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    v1.0.28
    OpenPayerPolicy UpdatesAdministrative/Operational PolicyNew Mexico HCA Family Planning Coverage Policy Upd…
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    CurrentNew Mexico Health Care AuthorityPolicy N/A

    TITLE 8 SOCIAL SERVICES CHAPTER 299: Medicaid Eligibility - Family Planning Services Part 400 Recipient Requirements

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    State rule defining who is eligible for New Mexico Medicaid limited to family planning and related services, including general and income requirements; applies to the general public.

    Policy Summary
    PayerNew Mexico Health Care Authority
    PolicyMedicaid Eligibility - Family Planning Services (Part 400 Recipient Requirements)
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateJan 1, 2019
    Last ReviewJul 1, 2025
    Next Review DateN/A
    Key ActionProvide Medicaid limited to family planning services only to individuals who are not pregnant, meet general recipient requirements at 8.291.410 NMAC, and meet income eligibility in Subsection B of 8.299.500.10 NMAC.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    3 eligibility criteriaexplicit recipient requirements listed
    2019-01-01policy effective date
    Permanentduration
    8.291 & 8.299 refs

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    references

    Eligibility for Family Planning Services

    Recipient eligibility criteria

    Criteria for receiving Medicaid limited to family planning and family planning related services (42 CFR 435.214):

    ALL of the following

    • Not pregnant

      Reference: 8.299.400.9 A

    • Meets the general recipient requirements found at 8.291.410 NMAC

      Reference: 8.299.400.9 B

    • Meets the income eligibility requirements found at Subsection B of 8.299.500.10 NMAC

      Reference: 8.299.400.9 C

    Coding and Income References

    No procedure or diagnosis codes specifiedmixed
    No codes listed
    Income eligibility reference
    Income eligibility referenceMeets the income eligibility requirements found at Subsection B of 8.299.500.10 NMAC.
    Related general recipient ruleRecipients must also meet general recipient requirements at 8.291.410 NMAC.
    Regulatory citationReferenced under 8.299.400.9 NMAC (42 CFR 435.214).

    Provider Responsibilities and Eligibility Conditions

    Prior Authorization

    Eligibility conditions for family planning services

    Medicaid limited to family planning and family planning related services is available only to individuals who are not pregnant, who meet the general recipient requirements at 8.291.410 NMAC, and who meet the income eligibility requirements in Subsection B of 8.299.500.10 NMAC.

    • Not pregnant (eligibility is restricted to individuals who are not pregnant).
    • Must meet general recipient requirements at 8.291.410 NMAC.
    • Must meet income eligibility in Subsection B of 8.299.500.10 NMAC.

    Definitions and Agency

    Definitions
    Definitions section status8.299.400.7 DEFINITIONS: [RESERVED] (no substantive definitions provided).
    Mission statementWe ensure that New Mexicans attain their highest level of health by providing wholeperson, cost-effective, accessible, and high-quality health care and safety-net services.
    Who can be a recipient (summary)Medicaid limited to family planning and related services is provided to individuals of any gender who are not pregnant and meet specified requirements.
    Issuing agency
    Issuing agency (abbreviation)HCA: New Mexico Health Care Authority.
    Formal citation8.299.400.1 ISSUING AGENCY: New Mexico Health Care Authority (HCA).
    Policy Summary
    PayerNew Mexico Health Care Authority
    PolicyMedicaid Eligibility - Family Planning Services (Part 400 Recipient Requirements)
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateJan 1, 2019
    Last ReviewJul 1, 2025
    Next Review DateN/A
    Key ActionProvide Medicaid limited to family planning services only to individuals who are not pregnant, meet general recipient requirements at 8.291.410 NMAC, and meet income eligibility in Subsection B of 8.299.500.10 NMAC.
    SourceLink
    On This Page
    Eligibility for Family Planning ServicesCoding and Income ReferencesProvider Responsibilities and Eligibility ConditionsDefinitions and Agency
    Statutory authority contextHCA administers Medicaid and other health programs under state and federal law per cited NMAC sections.