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MFW Families

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 which results in a prolonged dependency on medical care for which daily skilled nursing intervention is medically necessary.

Services provided through the MFW are case management, home health care, respite care, private duty nursing, physical, occupational and speech therapies, behavior support consultation, nutritional counseling and specialized medical equipment and supplies. The New Mexico Department of Health, Developmental Disability Services Division administers the MFW.a


Important Notice

The Medically Fragile Waiver renews in July 2021. HSD and DOH are actively preparing for the renewal at this time. DOH and HSD welcomes input from New Mexicans regarding the Waiver.

Please see the MFW Town Hall Presentation and MFW Renewal- Notice of Opportunity to Comment for additional information.

Please submit comments to:
Lorie Pacheco, Staff Manager
Human Services Department / Medical Assistance Division
Exempt Services and Program Bureau
PO Box 2348
Santa Fe, NM 87504-2348
Fax: 505-827-7277
Loriea.pacheco2@state.nm.us


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.

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).

For additional information on Medically Fragile Waiver eligibility, please visit the Eligibility Determination section of our website.

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 on the Central Registry by the date stamped on the MAD 325 form. The referral on the Central Registry is based upon a first come, first served basis. The appropriated funds by the New Mexico Legislature determine the number of allocated slots for the Medically Fragile Waiver Program statewide.


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.

The rate of fees charged for services and a schedule for when the services will be delivered are controlled by agreements established with DDSD and the providers of those services throughout New Mexico. These programs provide in-home services that support the family decision to care for their medically fragile family member at home instead of in an institution.

Learn more about the Case Management Program coordination of services by visiting Medically Fragile Case Management Program section of the University of New Mexico Center for Development and Disability website.


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 may use the How to Select a Home Health Agency learn about things to consider when choosing a provider.


Respite Services

Respite care services for the Medically Fragile allow the primary caregiver a limited leave of absence to reduce stress, accommodate caregiver illness, or meet a sudden family crisis or emergency. By permitting the caregiver a specific and limited break from the daily routine of providing care, burnout is avoided and the primary caregiver receives a source of support and encouragement to continue home care services.
The Provider Agency(s) will be required to coordinate all services with the recipient and/or the recipient representative and case manager.

Respite Services Provided May Include:

  • Skilled and non-skilled health care services such as personal care, bathing, showering, skin care, grooming, oral hygiene, bowel and bladder care, catheter and supra-public catheter care, preparation or assistance in preparation of meals and eating and administering G-tube feedings. As appropriate, also home management skills such as house cleaning, changing linens, making beds, washing dishes, shopping and errands.
  • Assistance with and provision of recreational activities for leisure and play. Assistance with enhancing self-help skills. Help with appropriate interpersonal communication skills and language and development of a trusting relationship with families from varying social, cultural, and economic backgrounds.
  • Additionally, services include help with arranging for health care needs and follow-up as directed by the primary care giver, physician, and case manager and ensuring the health and safety of the recipient at all times.

Get Involved

Please visit the Advisory Council on Quality and the Family Advisory Board sections of our website to get involved with the Medically Fragile Waiver program.


Learn More

Visit the following website resources to learn more.

Emergency Preparedness Resources

New Mexico Evacuation Workbook