The traditional waiver
The DD Waiver
A case manager coordinates and contracted provider agencies do the work. New Mexico calls it the "traditional" DD Waiver, and it is the path most families take.
The idea
On the DD Waiver, you get a case manager, and agencies under contract with the state deliver the services. The case manager is your coordinator: assessment, planning, linking you to providers, monitoring, the annual recertifications, and the budget submissions.
You are not a bystander. You choose the case management agency and the provider agencies, you lead the planning meeting, and you can change providers if one is not working. What you hand over is the hiring, the payroll, and the 6am phone call.
The Individual Service Plan
The ISP is the document that decides what your child actually gets. Your case manager compiles it, and the state expects it to contain:
- a written picture of your child: life experiences, strengths, gifts, preferences, relationships, work or volunteer history, and challenges
- where their life is now
- their dreams, long-term vision, and desired outcomes
- the supports and action plans to get there
- medical, therapy, and crisis plans for existing health and behavioral needs
- the specific training team members need to support your child properly
Read that list again before your ISP meeting. If the draft that comes back is a list of services with no picture of your child in it, it is incomplete, and you can say so.
What the DD Waiver covers
Grouped the way the service standards group it. Availability depends on age and on clinical justification or medical necessity.
| Group | Services |
|---|---|
| Case management | Advocacy, assessment, planning, linking you to providers, monitoring, plus allocation, annual recertification, and budget approvals. |
| Living care arrangements | Customized in-home supports, family living, supported living, intensive medical living, and respite. |
| Community supports and employment | Customized community supports and community integrated employment, built on a Person-Centered Assessment. |
| Professional services | Physical therapy, occupational therapy, speech and communication therapy, behavior support consultation. |
| Other waiver services | Adult nursing, preliminary risk screening and consultation, socialization and sexuality education, supplemental dental, nutritional counseling, environmental modifications, assistive technology, personal support technology, independent living transition, non-medical transportation, and crisis supports. |
If your child is under 18, read this twice. Only a subgroup of DD Waiver services is in the children's category: case management, behavior support consultation, customized community support (individual), respite, non-medical transportation, supplemental dental care, nutritional counseling, and environmental modifications.
That is not the whole story, though. For a child, most therapy and nursing comes through EPSDT (which for Medicaid runs to age 21), Medicaid school-based services, the public school system, and, for the youngest, the Family Infant Toddler program. The waiver is designed to add to those, not replace them. See children and school.
Choosing agencies, and what to do about a bad one
Every DD Waiver provider must hold a contract with the state and follow the DD Waiver Service Standards. DDSD publishes a Provider Selection Guide to help you choose, and the Quality Management Bureau runs unannounced surveys of case management and provider agencies and publishes reports of findings.
Practically: ask a prospective agency how long their staff stay, who covers a missed shift, and how they handle a complaint. If an agency is not delivering what the ISP says, tell your case manager, then the agency's director, then your regional DDSD office (opens an outside website). You can change providers.
Official DD Waiver pages
- Developmental Disabilities Waiver Program overview, how to apply, and the numbered memos that carry policy changes.
- DD Waiver services and supports Service standards, the master lists of acronyms and definitions, the children's category.
- DD Waiver service planning and budgets ISP forms for children and adults, the instruction guide, budget worksheets.
- DD Waiver case management services What case management must do, and the survey findings for agencies.
Weighing this against self-direction? Put them next to each other.