DD Waiver in New Mexico: Eligibility, Services, and Waitlist

The Developmental Disabilities Waiver in New Mexico is a Medicaid program that pays for home and community-based services for people with intellectual and developmental disabilities who would otherwise qualify for care in an institution. It is authorized under Section 1915(c) of the Social Security Act and is now run by the New Mexico Health Care Authority (HCA) through its Developmental Disabilities Supports Division (DDSD). People commonly call it the DD Waiver.

The program lets eligible New Mexicans receive residential, employment, therapeutic, and community-integration supports in their own homes and communities instead of in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID).¹

Who Qualifies and How Services Are Planned

To receive the DD Waiver, a person must meet the ICF/IID level of care. Medical eligibility, the service plan, and the budget are reviewed and approved by a Third-Party Assessor, currently Comagine Health.²

Services are built around a person-centered plan. Each participant works with a case manager and an interdisciplinary team to put together an Individual Service Plan (ISP) that identifies goals, needed supports, and the specific services authorized to meet those goals, along with an Authorized Annual Budget.²

The Department of Health still handles certain pieces of eligibility work under an agreement with HCA, including determining whether a person meets the state’s definition of a developmental disability.³

What the DD Waiver Pays For

Of New Mexico’s home and community-based waivers, the DD Waiver is the most comprehensive. The state also runs the Mi Via Waiver, a self-directed alternative for people who want to hire and manage their own workers, and the Medically Fragile Waiver. The DD Waiver covers a broad range of residential, day, employment, therapeutic, and community services.¹

Participants also have access to cost-based services with set caps. Under rate models proposed in the FY2026 rate study, those caps would increase: environmental modifications from $5,000 to $25,000 per five-year period, assistive technology from $500 to $5,000 per year, and vehicle modifications from $5,000 to $20,000 per five-year period. The proposals also include new telehealth rates across multiple services and would lower maximum caseloads for case managers and Mi Via consultants from 50 to 35.⁴⁵

Participants also have certain federal protections in residential settings. By June 2015, the state updated DD Waiver standards to guarantee access to food at any time, the right to visitors at any time, and leasing arrangements that ensure privacy, including lockable doors and keys.⁶

The Waitlist and the End of the Supports Waiver

For years, people who qualified for the DD Waiver could wait years for an allocation. To bridge that gap, New Mexico launched the Supports Waiver on July 1, 2020, offering a limited set of services capped at a $10,000 annual Individual Budgetary Allotment for people on the DD Waiver waitlist.¹

In 2021, DDSD ran a “Super Allocation” initiative that moved large numbers of people off the waitlist into the comprehensive DD Waiver or the Mi Via Waiver. Fiscal Year 2026 House Bill 2 funding continued that effort. By May 2025, every person enrolled in the Supports Waiver had been offered an allocation to the DD Waiver or Mi Via Waiver, and HCA proposed repealing the Supports Waiver regulation (NMAC 8.314.7) effective April 1, 2026. A public hearing on the repeal was held on December 8, 2025.⁷

Who Runs the Program Now

The DD Waiver used to be split between two agencies: the Human Services Department handled the Medicaid side, and DDSD inside the Department of Health ran daily operations. That changed when the New Mexico Health Care Authority launched on July 1, 2024, absorbing the Human Services Department and bringing DDSD and the Division of Health Improvement over from DOH.⁸

DOH still has a role. Under an ongoing agreement, it continues to handle provider contracting, developmental disability determinations, provider monitoring, and participation in fair hearings.³ Investigations of abuse, neglect, and exploitation are handled by the Division of Health Improvement, now housed inside HCA.⁹

Pay for Direct Support Professionals

DD Waiver services depend on Direct Support Professionals, the workers who assist participants in their homes, residential programs, and community settings. In 2021, the average hourly rate for a New Mexico DSP was $11.96, and the state has struggled with recruitment and retention.¹⁰

House Bill 395, signed into law on April 5, 2023, now requires DD Waiver providers to report annual workforce data to the state, including wages, recruitment, retention, and vacancy rates. The law also requires rate studies for DD Waiver providers to calculate DSP wages at 150 percent of the state minimum wage when setting reimbursement rates.¹⁰

In fiscal year 2025, DD Waiver provider rates went up by an average of 16.5 percent, based on a 2023 rate study plus a 5.32 percent cost-of-living adjustment. CMS approved the changes in December 2024, and they applied retroactively to July 1, 2024, for the DD Waiver and Medically Fragile Waiver, and to October 1, 2024, for the Mi Via Waiver.¹¹

A follow-up rate study was conducted between May 2025 and January 2026. It used an $18.92 hourly base wage for direct support staff, drew on a provider survey with an 80 percent response rate, and projects an overall spending increase of 16.1 percent if the recommended rates are fully funded. DDSD stated that it does not intend to adopt any recommended rate reductions.⁴

The proposed models do not yet reflect the CMS 2024 “Ensuring Access to Medicaid Services” rule, which requires that 80 percent of certain Medicaid payments go toward direct care worker compensation. CMS implementation guidance on that rule is still pending.⁴

What’s Next: Waiver Renewal

The current DD Waiver term runs from July 1, 2020, through June 30, 2026. The state is expected to submit a renewal application to the Centers for Medicare and Medicaid Services ahead of that expiration, and the DD Waiver Steering Committee engages self-advocates, families, providers, and advocacy groups in the policy work tied to the renewal cycle.¹²

1
New Mexico State Records Center and Archives. NMAC 8.314.7 – Supports Waiver
2
New Mexico Health Care Authority. Mi Via Service Planning and Budgets
3
Medicaid.gov. State Plan Amendment NM-24-0002
4
Health Management Associates. HCBS Rate Study Recommendations – Final Report
5
DDSD. HCBS Rate Models – Proposed
6
Medicaid.gov. New Mexico HCBS Statewide Transition Plan
7
New Mexico Health Care Authority. Notice of Opportunity to Comment on Proposed Repeal of NMAC 8.314.7
8
New Mexico Health Care Authority. Final Transition Plan Report
9
DDSD. DD Waiver Service Standards
10
PHI National. New Mexico Advocates Score a Major Win for Direct Support Professionals
11
New Mexico Health Care Authority. New Mexico Raises Medicaid Rates for Services Supporting Individuals With Disabilities
12
New Mexico Health Care Authority. DD Waiver Steering Committee