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 people who have been diagnosed with a medically fragile condition before reaching the age of twenty-two (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 MFW, 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 MFW Program receives a copy of the waiver registration via mail, secure fax, SCOMM, or in person. The MFW program manager will then enter them into the Central Registry (CR) by the date stamped on the form or enter the date we receive it. The CR 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 MFW Program statewide.
Determination
Application for the MFW 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/MFW. Financial eligibility for MFW applicants is determined by the Medicaid Income Support Division at the Health Care Authority (HCA)
The medical eligibility for the MFW applicants is determined by the contracted Third-Party Assessor (TPA) with the HCA Medical Assistance Division (MAD). The applicant for the MFW must meet both the financial and medical eligibility set forth by Medicaid. The medically fragile person must meet the same medical level of care (LOC) criteria required for Intermediate Care Facility (ICF) for the Intellectually/Developmentally Disabled (IDD).
Case Management Services
The MFW Program works with a statewide contracted Nurse Case Management Agency (NCMA). All NCMAs are Registered Nurses only. The Program is to coordinate the necessary services the waiver recipient needs with the contracted direct service providers (i.e., home health agencies) throughout the state.
Each Nurse Case Manager (NCM) lives and serves in the community and provides services in the surrounding rural areas. The Nurse Case Management Program comprises a model of family-centered service coordination for people who are medically fragile and their families in a culturally diverse state.
The NCM, 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 MFW Program are controlled by agreements established with DDSD and the providers of those services.
Choosing Providers
You have a choice of MFW Providers in your service area. Your choice will be documented on the Secondary Freedom of Choice form provided by your MFW nurse 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 Relations Unit (PERU) page using the left side navigation menu.
Get Involved
Please visit the Advisory Council on Quality sections of our website to get involved with the MFW 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