What is the DD Waiver and Why Does it Matter for Special Needs Families?

The DD Waiver is the Developmentally Disabled Waiver in New Mexico. It is a Medicaid program that provides services to qualifying individuals with intellectual and developmental disabilities. Often people ask what the “waiver” part means. One of the qualifying questions for the DD Waiver is whether the individual would otherwise qualify for nursing home level of care (NHLOC). If so, the individual can “waive” NHLOC and receive their services in the community instead. This is why it is called a “waiver.”

Historically many of the people now on the DD Waiver would have had no option for care other than institutionalization. The DD Waiver is a person-centered, community oriented approach to deliver support to individuals and help them oversee their own lives as much as possible, including providing opportunities to enhance their lives and allow them to participate in their communities. The waiver is also meant to share the responsibility for care between public funds and the individual and their families.

The DD Waiver provides an array of services including residential, in-home, community, employment, therapeutic, and family support services for eligible individuals. The DD Waiver is funded with State General Funds that are matched with federal funds from the Centers for Medicare and Medicaid Services. It is intended to add to and not replace other supports that a person may have such as medical services through Medicaid, family support, and other community services. However, many families simply cannot afford the level of care that is needed for their loved one with a disability, so the services provided by the DD Waiver can be crucial.

To be found eligible, an individual must first file an application with the NM Human Services Department and provide extensive medical and financial information. Generally, if a person with an intellectual or developmental disability meets the qualifications for disability under the Social Security regulations, they will be eligible for services through the DD Waiver. The criteria are generally:

  1. That the person has an intellectual disability with onset by age 18; or
  2. That the person has a specific related condition such as cerebral palsy, autism, Down syndrome, etc.; and
  3. That the person has significant limitations in at least three areas of major life activity that began prior to age 22.

But it does not end there. Because the services provided by the DD Waiver are extensive and the funding is limited, there is a significant waiting list for receipt of services. Currently, the wait is approximately 12-16 years from the date an individual is found eligible until they are allocated for services. For most individuals, they are able to receive many if not all of the services they need from their school district while they are enrolled and attending school. However, once an individual ages out of the educational system, there are few opportunities for them.

Therefore, it is critical that once a family learns that their child has been diagnosed with an intellectual or developmental disability, they begin the process for eligibility so their child can be placed on the waiting list. If this is done when the child is in the preschool or elementary school years, the likelihood that they will be allocated for services by the time they transition out of high school is much greater.

Submitting an application is not difficult. The application can be found on the NM Department of Health website at nmhealth.org/about/ddsd/intake/eligi/ or if you Google NM DD Waiver eligibility. You will get a link to the NM Department of Health website, scroll down to Frequently Asked Questions, and click on the link for HCBS Registration Form. HCBS means Home and Community Based Services and is the category under which the DD Waiver falls. You can also apply by telephone by calling the Department directly at 505-841-5552.

If you think your child may be eligible, do not wait! Submit an application as soon as possible. If your child is denied, you are allowed to reapply if their condition manifests differently as they grow older or if you obtain additional medical information.