Eligibility Determination

Individuals with intellectual and developmental disabilities who meet the definition of developmental disability in accordance with New Mexico Administrative Code NMAC 8.290.4 are eligible for the DD Waiver. In general, to match the definition of a developmental disability the individual must:

• Have an Intellectual Disability, onset by age 18 or
• A specific related condition (Cerebral Palsy, Autistic Disorder, Down Syndrome, Epilepsy, etc.) and
• Have significant limitations in at least 3 areas of major life activity that began prior to age 22.

Every 5 years, New Mexico submits a renewal application to the Centers for Medicare and Medicaid Services to continue providing DDW services and supports. The approved application contains the definition of eligibility DDSD must use when processing cases.

Please see the DDW Eligibility Definition 2020 document for the current, approved definition.

Frequently Asked Questions

How do I apply for the DDW?

The first step in the process is to complete the HCBS Waiver Application. You may obtain an application packet on this webpage or you can contact the Eligibility Worker in your region. The date the completed Application Packet is received by DDSD is your application date. The application date is important because if you are found eligible for DD Waiver services, you will receive an offer to come into service based on that application date.

After the regional DDSD office receives the application packet, an Eligibility Worker will contact you if additional information is needed. All individuals applying for DDW have 60 days to return the application packet and supporting documentation. If the packet has not been returned or the Eligibility Worker has not been contacted, a Closure Warning Letter is sent. This letter is notification that your application will be closed in 30 days if the completed application packet has still not been returned.

Who determines eligibility?

An eligibility worker reviews information you, your guardian, and/or your authorized representative submit to DDSD and makes a determination regarding your eligibility for DD Waiver programs. This documentation may include a/n:

1. Educational Evaluations
2. Individual Educational Program (IEP)
3. Review of Existing Evaluation Data (REED)
4. Multidisciplinary Evaluation Reports
5. Neuropsychological/Psychological Evaluations
6. Medical Diagnosis Records
7. Autism/Autistic Spectrum Disorder (ASD) Evaluations

Please provide us copies of your paperwork and keep the originals for your records.

All documentation is accepted and reviewed based on the current definition of eligibility. Individuals who have certain conditions or mental health diagnoses, in addition to ID and/or a related condition, receive a second level review by a licensed practitioner to make sure the individual matches the DD criteria.

If you are eligible, you will receive a “Yes Match” letter indicating your name is on the wait list for services based on your registration date. There is an extensive wait list, so it could be several years before you receive DD Waiver services.

What services are available while I am on the wait list?

While you are on the wait list, there may be other services available. These services may include State General Funds (SGF), Centennial Care Community Benefits, and other community resources.

What if I receive a letter saying I am not eligible?

If you receive a “No Match” letter stating you are not eligible and your name will not be placed on the wait list, you may:

• Contact your Eligibility Worker for additional information;
• Request, in writing or by phone, an agency review conference. This is an opportunity to have a more in-depth conversation with the Central Registry Unit Manager about the denial;
• Request a Fair Hearing. This is an evidentiary hearing before an impartial Administrative Law Judge. You have 90 days from the date of the letter stating you are not eligible to ask for a hearing.