LOOKING FOR ASSISTANCE
The Health Care Authority’s mission is: We ensure that New Mexicans attain their highest level of health by providing whole-person, cost-effective, accessible, and high-quality health care and safety-net services.
MFW Families and Providers
The Medically Fragile Waiver (MFW) serves individuals who have been diagnosed with a medically fragile condition before reaching age 22, and who either have a developmental disability or delay or who are at risk for developmental delay. A medically fragile condition is defined as a chronic physical condition that results in prolonged dependency on medical care for which daily skilled nursing intervention is medically necessary.
There are many services available including respite. Individuals should expect to receive services that meet these standards published by DDSD.
Legally Responsible Individuals (LRI’s), relatives, and legal guardians are permitted to provide Medically Fragile Waiver Respite, Home Health Aide, and Private Duty Nursing. Details are included in resources below.
- Requirements for Payment to Legally Responsible Individuals (LRIs), Relatives and Legal Guardians and Q & A
- LRI Information Form
Resources
Medically Fragile Waiver Service Standards
DDSD Master List of Definitions
Eligibility
In order to receive services on the Medically Fragile Waiver, individuals must meet the requirements for financial and medical eligibility for the program. Individuals must maintain eligibility to continue receiving waiver services.
Central Registry/ Allocation
The Medically Fragile Waiver Program receives a copy of the waiver registration form (MAD 325) from the ISD office and the referral is registered in the Central Registry by the date stamped on the MAD 325 form. The Central Registry referral is based upon a first come, first served basis. Funds appropriated by the New Mexico Legislature determine the number of allocated slots for the Medically Fragile Waiver Program statewide.
Determination
Application for the Medically Fragile Waiver is made with the Income Support Division (ISD) office in the county where the applicant resides.
To be considered financially eligible, the applicant must meet the Medicaid income guidelines specific to Category 95/Medically Fragile Waiver. The financial eligibility for the Medically Fragile Waiver applicants is determined by the Medicaid Income Support Division at the Human Services Department (HSD).
The medical eligibility for the Medically Fragile Waiver applicants is determined by the contracted Medicaid Utilization Review Agent with the HSD Medical Assistance Division (MAD). The applicant for the Medically Fragile Waiver must meet both the financial and medical eligibility set forth by Medicaid. The medically fragile individuals must meet the same medical level of care criteria required for Intermediate Care Facility (ICF) for the Intellectually/Developmentally Disabled (IDD).
Case Management Services
The Medically Fragile Waiver Program works with a state-wide contracted Case Management (Registered Nurses only) Program to coordinate the necessary services the waiver recipient needs with the contracted direct service providers (i.e., home health agencies) throughout the state.
Each case manager lives and serves in the community and provides services in the surrounding rural areas. The Case Management Program comprises a model of family-centered service coordination for individuals who are medically fragile and their families in a culturally diverse state.
The case manager, combined with direct services providers and/or family, develops an Individual Service Plan (ISP) with the recipient’s primary care physician. This plan defines the services the medically fragile recipient will receive, including the cost of services.
Fee schedules for services delivered through the Medically Fragile Waiver Program are controlled by agreements established with DDSD and the providers of those services.
Choosing Providers
You have a choice of Medically Fragile Waiver Providers in your service area. Your choice will be documented on the Secondary Freedom of Choice form provided by your MFW case manager. You can use the How to Select a Home Health Agency to learn about things to consider when choosing a provider.
Provider Enrollment
Learn how to become a Medically Fragile Waiver Provider by visiting the Provider Enrollment pages using the left side navigation menu.
Get Involved
Please visit the Advisory Council on Quality sections of our website to get involved with the Medically Fragile Waiver program.
Learn More
Visit the following website resources to learn more.
- University of New Mexico Center for Development and Disability
- Medically Fragile Case Management Program at the University of New Mexico Center for Development and Disability
- Information Network Library – University of New Mexico Center for Development and Disability
- Ready Emergency Preparedness for Individuals with Disabilities