HSD Proposed Rates: Likely Decrease For Most Vulnerable on DD Waiver – Despite Legislators Approving Budget Increases

Despite 2023 State Study Noting Serious Deficiencies and Unavailability of Services, the Developmental Disabilities Wavier Programs for 1,266 of the Most Severely Disabled Likely to See Rate Cuts Under HSD Proposal to the Centers for Medicare and Medicaid Services.

Updated June 6, 2024

In February, New Mexico legislators approved a state budget scheduled to begin on July 1, 2024, which included sufficient funds to provide increases over the current year’s budget for programs and services for Developmentally Disabled New Mexicans – or so they expected.

About two weeks ago, the New Mexico Human Services Department, headed by Secretary Kari Armijo, released its proposal to the federal Centers for Medicare and Medicaid Services (CMS) for approval for increases in some of the rates for the various DD Waiver systems programs.

But, for more than 1,250 of the most vulnerable clients in the New Mexico DD Waiver program, the HSD proposal would likely cut rates for vital services in the programs for Intensive Medical Living and the Category 4 Supported Living Program for Extraordinary Medical and Behavioral Health Support programs.

Despite claims by the Lujan Grisham Administration that New Mexico no longer has a wait-list for DD Waiver services, the reality is many are waiting for vital services for which the list of professionals available to provide the services is shrinking.

There is a nexus between availability of services and rates.

According to a 2023 state study, entitled “New Mexico Department of Health Developmental Disabilities Supports Division – Provider Capacity Assessment,” 26% of case managers for DD Waiver clients identified that “Supported Living Services” for those in need of supported living was not always available.

The Public Consulting Group (PCG), which performed the study for the state, noted in its final report, that rates were directly related to fixing and expanding services.

Provider agencies have been complaining for years that rates are woefully insufficient and inhibit their ability to retain and recruit sufficient staff.

As a result, providers have limited the availability of their services and many have declared self moratoriums on acceptance of any new clients.

Some key take-a ways from the PCG study report:

  • There were 15 counties with no openings,
  • A high proportion of providers are on self-imposed moratorium,
  • Staff leaving provider agencies,
  • A significant number of providers not accepting new participants, and
  • Supported Living had the highest number of Regional Office Request for Assistance of any service for the Developmental Disabilities Waiver.

Despite the September PCG report’s linking rates to the ability of provider agencies to retain and recruit staff, and provider agencies self-imposing moratoriums on their services, the HSD is seeking approval of rates that likely will be decreased from this year for supported living for those needing extraordinary medical and/or behavioral services and intensive medical living services.

Explanation of How The Candle Compared Rates Proposed for New Year 4 to Existing Rates

Below, are snapshots of pertinent sections of the proposed Amendment of the DD Waiver as released by HSD on May 16, 2024.

The snapshots are of years 1 through 4 of the current CMS approved 5-year DD Waiver program. New Mexico is currently in year 3 of the program, with year 4 beginning on July 1, 2024.

According to the DEVELOPMENTAL DISABILITIES WAIVER FEE SCHEDULE (click here to link to HSD Fee Schedule) issued in March (which includes the recently approved CMS increase for the past year) the rates for the Intensive Medical Living and the Category 4 Supported Living Program for Extraordinary Medical and Behavioral Health Support programs match the current Waiver Year 3 rates in the snapshots below.

The new rates proposed by Armijo’s HSD for these two programs for year 4, are clearly below the rates of both Waiver Year 2 and the current Waiver Year 3, despite promises from the Administration to legislators that rates would not go down – especially when the legislature appropriated additional funds for the DD Waiver programs and workers.

Clicking here will connect to the full DD Waiver Proposed Amendment.

Interestingly, the HSD DD Waiver proposed amendment includes the following statement,

On June 17, 2024, [sic] the state sent a notice to all interested parties summarizing the proposed changes to the waiver renewal and notification of the public hearing. The notice provided the web link to the full waiver application website posting on the HSD webpage. A contact name, number and email were provided on the public notice for individuals who had questions or needed more information. Notices for Public Comment will be published in the Las Cruces Sun and Albuquerque Journal on June 13, 2024. The Albuquerque Journal is distributed statewide.”

Obviously, at the time of publishing this story, the notice has yet to be sent to “all interested parties summarizing the proposed changes to the waiver renewal and notification of the public hearing.

The Candle has spoken with some DD Waiver advocates about the insufficiency of the proposed rates for key services in the HSD proposed Amendment to the Waiver.

Legislative Health and Human Services Committee Meeting – June 5 through 7, 2024

Some have indicated they will register their concerns to legislators next week at a hearing of the New Mexico Legislative Health and Human Services (LHHS) which meets Wednesday, June 5, 2024, through Friday, June 7, 2024.

The LHHS meeting is being held at the University of New Mexico’s Lobo Rainforest Building, in Collaboration Space 101, at Broadway Boulevard NE in Albuquerque.

There is a public comment session held during each day of the three days of LHHS meeting.

Besides being able to make in person pubic comment at the meeting, the LHHS agenda states: “Members of the public may make virtual public comments during the public comment period of the meeting by following the instructions under the “Virtual Public Comment” section of the LHHS web page.”

Click here to link to a full copy of the LHHS agenda.

Developmental Disabilities Wavier Program – Intensive Medical Living

Developmental Disabilities Wavier Program – Supported Living Category 4, Extraordinary Medical/Behavioral Support