On March 22, 2019, the New Mexico Governor Michelle Lujan Grisham instructed the Department of Health (DOH) and the Human Services Department (HSD) to develop a new Medicaid home- and community-based services (HCBS) supports waiver program for people with intellectual/developmental disabilities (I/DD) waiting for supportive services. The purpose of the waiver in development is to create new service slots for people who are on the wait list for the current Developmental Disabilities (DD) Waiver and the Mi Via Waiver.
The average wait time is 13.3 years for an allocation to service slot through the DD Waiver or the Mi Via Waiver. Approximately 5,000 people are waiting for DD waiver services; about 53% are under age 22. While on the wait list, individuals may receive DOH state general fund services and those who meet Medicaid financial and eligibility criteria may receive non-waiver Medicaid services.
The DOH Developmental Disabilities Supports Division (DDSD) and the HSD Medical Assistance Division will work together and develop the new supports waiver. The work will include researching how the other states with supports waivers administer their waivers. The waiver development team will also analyze the program elements and population served, funding allotments for service plans, and will survey HCBS needs for a random sample of 1,600 out of the approximately 5,000 people on the DD wait list. On April 12, 2019, a timeline was shared with the Advisory Council on Quality Supports for Individuals with Intellectual and Developmental Disabilities and their Families (ACQ) which included plans for a January 1, 2020 implementation date.
According to a program evaluation of the DD and Mi Via Waivers by the New Mexico Legislative Finance Committee Program Evaluation Unit, the waivers served nearly 5,000 people in fiscal year 2017, at a cost of $360 million, which includes $111 million in state funds. The participants receive living supports, day habilitation, therapy, employment, and other services in their homes and communities rather than institutional settings. Since 1997, New Mexico has operated no state-run institutions for people with I/DD. Additional findings were as follows:
- Enrollment in the DD Waiver has declined by 13% between fiscal years 2014 and 2017. However, the cost per participant increased by 17%. Total costs for fiscal year 2017 were $274 million in state and federal funding. Waiver participants can receive services including, but not limited to, residential care in an agency supported living home or their own home, integrated community-based day habilitation, behavioral supports, physical, occupational, and speech and language therapy, and assistive technology and environmental modifications to facilitate the ability to live independently. Participants work with case managers and an interdisciplinary team (IDT) to develop an individual service plan (ISP) and choose service provider organizations. Approved services and amounts are determined through an outside review by applying clinical criteria. If growth continues at the current 7% rate, the waiver could fail the federal cost neutrality test by fiscal year 2027. DDSD and HSD have not been successful in predicting the waiver costs, which has required the legislature to provide additional funding to cover a cost of $15 million between fiscal years 2008 and 2018.
- Enrollment in the Mi Via Waiver, which launched in 2007 to support self-direct services reached 1,434 participants in fiscal year 2017, with costs at $86 million. Of the 1,434 participants, 42 are their own “employer of record.” Participants work with a consultant to regulate and monitor service delivery. Annual costs for Mi Via participants increased by 20% between fiscal years 2016 and 2017. By fiscal year 2019, annual costs for new Mi Via participants in 2017 are projected to reach the annual budget cap of $72,710.
The wait list is a listing of people that have been determined to meet the definition of developmental disability. The individual must apply to be placed on the DDSD Central Registry. After the application, the individual is screened during an intake exam to determine if the individual meets the definition for I/DD. If the individual qualifies, the individual is placed on the wait list for waiver services. Medicaid medical and financial eligibility are established only after the person reaches the top of the wait list and is notified about an available funded slot. Those who qualify are offered services under the traditional Developmental Disabilities waiver, the Mi Via self-directed waiver, or in an intermediate care facility for individuals with intellectual disability.
The LFC recommended that the DOH consult with HSD to create a five-year plan to reduce the wait list by 25% to 50%. Doing so would require the legislature to commit a total of about $4 million (at a 25% reduction) to $8 million (at a 50% reduction) in general funds for the first year of waiver services over the five-year period. Subsequent years would require a commitment of funds from $33 million to $65 million. The LFC advised DOH to examine cost drivers within the Developmental Disabilities and Mi Via Waivers to identify patterns leading to cost increases, and address issues programmatically.
A link to the full text of “New Mexico Legislative Finance Committee Program Evaluation Unit: Developmental Disabilities & Mi Via Waivers” may be found in the OPEN MINDS Circle Library at www.openminds.com/market-intelligence/resources/072018nmlfcprgevalddwaivers.htm.
For more information about the new I/DD supports waiver, visit https://nmhealth.org/about/ddsd/pgsv/ddw/, or contact:
- Christina Hill, Program Manager, Developmental Disabilities Waiver, Developmental Disabilities Supports, New Mexico Department of Health, 1190 South Saint Francis Drive, Santa Fe, New Mexico 87505; 505-476-8972; Email: firstname.lastname@example.org; Website: https://nmhealth.org/about/ddsd/pgsv/ddw/
- Jodi McGinnis Porter, Director of Communications, New Mexico Human Services Department, Post Office Box 2348, Santa Fe, New Mexico 87504; 505-476-7203; Email: email@example.com; Website: http://www.hsd.state.nm.us/default.aspx