New Mexico Medicaid Facts

• State Medicaid Website: New Mexico
• New Mexico Developmental Disabilities Planning Council Website
• The Arc of New Mexico

New Mexico Medicaid Facts: From Kaiser Family Foundation Medicaid Fact Sheet (2009)

There are 57,100 people with disabilities covered by Medicaid in New Mexico. New Mexico spent $17,481 on each Medicaid recipient with a disability in 2007.

Only 11% of all people covered by Medicaid in New Mexico have a disability, which is much lower than the national percentage of people covered by Medicaid who have a disability (15%).

New Mexico spends 39% of all the money it spends on Medicaid on services for people with disabilities, while the national percentage of Medicaid spending on these services is 42%.

New Mexico Salud!:

This program covers children with disabilities and adults with disabilities who are not covered under Medicare or a DE waiver. This plan also has a separate mental health component that covers adults and children with disabilities.

• Community: non-IEP-based school services, transportation
• Health: ambulatory surgical centers, anesthesia, audiology, dental, dialysis, durable medical equipment, emergency room services, early and periodic screening, diagnosis, and treatment, private duty nursing, family planning, federally qualified health centers, hospice, immunization, hospital, laboratory, midwife services, nutritional services, occupational therapy, pharmacy, physical therapy, physician services, podiatry, prosthetics and orthotics, rehabilitation, reproductive health, rural health clinics, speech therapy, transplants, vision, x-ray
• Home: home health care, personal care
• Social Services: case management

Coordinated Long-Term Services:

This program provides long-term supports to adults with disabilities and children who have special needs according to the state. This plan covers people who do not participate in an HCBS waiver and who are not eligible for Medicare. The goal of this plan is to provide long-term supports and let people decide whether they want to have these services provided in their homes, communities, or in a nursing or assisted living facility.

• Community: transportation
• Health: chiropractic, dental, disease management, durable medical equipment, early and periodic screening, diagnosis, and treatment, family planning, hearing, hospice, immunization, hospital services, institutional care, laboratory, occupational therapy, personal care, pharmacy, physical therapy, physician, podiatry, skilled nursing facilities, speech therapy, vision, x-ray
• Home: home health
• Social Services: case management

Program of All-Inclusive Care for the Elderly (PACE):

PACE programs are designed for people 55 and older who need nursing care, which includes many people with disabilities. These programs provide integrated care and support including a high level of preventive care. PACE programs must provide all services otherwise included in a person’s Medicaid or Medicare benefit, as well as all other services deemed medically necessary.

Ages: 55 and older

Level of Care: nursing

Restrictions: people must live close enough to a PACE center to be eligible.

• Community: health-related transportation
• Health: primary and specialty care, nursing, physical, occupational and speech, recreation therapy, prescription drugs, day health care
• Home: home care, home and environmental modifications
• Social Services: social services

Mi Via:

Mi Via is New Mexico’s self-directed waiver program, and is designed to help patients take more control and have more choices about what kind of care they get. Mi Via includes four separate waiver programs: one for older adults with disabilities, one for people with developmental disabilities, one for people who are considered medically fragile, and one for people who have brain injuries. Mi Via is the first program in the country to make self-direction available to all of these groups through their waiver programs, and now people who are eligible for Medicaid in New Mexico can choose Mi Via as an option.

Options for Self-Direction: Mi Via is an entirely self-directed waiver program. You will work with Medcaid agents and providers to plan for the services you need.

Developmental Disabilities waiver (DD waiver):

This waiver, like other DD waivers, is designed to help people with I/DD get care at home or in their communities instead of in a residential facility or state hospital.

• Community: day care, non-medical transportation, and community membership
• Health: nursing, nutritional counseling,
• Home: respite care, personal care, environmental accessibility modifications
• Work: vocational habilitation, supported employment

Medically Fragile waiver:

This waiver covers people who have been diagnosed with a medically fragile condition before the age of 22, including many people with developmental disabilities or developmental delays or brain injuries. A ‘medically fragile condition’ is a physical condition that requires long-term dependence on medical care, including daily skilled nursing care.

• Health: speech therapy, private duty nursing, physical and occupational therapy, psychosocial treatments, nutritional counseling
• Home: home health care, respite care
• Social Services: case management

Coordinated Long-Term Care Services (CoLTS):

The goal of this program is to coordinate the wide array of services provided by other Medicaid programs for recipients who need long-term care. This program is also designed to provide these options in a community setting rather than an institutional one.