New Mexico Medicaid Fair Hearing for Medicare Savings Program Denials
When to File
If the Income Support Division denies an MSP application, reduces benefits, or terminates coverage, they must send a written Notice of Case Action (NOCA). That notice triggers your right to request an administrative fair hearing.
You have 90 calendar days from the date on the notice to file. That window is generous compared to many states, but it starts from the print date on the notice, not the date your parent actually receives it.
Continuation of Benefits
If your parent already has MSP coverage and the state moves to terminate or reduce it, filing a hearing request within 13 calendar days of the notice date (or before the effective date of the action) preserves coverage while the appeal is pending. This is called Continuation of Benefits.
The practical value is significant: if the state terminates QMB coverage and you file within 13 days, Part B premiums keep being paid and billing protections remain active throughout the hearing process. Without COB, coverage stops on the effective date and you'd need to re-establish it after winning.
One risk: if the state's action is upheld at the hearing, the state can recover benefits paid during the continuation period.
How to File
Three options:
- Online through the YesNM portal (yes.nm.gov) — look for the hearing request option in your case dashboard
- By phone at 1-800-283-4465 (the Consolidated Customer Service Center)
- By mail to the Health Care Authority Fair Hearings Bureau, P.O. Box 2348, Santa Fe, NM 87504
Put the request in writing whenever possible. Include the case number from the notice, the date of the adverse action, and a clear statement of what you're disputing.
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Resource Denials to Challenge
An MSP denial for "excess resources" misapplies institutional Medicaid asset rules ($2,000 limit) to an MSP application, even though New Mexico eliminated the MSP asset test in 2021.
If your parent's NOCA says the denial is based on resources or assets, the caseworker made an error. File the hearing request and cite 8.240.500 NMAC (or 8.245.500/8.250.500 for SLMB/QI), which codifies the zero-asset standard. Also request an immediate supervisory case review — this error often gets corrected before the hearing takes place.
What Happens at the Hearing
Before the hearing, ISD must compile a Summary of Evidence detailing the income calculations, verification documents, and NMAC rules they applied. A copy must be provided to your parent or their representative.
At the hearing, your parent has the right to:
- Inspect the complete case file in advance
- Present documents and witnesses
- Bring an advocate, attorney, or family member
- Request free language translation or disability accommodations
The hearing is conducted by an administrative law judge who reviews whether ISD correctly applied the rules and issues a decision on the state's action.
Getting Help
NM SHIP counselors at the Aging and Disability Resource Center (1-800-432-2080) provide free, objective guidance and can help prepare for a hearing. Legal Aid New Mexico may take MSP denial cases at no cost for qualifying low-income applicants.
The New Mexico Medicare Savings Programs & Extra Help Guide includes a fair hearing filing guide with step-by-step instructions and a template for the hearing request letter, plus a checklist for organizing evidence before the hearing date.
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Download the New Mexico — Medicare Savings Program Eligibility Checklist — a printable guide with checklists, scripts, and action plans you can start using today.