Overview of Public Benefits Programs in New Mexico

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1 Overview of Public Benefits Programs in New Mexico Craig Acorn, Senior Attorney - New Mexico Center on Law and Poverty

2 Overview of Public Benefits Programs in New Mexico Craig Acorn, New Mexico Center on Law and Poverty

3 Public Benefits Government programs for low-income people. Helps with basic needs (food, cash, healthcare, etc.). Usually at no cost to participants but some programs require work activities. Eligibility is generally based on income compared to the federal poverty level (FPL) and immigration status. 3

4 The SNAP Program The Supplemental Nutrition Assistance Program (SNAP) was formerly known as Food Stamps. Provides an EBT card that can be used to buy food but not alcohol, tobacco, soap, paper products or other non-food items. 4

5 SNAP: Who is Eligible? Most low-income people can get SNAP benefits. Must be a U.S. Citizen or qualified lawful resident Households must meet two different income tests to qualify: 1. Gross monthly income must be at or below 165% FPL; and 2. Net monthly income must be at or below 100% FPL. 5

6 SNAP: Who Is The Household? For SNAP, a household is a person or group of people living together who purchase food and prepare meals together. There can be more than one SNAP household under the same roof. Mixed-status households are eligible! Some people are always included even if they don t buy food or prepare meals together: spouses, parents and their children under 22, and children under 18 (except foster kids) living with other than parents. 6

7 SNAP: Gross Income Test Gross income is to the total income of a household before taxes. For mixed households that have some ineligible members (like undocumented immigrants), only a portion of the income is used: - Take the income of all household members (even if not eligible). - Divide the amount by the total people in the household, - Then multiply by the total people who are eligible for SNAP. EXAMPLE: Undocumented mother with three U.S. citizen children makes $1,000/month. Four people are in the household, but only three members are eligible for SNAP. Divide $1000 by 4 people to get $250. Multiply $250 by 3 eligible people to get $750. 7

8 SNAP: Net Income Test Net income = gross income after certain deductions. Families should claim all possible deductions to ensure they meet the net income test. Deductions include: 20% deduction from earned income; Standard deductions for household size; Medical expenses for elderly or disabled members (if more than $35/month); Dependent care expenses (while working or training or education); Legally owed child support payments; Shelter and utility expenses 8

9 SNAP in an Emergency Expedited SNAP is an emergency program for some very low-income households. They must be provided EBT cards in 7 days. For expedited SNAP, the household must: Have gross income of less than $150 per month, and less than $100 in countable liquid resources; or Have housing costs (monthly rent, or mortgage, and utilities) that are greater than the household s combined gross monthly income and countable liquid resources; or Be migrant farm workers who have $100 or less in countable liquid resources and are determined to be destitute. 9

10 Women, Infants & Children (WIC) Provides nutritional counseling and free WIC approved foods. For pregnant, postpartum and breastfeeding women and children up to age 5. Gross income must be at or below 185% FPL. Available to undocumented immigrants. 10

11 School Lunch Program For free meals: Family income must be at or below 130% FPL. For reduced-price meals: Family income must be at or below 185% FPL. Apply at school at any time during school year. Undocumented children are eligible. 11

12 Summer Meal Programs More children go hungry in the summer than at any other time of the year. Free* breakfast and/or lunch at various sites. Call EatCool or go to to find the nearest site. * There is no income restriction or application! 12

13 TANF/New Mexico Works TANF is a cash assistance program. TANF is for very poor families with dependent children (or for women in the last trimester of pregnancy). Families must meet three income & asset tests: 1. Gross income must be at or below 85% FPL, and 2. Net income must be less than the standard of need, and 3. Countable assets cannot exceed $1,500 in liquid assets or $2,000 in nonliquid assets. Children must be U.S. citizens or be eligible immigrants. Immigrants do not have to wait 5 years to apply. 13

14 TANF/NMW: Gross Income Test Gross income of everyone in the benefit group must be below 85% FPL. Subtract up to $100 of child support collected by CSED. # in benefit group: 85% FPL: 1 $791 2 $1,072 3 $1,352 4 $1,633 For mixed households that have some ineligible members (like undocumented immigrants), only a portion of the income is used. See slide 7 for how to calculate this. 14

15 TANF/NMW: Using Deductions to Calculate Net Monthly Income Use these deductions to determine net income: 1. Earned Income: If one parent family, subtract $ from earnings and ½ of the remaining income. If two-parent family, subtract $ from earnings and ½ of the remaining income. 2. Child care - subtract actual expenses up to: $ for a child over two. $ for a child under two. 15

16 TANF/NMW: Asset/Resource Test Assets cannot exceed $1,500 in liquid* assets or $2,000 in non-liquid assets. But the following assets do not count! Home where the household lives; Household goods necessary for the operation and maintenance of the home; Burial plots/funeral agreements; Vehicle used for daily living activities; Work-related equipment (up to $1,000/person); Livestock; and Individual Development Account. * Liquid assets are those that can easily be turned into cash 16

17 TANF/NMW: Calculating Benefit Amount Step One: Subtract net income from Standard of Need* Step Two: Subtract Benefit Adjustment * The amount the state says your household needs to survive # in benefit group: Standard of need: Benefit 1 $266 - $39 2 $357 - $53 3 $447 - $67 4 $539 - $80 Adjustment: EXAMPLE: For a family of three with net monthly income of $200. $447 (Standard of Need) - $200 (net income) = $247 $247 $67 (Benefit Adjustment) = $180 Monthly benefit amount = $180 17

18 Support Services Support services are available to families with children who would be eligible for TANF but do not meet the income tests. Gross income must be below 100% FPL. Support services can include help with: Child care costs; Transportation costs; Domestic violence services; Job training/work readiness/education; and Substance abuse counseling. 18

19 Diversion Program The diversion program provides one-time cash assistance payment to help meet a short term need (up to $1,500 for 1-3 people, and up to $2,500 for 4+ people). To be eligible, participants: Must otherwise be eligible for TANF; but Cannot also receive monthly cash assistance; and Cannot have received TANF cash assistance in the past month. 19

20 General Assistance Primarily serves: very low-income disabled adults (who are unemployed because of disability) dependent children who would be eligible for TANF but are not living with a relative. Provides cash assistance and up to $200 towards funeral expenses. Person cannot be on TANF/NMW. Qualified immigrants and any persons residing under color of law are eligible (no 5 year bar). 20

21 General Assistance (continued ) The income requirements for GA are: 1. Gross income must be at or below 85% FPL, and 2. Net income must be less than standard of need, and 3. Countable assets cannot exceed $1,500 in liquid assets or $2,000 in non-liquid assets. Applicants must complete an interim assistance reimbursement* form and apply for SSI within 60 days of GA approval, and must appeal to the ALJ hearing if SSI is denied. *If SSI is granted, the state will get paid back the GA amount out of the retroactive SSI benefits covering the same period. 21

22 General Assistance: Gross Income Test The total income available to the benefit group must be at or below 85% FPL. # in benefit group: 85% FPL: 1 $791 2 $1,072 3 $1,352 4 $1,633 22

23 General Assistance: Net Income Test The net income must be less than the GA standard of need. Use the following deductions: For a single adult: Subtract $125 from gross income and subtract half of the remaining income. For two adults in group: Subtract $225 from gross income and subtract half of the remaining income. # in benefit group: Standard of need: (subject to change) 1 $245 2 $329 3 $412 4 $496 Note: The cash assistance amount that the benefit group will receive will be the net income subtracted from the standard of need amount. 23

24 General Assistance: Resource/Asset Test Countable assets cannot exceed $1,500 in liquid assets or $2,000 in nonliquid assets. What does NOT count is the same as for TANF (see slide 16). 24

25 MEDICAID Healthcare coverage (similar to insurance). Pays for most medical care at most facilities, such as doctors offices, clinics and hospitals. Free (or low cost). Membership usually lasts one year and then must be renewed. 25

26 Who Can Get Medicaid Now? CHILDREN (under 19) Generally under 235% FPL PARENTS Under 69% FPL if employed Under 30% FPL if not employed WOMEN, if Pregnant and under 235% FPL Family planning and under 235% FPL Diagnosed with breast or cervical cancer and under 250% FPL. 26

27 Who Can Get Medicaid Now? (continued ) ELDERLY, if PEOPLE WITH DISABILITIES, if SSI-recipient who is under 75% FPL Working disabled individual under 250% FPL In nursing facility and under 225% FPL Under 225% FPL and meets criteria for Medicaid waiver programs (often wait-listed) Medicare enrollee and under 135% FPL In nursing facility and under 225% FPL Under 225% FPL and eligible for Medicaid CoLTS long term care (formerly D&E waiver) 27

28 The Medicaid Expansion Medicaid in New Mexico currently does not provide healthcare coverage to all lowincome people, only those I just mentioned Who is missing? Most low-income adults That is about to change! Beginning on January 1, 2014 people with incomes up to 138% of FPL can get Medicaid

29 Who gets covered & How? Currently, NM has the 4 th highest rate of uninsured people in the country (22.6% of population.) In 2014, when ACA takes full effect, more than 400,000 people (20% of the population) could get health coverage!

30 Who gets covered and how? Uninsured get coverage in 2 main ways: 170,000+ through Medicaid Expansion 225,000+ through Exchange

31 THE EXCHANGE What Is It? A competitive marketplace where people can shop for health insurance, comparing prices and benefits of various health plans, to enroll in the plan of their choice.

32 Online Marketplace Image reprinted with permission from Edward Mullen Studio, February 2012,

33 ACTIVITY: Coverage Options after 2014 Household Size Medicaid up to 138% FPL Subsidized Coverage on Exchange Unsubsidized Exchange Coverage above 400% FPL 1 $1,285 $3,724 between 2 $1, % and 400% FPL $5,044 3 $2,196 $6,364 4 $2,651 $7,684

34 Can Immigrants Get Medicaid? Many immigrants can get Medicaid (but not all!). Some have to wait 5 years before applying. Children & Pregnant Women: Any lawful immigrant who is a child (under 19) or a pregnant woman can get Medicaid without waiting 5 years. Undocumented immigrants usually cannot get Medicaid even after the expansion - BUT there is one big exception! 34

35 EMSA: Emergency Medical Services for Aliens Pays only for an emergency (incl. labor & delivery) Available to anyone who does not qualify for Medicaid solely because of immigration status. With Medicaid expansion many more will be eligible BUT to get EMSA, the person must still meet all other eligibility criteria for Medicaid: Fits in category (child, parent, pregnant, disabled, elderly), and Meets the income test for the category, and Meets state residency requirement (ex: visitors cannot get EMSA) Apply for EMSA through the hospital and the Income Support Division (ISD). 35

36 Which Immigrants Are Eligible? Categories of people who may be eligible: 1. Citizens 2. Lawful Permanent Residents (LPR) 3. Qualified Immigrants 4. Lawfully Residing Pregnant Women & Children 5. Other Eligible Immigrants (including undocumented immigrants) 36

37 U.S. Citizens Citizens are eligible for every public benefit program. Even if the household is mixed with some citizens and some ineligible immigrants, the citizens can still get public benefits Ex: If an undocumented mother has three citizen children, she can apply for benefits solely for the children. 37

38 Lawful Permanent Residents Lawful permanent residents (LPRs or green card holders ) are eligible for every program There is sometimes a 5-year waiting period for them to receive benefits ( 5-year bar ), but there are many exceptions Under federal law, the waiting period begins when the immigrant obtains qualified status, and ends five years after that date. 38

39 LPRs & the 5 Year Bar There is NO 5-year bar LPRs who have worked 40 quarters or for LPRs seeking: Medicaid for pregnant women or children SNAP (food stamps) for children or people receiving disabilityrelated assistance. State-funded TANF General Assistance LIHEAP Housing (HUD & Section 8) Child Care Assistance 39

40 Qualified Immigrants Qualified immigrants are eligible for most programs (but not all!). Qualified immigrants are (by federal law): Lawful Permanent Residents (LPRs) Refugees & Asylees Persons granted withholding of removal/deportation Conditional entrants Persons paroled into the U.S. for at least one year Cuban/Haitian entrants Certain battered spouses and children 40

41 Other Eligible Immigrants Some groups are not qualified immigrants but they are still be eligible for some programs: Victims of Trafficking Certain American Indians Born Abroad Iraqi/Afghans with Special Immigrant Visas EMSA (Emergency Medical Services for Aliens) is available for unqualified immigrants. 41

42 Undocumented Immigrants Undocumented immigrants are not eligible for most public benefits, except: WIC (Women, Infant, Children) EMSA (Emergency Medicaid) School Lunches Summer Meals Program Many community services and healthcare programs are available to everyone regardless of immigration status, such as: Charity care through hospital (or county) Public health centers Department of Health Children s Medical Services Nonprofit health clinics 42

43 Special Note: SSNs Many immigrants do not have Social Security Numbers Immigrants can be eligible for some benefits programs without an SSN Example: pregnant woman with U-visa can get Medicaid Some immigrants may not have SSNs and it is ISD s job to help them apply Example: mother and children with VAWA prima facie letter applying for SNAP NEVER put a false SSN on an application Household members who are not asking for benefits do not have to provide SSNs or immigration status 43

44 Child Care Assistance Makes payments to child care providers for children age 6 weeks to 13 years. Only for parent to engage in work, attend school or engage in job training or education programs. Gross income test 100% FPL. Co-payments may be required. Undocumented parents can apply for their U.S. citizen or qualified immigrant child. 44

45 Low Income Energy Assistance Program (LIHEAP) LIHEAP offers assistance with heating and cooling costs for people whose income is less than 150% FPL. LIHEAP could be available in as little as 18 hours if situation is life-threatening or 48 hours if the situation is a crisis. The household must contain at least one U.S. citizen or qualified immigrant. 45

46 HYPO #1 1. Louisa has two young children, ages 2 and 4, and she is 38 years old. She is employed and earns $1100 per month. What programs is the family potentially eligible for? 46

47 HYPO #2 2. Maria is pregnant and has one child who is 4-years old. She is single. She is employed and earns $1200 per month. Her brother lives in her apartment and earns $1500 per month. He does his own shopping and fixes his own meals. Is this family eligible for any of the nutrition programs SNAP, school lunches, or WIC? 47

48 HYPO #3 3. John is 29 years old and has no health insurance. He is employed and earns $550/month. He is single and doesn t have children. What programs can you refer him to? 48

49 Strategies for Overcoming Barriers Keeping Records Denial and Disqualification Fair Hearings Reasonable Accommodations Discrimination Complaints 49

50 Keeping Records Always ask for a RECEIPT for every document that has been submitted! Make PHOTOCOPIES of everything you turn in to ISD. Request your CASE RECORDS using ISD Form 121 Applicants or their representatives can request case records at any time during or after the application process. 50

51 Denial and Disqualification The application process can be difficult HSD has many documentation requirements they often ask for things and deny the application improperly DON T GIVE UP! Work rules in TANF and SNAP can be difficult to meet especially for people with barriers like disability, language, age, transportation and child care problems these can provide good cause for a rule violation Rule violations result in sanctions that result in lost benefits remember that HSD is often wrong!

52 Fair Hearings Whenever HSD takes an action you think is wrong you can ask for a hearing to challenge the action Keep ALL paperwork HSD sends! Especially the notice of adverse action. How to Request a Fair Hearing: Get a Fair Hearing Form from ISD, or Give ISD a request written on plain paper with your name and contact information, or If you cannot go to ISD, call , extension 6, and request a hearing by phone. When: Ask for the hearing as soon as HSD notifies you of adverse action Hearing can be requested up to 90 days after HSD denies benefits (or takes action that you disagree with), unless there is good reason why the request was not made in 90 days. But you must request a hearing within 13 days to continue receiving benefits during that time. 52

53 Fair Hearings, continued Prior to the Hearing: Seek legal help from Law Access New Mexico, New Mexico Legal Aid or the Center on Law and Poverty Request a Copy of the Summary of Evidence : Within 7 days of your hearing request, ISD must create a summary of all the documents and rules that were used to determine your case. Examine Your Case File: You have the right to all the documents in your case record free of charge. Ask for An Agency Conference: Meet with the supervisor and caseworker before the hearing to try to resolve the case. DO NOT WITHDRAW your case until you get results! 53

54 Reasonable Accommodations The Americans with Disabilities Act (ADA) prohibits discrimination based on disability A person who has difficulty with program requirements filling out forms, keeping appointments, remembering things, traveling or working should ask HSD for help It helps to have medical documentation It may be illegal for HSD to sanction someone for a problem related to their disability

55 Discrimination Complaints Complaints can be filed with the state agency, the federal government, or both. Discrimination includes: Rude treatment, harassment or failure to accommodate Failure to provide language services Must be discrimination on basis of age, race, color, sex, disability, national origin, religion or political belief. 55

56 PERSEVERE!!! Apply and get a receipt for all documents! Ask for a hearing if HSD doesn t respond, or you don t understand the response, or you think the response is wrong Seek legal help from Law Access New Mexico, New Mexico Legal Aid or the Center on Law and Poverty Try to resolve the issue at conference Go to the fair hearing and make your case! Don t take no for an answer until you are convinced that it is the right answer even if you lose the hearing, you can appeal to the courts Go back to the legal service providers ONWARD AND UPWARD! 56

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