 to 4/30/25
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
Archived 8.250 QIS Rules
QIS 8.250.400 NMAC 1/1/14 to 12/31/21
Archived 8.252 BCC Rules
BCC 8.252.200 NMAC 7/1/02 to 12/31/21
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
Archived 8.281 ICM Rules
ICM 8.281.600 1/1/2019 – 10/31/2025
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
Archived 8.285 ESA Rules
ESA 8.285.400 NMAC 5/1/20 to 12/31/21
ESA 8.285.500 NMAC 12/1/08 to 12/31/21
ESA 8.285.600 NMAC 5/1/20 to 12/31/21
Archived 8.290 WAV Rules
WAV 8.290.600 1/1/2019 – 10/31/2025
WAV 8.290.400 1/1/19 to 4/30/21
Archived 8.291 ACA Rules
ACA 8.291.430 NMAC 4/1/2025 – 7/31/2025
MAD 8.291.430 NMAC 8/1/24 to 3/31/2025
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 8.291.410 NMAC 10/1/17 to 12/31/21
Archived 8.292 Parent Caretaker Rules
PC 8.292.400 1/1/14 to 6/30/21
PC 8.292.500 1/1/14 to 12/31/21
Archived 8.293 Pregnant Women Rules
PW 8.293.500 5/1/15 to 12/31/21
Archived 8.294 Pregnancy-Related Rules
PR 8.294.500 1/1/14 to 12/31/21
Archived 8.295 Children Under 19
Archived 8.296 Other Adults
Archived 8.299 Family Planning Services