CMS Approves NM’s Disability Waivers for Next Five Years – But Governor and Legislators Under-fund Programs

According to the Centers for Medicare & Medicaid Services (CMS) both the Medically Fragile Waiver (MFW) and the the Developmental Disabilities (DD) Waiver have been authorized for another five-year period, beginning July 1, 2026.

The Mi Via Waiver application was approved for five years in October of 2025.

According to testimony before the New Mexico Legislative Finance Committee in September of 2025, more than 8,700 New Mexicans receive critical care from these three waiver programs.

While the Waivers have been extended, with a number of enhancements according to the state’s Developmental Disabilities Supports Division (DDSD), the Legislature and the Governor provided only a fraction of the $47 million requested by the Waiver agency in additional appropriations to enable it to address years of under-funding the services.

Legislators and the Governor have a long history of under-funding programs for these vulnerable residents and the families that try to give them safe and humane care.

As The Candle previously reported, “on January 31, 2024, Representative Nathan Small (D), the House Appropriations and Finance Committee Chairman, opposed an amendment made by Representative John Block – (R) to increase by $10 million the appropriation needed to raise the pay for people caring for New Mexican residents qualified for Developmentally Disabled Waiver (DD Waiver) services.”

Small stated in the debate on the Lock amendment, “We’re doing a rate study. We want to make sure that we are caught up across all areas of health care. This is year one of the Health Care Authority, and so, Mr. Speaker, we’re sort of not doing this piecemeal. Instead we have robust increases in our budget, a rate study coming, and the ability to continue to invest and to right-size as we match federal money.”

Last year, after fumbling the request for proposals to conduct the rate study, the Health Care Authority finally contracted the consulting company Health Management Associates to conduct a study to update rates that serve as the basis for the pay received by those who provide the day to day care to those on the three Waivers.

Despite the clear need for increased appropriations to address the study’s recommendations – and to actually follow through on Small’s 2024 comments related to the study – the Legislature and the Governor failed again to fund the budget request of HCA and DDSD during the budget session in February.

In a memo from the agency and released to stakeholders in the DD Waiver community, “DDSD did not receive any appropriations tied to the 2025 Rate Study conducted by Health Management Associates (HMA). The Final Rate Study Report can be viewed on the HCA website at: https://www.hca.nm.gov/directors-office-rate-studies/.”

More to come in reporting next week.

Description of Three New Mexico Disability Related Waivers From Centers for Medicare & Medicaid Services

NM Developmental Disabilities Waiver Program (0173.R08.00) 

Provides case management, community integrated employment, customized community supports, living supports, respite, nutritional counseling, occupational therapy for adults, physical therapy for adults, speech and language therapy for adults, supplemental dental care, adult nursing, assistive technology, behavioral support consultation, crisis support, customized in-home supports, environmental modifications, healthy relationships and personal safety education, independent living transition service, non-medical transportation, preliminary risk screening and consultation, and remote personal support technology services to individuals with autism, intellectual disabilities, or developmental disabilities ages 0 or older who meet an ICF/IID level of care.

NM Medically Fragile Waiver (0223.R07.00)

Provides case management, customized community supports, home health aide, respite, nutritional counseling, skilled therapy for adults, behavior support consultation, environmental modifications, individual directed goods and services, private duty nursing, specialized medical equipment and supplies, specialized therapies, and vehicle modification services to individuals who are medically fragile ages 0 or older who meet an ICF/IID level of care.

NM Mi Via – ICF/IDD Waiver (0448.R04.00)

Provides consultant services, customized community group supports, employment supports, home health aide services, homemaker/direct support services, respite, skilled therapy for adults, personal plan facilitation, behavior support consultation, community direct support, emergency response services, environmental modifications, in-home living supports, individual directed goods and services, nutritional counseling, private duty nursing for adults, specialized therapies, and transportation services to individuals who are medically fragile, individuals with autism, with intellectual disabilities, or with developmental disabilities ages 0 or older who meet an ICF/IID level of care.