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Disabled and Elderly Waiver Program

Definition of Program

The Disabled and Elderly Waiver Program (D&E Waiver) at TACIL is a community-based Medicaid waiver program. D&E Waiver is designed to facilitate the integration of disabled and/or elderly individuals from dependent living in residential facilities to independent living in their own homes.

Reason for Existence

D&E Waiver programs were initiated in 1983 by the New Mexico State Legislature to furnish in-home care and community-based services for frail, elderly, and disabled individuals instead of nursing facilities or other institutional care. D&E Waiver is managed by the Department of Health.

D&E Waiver consistently demonstrates that people's quality of life is higher when they can remain at home. Recipients receive waiver services and the support of family, friends, and community resources.

Federal cost effectiveness mandates require that the total cost for furnished services must not exceed the cost of institutional care. Individuals whose medical and other needs exceed the cost of institutional care may be ineligible for waiver in-home care and community-based services.

Services in Program

Case Management (includes specialized services)

This service assists individuals in obtaining home and community-based Medicaid waiver services and to access other medical, social, and educational resources.

Case management services include:

  • Initial case assessment, development and implementation of the individualized service plan (ISP)
  • Referral, access, and coordination of waiver and non-waiver services
  • Facilitation of the interdisciplinary team
  • Monitoring appropriateness of services to validate the cost-effectiveness of the ISP
  • Reassessment of medical eligibility

Case management services provided to deinstitutionalized individuals do not duplicate discharge planning activities.

Eligibility Requirements

The Social Security Department, Disability Determination Unit has defined “disabled” as:

“The inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than twelve months.”

The definition of “elderly” for the purposes of D&E Waiver is an individual who is aged 65 or older.

Additional Requirements

The individual must meet both the medical level of care requirements and the financial eligibility requirements for institutionalization in a nursing facility. The income and resource criteria established by the Department of Health for all waiver programs are the same as those for institutional placement under the Medicaid State Plan, except for certain income restrictions.

To be financially eligible for D&E Waiver services, an individual must meet all supplemental security income eligibility criteria and their monthly gross income must be less than $1268.00.

  • The monthly gross income limit is adjusted annually by the Medical Assistance Division, Human Services Department.
  • Spousal impoverishment and community property regulations do not apply to the financial eligibility determination for applicants for Department of Health community based services.
  • As of March, 1997 there is also a complex resource limitation.

Medical Eligibility

The medical criteria established by the Department of Health require D&E Waiver applicants to meet a level of functional impairment sufficient to require institutionalization in a low or high nursing facility or an intermediate care facility for the mentally retarded.

Medical eligibility determination is made and verified by a certified peer review organization. The Department of Health must furnish the Health Care Financing Administration with sufficient information to support institutional medical level of assurances.

Traditional Funding Sources

D&E Waiver is a Medicaid waiver program, with seventy percent of program funding provided by the federal government and thirty percent by the state.

Similar Programs in Area

Area agencies offering similar services are:

Case Management

  • Desert State Case Management—Las Cruces
  • Professional Home Health—Las Cruces
  • Sun County Case Management—Las Cruces
  • Peak Developmental Services—Alamogordo
  • Fort Bayard Case Management—Fort Bayard

Homemaker/Companion and Respite Care

  • Ambercare, Inc.—Las Cruces
  • Coordinated Care—Las Cruces
  • Mountain Shadows Home Health—Las Cruces
  • Options, Inc.—Las Cruces
  • Gila Regional Home Health—Silver City