Written by a parent, not a doctor. Nothing here is medical advice.

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New Mexico program

Medicaid that can leave parents’ income out (Medically Fragile Waiver)

A limited Medicaid route for children with daily skilled nursing needs and developmental needs.

What it is

A limited Medicaid route for children with daily skilled nursing needs and developmental needs.

The Medically Fragile Waiver can open Medicaid when parents’ income is too high for ordinary coverage. It requires daily skilled nursing plus a developmental disability, delay or risk of delay. A cancer diagnosis alone does not establish that fit. Waiver services can also be worth discussing when ordinary Medicaid already covers your child.

Eligibility rules
  • The medically fragile condition must be diagnosed before age 22.
  • The clinical test requires a chronic physical condition and prolonged dependence on medical care. Daily skilled nursing must be medically necessary, alongside a developmental disability, delay or risk of delay.
  • The required level of care is that of an intermediate care facility for people with intellectual disabilities.
  • Parents’ income and resources can count in the allocation-letter month. From the next month, the child’s own income and countable resources are tested, including the $2,000 resource ceiling.
  • Only your child's own income counts from the month after the allocation letter, and most children have none. Savings in the child's name must be under $2,000.
  • This waiver is one route, not the whole disability-Medicaid review. The social worker can ask HCA about SSI-linked coverage, institutional categories and other home-and-community routes. HCA can confirm whether a Katie Beckett/TEFRA category, buy-in or spenddown is currently available.
What you get
  • Full Medicaid and approved services at home once a place is allocated and enrollment is completed.
  • Only your child’s own income and savings count from the month after the allocation letter.
What this includes
  • Services support care at home rather than in an institution.
  • The waiver’s financial rule does not take an institutional medical-care contribution from the child’s income. The waiver team can confirm any applicable fees and identify which services or purchases are outside the approved plan before the family agrees to a charge.
If you decide to apply
  1. Ask the oncology social worker about a referral to the Medically Fragile Waiver team at 505-670-8954.
  2. Have diagnosis dates, nursing notes and your child’s own income and savings information ready.

The Developmental Disabilities Supports Division screens and allocates; the Health Care Authority then decides the financial side · 505-670-8954 · Official page ↗

After you apply
  • The Developmental Disabilities Supports Division decides clinical eligibility and allocation. New Mexico Health Care Authority reviews finances. Pre-service intake is also available at 505-350-0034 or 505-470-5825.
  • There are three steps: a clinical screen, the offer of a funded place, and the Medicaid financial decision. Places are limited, so ask the waiver team how long the wait is now.
Good to know

Places are capped by funding and enrollment limits. A clinical screen does not promise an available place.

Other details
  • A written refusal identifies whether the issue is nursing needs, developmental criteria or another requirement. The social worker can ask about other Medicaid categories.

Federal background: Home and community-based Medicaid waivers.

Official sources
Ask your social worker

“Could our child’s nursing and developmental needs fit this waiver? What are the benefits and drawbacks, and could you help us seek a screening if you recommend it?”

Why I’m asking: We want to know whether our child has another Medicaid route if household income is too high.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

Ask to be screened by name, and get any refusal in writing so it can be appealed.

Your social worker

The oncology social worker can make the referral and send the medical records that describe the nursing your child needs.

The care team

The doctors describe the daily skilled nursing your child needs at home; that description is what the screening turns on.

Who decides
The Developmental Disabilities Supports Division decides the clinical side and the allocation; the Health Care Authority decides the money.
Ask your social worker
“Can we be screened for the Medically Fragile Waiver, and can someone ask in writing whether New Mexico has a Katie Beckett category?”

How to apply

First step: Call 505-670-8954 and ask to be screened for the Medically Fragile Waiver by name.

  1. Call 505-670-8954 and ask to be screened for the Medically Fragile Waiver by name.
  2. Ask whether New Mexico elects a Katie Beckett category, and ask for the answer in writing.
  3. Ask where your child sits on any list and what the wait has been.

Official application / program page ↗

Where it starts: Call the Medically Fragile Waiver programme manager on 505-670-8954, or pre-service intake on 505-350-0034 or 505-470-5825, and ask to be screened. Ask in the same call whether New Mexico has a Katie Beckett category.

What to gather

  • Clinic notes describing the nursing your child needs at home
  • The date of diagnosis
  • Your child’s own income and savings, if any

How long: Unknown. No assessment deadline or observed wait is published.

What a yes looks like

An allocation letter. From the month after it, only your child’s income and savings are counted.

What a no looks like, and the next move

A refusal on the level of care or the developmental criterion. Ask for it in writing and ask what other category the office can screen for.

Watch out

  • Leukemia alone is not the test: the rule asks for daily skilled nursing plus a developmental disability, delay or risk of one.
  • Places are capped by funding and a head count, and no waiting-list figure is published.
  • Nobody has confirmed whether New Mexico has a Katie Beckett category. Ask, and get the answer in writing.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

From the month after the allocation letter, only your child’s own income and savings count, against a $2,000 resource ceiling.

  • $2,000 — Countable resource ceiling for the child once parental resources stop counting

Covers: Full New Mexico Medicaid once enrolled · Waiver services in the home rather than an institution

Legal protection: Parental income and resources can count through the allocation month; the child-only financial test begins the following month.

What it costs the family: Unknown. No premium schedule was published where we could read it.

The eligibility facts, as published

Age
a medically fragile condition diagnosed before age 22
Income
the child’s own income from the month after the allocation letter; parents’ income counts in the allocation-letter month itself
Resources
Parents’ income and resources can count in the allocation-letter month. From the next month, the child’s attributable available resources are tested against $2,000.
Level of care
the level of care provided in an intermediate care facility for people with intellectual disabilities
Clinical
a chronic physical condition with prolonged dependency on medical care for which daily skilled nursing is medically necessary, plus a developmental disability, delay or risk of delay

Expect friction on: Enrolment is capped by the money the legislature appropriates and by a federally authorised head count

The trap: Leukemia on its own is not the published test. The waiver asks for a medically fragile condition diagnosed before 22, a developmental disability or delay or a risk of one, and a level of care usually provided in an institution. Ask to be screened rather than assuming either answer.

Where I read this

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