NM Mi Via Waiver

The Mi Via Waiver program, initiated in 1999 by the Centers for Medicare and Medicaid Services, is a pioneering self-directed Home and Community-Based Services (HCBS) endeavor. Derived from the Spanish phrase meaning "my path" or "my way," Mi Via offers a unique opportunity for eligible children and adults with Intellectual and Developmental Disabilities (IDD) or medically fragile conditions to take control of their services and support. This person-centered and community-oriented approach has revolutionized healthcare, emphasizing inclusion and empowering family caregivers in New Mexico.

Overview of Mi Via Waiver

The Mi Via Waiver is a pivotal component of New Mexico's array of Medicaid waivers. It offers an alternative to institutional care by promoting participant autonomy, choice, and control over their services and supports. This self-directed Home and Community-Based Services (HCBS) program, established in 1999, aims to empower individuals with Intellectual and Developmental Disabilities (IDD) or medically fragile conditions to lead fulfilling lives within their communities.

At its core, Mi Via embodies several fundamental principles:

1. Self-Directed Lives: The program encourages individuals with IDD to take charge of their lives to the greatest extent possible.
2. Resourceful Living: Participants are given opportunities to utilize resources to enrich their lives and foster community engagement.
3. Shared Responsibility: Mi Via emphasizes the responsible use of public funds and recognizes the contributions of individuals with IDD and their families.
4. Efficient and Fair Management: The program strives to manage resources efficiently and fairly for all participants.

The guiding principles of New Mexico's self-directed waiver program affirm that all participants possess inherent value and potential and should be evaluated based on their abilities rather than limitations. Every individual has the right to participate and be fully included in their community, receiving services and support tailored to their unique needs within the most integrated settings possible.

Upon approval for Medicaid waiver services by the Department of Health and meeting medical and financial requirements, eligible individuals can opt for the Mi Via Waiver. With the guidance of a consultant, participants develop their personalized Service and Support Plan (SSP) to address their functional, medical, and social needs. Empowered by this flexibility, care recipients have the authority to determine the types of services required and how to allocate their Mi Via budget, enabling them to design a path that best suits their aspirations and aspirations.

Eligibility Requirements for Mi Via Waiver

To qualify for the Mi Via Waiver program, individuals must meet specific New Mexico Department of Health criteria. The eligibility requirements include:

1. Age: Applicants must be at least three years old but at most 64 years at the time of application.
2. Disability Status: Individuals must have Intellectual and Developmental Disabilities (IDD) or medically fragile conditions, such as severe physical or cognitive impairments that substantially limit their daily functioning.
3. Functional Eligibility: The applicant's level of impairment should warrant the need for Home and Community-Based Services (HCBS) rather than institutional care.
4. Financial Eligibility: There are financial limitations that applicants must meet to qualify for Medicaid waiver services. These criteria are assessed through income and asset tests to determine financial need.
5. Medical Eligibility: Applicants must be eligible for Medicaid and meet the medical criteria to receive Medicaid-funded services.
6. Residency: Individuals must be legal residents of New Mexico.

Meeting these requirements does not guarantee immediate enrollment, as there may be a waiting list due to program capacity limitations. The state regularly reviews and reassesses the eligibility of applicants to ensure that resources are allocated fairly and effectively to those most in need.

Services and Supports under the Mi Via Waiver

The Mi Via Waiver program offers comprehensive services and supports to eligible individuals with Intellectual and Developmental Disabilities (IDD) or medically fragile conditions. Participants have the flexibility to design their Service and Support Plan (SSP) with the assistance of a consultant, tailoring it to their unique needs and preferences. The services and supports available through Mi Via include:

1. Personal Care Services: Assistance with activities of daily living, such as bathing, dressing, and eating.
2. Respite Care: Temporary relief for caregivers, allowing them to take breaks from their caregiving responsibilities.
3. Skilled Nursing Services: Medical care provided by licensed nurses, including medication management and wound care.
4. Behavioral Supports: Professional guidance and interventions to address behavioral challenges.
5. Assistive Technology: Devices and equipment to enhance independence and accessibility.
6. Supported Employment: Assistance in finding and maintaining suitable employment within the community.
7. Community-Based Day Supports: Engaging activities and skill development opportunities in a community setting.
8. Home Modifications: Adaptations to the participant's home to accommodate their needs.
9. Transportation: Access to transportation services to facilitate community integration.
10. Counseling and Therapies: Mental health counseling and various therapies, such as occupational, physical, and speech therapies.
11. Goods and Services Necessary for Health and Welfare: Essential items for health and well-being.
12. Self-Directed Goods and Services: Participants can purchase certain goods and services related to their goals and interests.
13. Participant-Directed Community Supports: Funding activities promoting community involvement and social interactions.
14. Financial Management Services: Assistance with budgeting and managing the allocated funds.

These services and supports empower individuals with disabilities to live independently, actively participate in their communities, and pursue their aspirations while acknowledging family caregivers' vital role in supporting their loved one's well-being.

Compensation for Caregivers

The Mi Via Waiver program recognizes the significant contributions of family caregivers and their essential role in supporting individuals with Intellectual and Developmental Disabilities (IDD) or medically fragile conditions. While the program does not provide direct financial compensation to unpaid family caregivers, it does offer opportunities for self-direction, allowing care recipients to decide how to allocate their budget and utilize services.

The mechanism through which family caregivers can receive compensation within the Mi Via Waiver program is "Participant-Directed Goods and Services" (PDGS). This provision allows eligible individuals with Intellectual and Developmental Disabilities (IDD) or medically fragile conditions to choose the goods and services they need to meet their health and welfare needs, including support from family members.

Here's how it works:

1. Service and Support Plan (SSP) Development: With a consultant's assistance, participants develop their personalized SSP outlining their specific needs and goals.
2. Budget Allocation: The participant is allocated a budget based on the approved SSP. This budget is determined by the required level of care and support and may vary from person to person.
3. Participant-Directed Goods and Services (PDGS): Participants can include PDGS within the SSP, allowing them to choose certain goods and services to support their health and welfare goals.
4. Family Caregiver Compensation: If a participant requires caregiving assistance and wishes to receive support from a family member, they can use their PDGS budget to compensate the family caregiver for their services. This could involve payment for caregiving hours or other related expenses.

Compensation for family caregivers must comply with specific guidelines and restrictions outlined by the program. Additionally, participants must adhere to Medicaid program rules and regulations to appropriately use allocated funds. The primary goal of this mechanism is to empower individuals with disabilities to have more control over their care while promoting family involvement and community integration.

Learn more about Medicaid participant-directed care >>

A Note from Givers

If you or someone you know provides caregiving support for a family member with IDD or a medically fragile condition, fill out this form to determine your eligibility for compensation.