1. Program Definition and Services

Family Living Services in New Mexico provide a structured, family-like living environment for individuals with intellectual or developmental disabilities. The program aims to help maintain individuals with disabilities in the community, averting the need for institutional or long-term services and supports. Services include:

• In-Home Personal Care: Individual support in the individual/family home or community (Personal Care Assistance with ADLs, Skill Building and Training, Health Monitoring and Medication Administration, Behavioral Support, and Caregiver Training and Guidance)
• Residential Personal Care: Supervision and care in a licensed residential or shared community-based setting (24/7 Supervision and Structural Support, Community Integration and Socialization Tracking, Emergency and Safety Planning, Progress Reporting, and Individualized Service Plan [ISP] Compliance Monitoring)

2. Regulations

The program is governed by the following regulations:

• New Mexico Administrative Code, Title 8, Chapter 314, Part 5 (Developmental Disabilities Home and Community-Based Services Waiver)
• New Mexico Administrative Code, Title 8, Chapter 314, Part 3 (Medically Fragile Home and Community-Based Services Waiver)
• New Mexico Health Care Authority (HCA) Developmental Disabilities Supports Division (DDSD) Waiver Service Standards (Living Supports - Family Living Service Requirements)
• The New Mexico Nurse Practice Act (NMSA 1978, Chapter 61, Article 3, concerning medication delegation rules in community environments)

3. Licensing or Certification

An agency must be certified as a Living Supports provider by the New Mexico Health Care Authority (HCA) and the Developmental Disabilities Supports Division (DDSD), following all Home and Community-Based Services (HCBS) requirements. If the provider agency operates community properties directly or delivers services in coordinated community home environments, they must satisfy local zoning and fire safety standards, as well as clear residential care guidelines monitored by the Health Care Authority's Division of Health Improvement (DHI).

4. Responsible State Agency

The New Mexico Health Care Authority (HCA), through its Medical Assistance Division and in coordination with the Department of Health (NMDOH) Developmental Disabilities Supports Division (DDSD), is responsible for reviewing applications, vetting organizational models, conducting provider readiness evaluations, and certifying family living services providers.

5. Application Process

The application process is conducted through the electronic New Mexico Medicaid Provider Enrollment Portal (YES.NM.GOV). Providers must submit forms online to initiate the enrollment process after successfully responding to a regional DDSD provider recruitment call or open-enrollment cycle and demonstrating adequate infrastructure to support home placements.

6. Required Documentation

While specific documentation requirements vary based on the target waiver, providers typically need to submit:

• Proof of compliance with state safety, corporate registration, and residential support operational rules
• Agency policies and procedures (including caregiver oversight protocols, incident management systems, medication oversight workflows, and clinical escalation paths)
• Staff and primary caregiver qualifications, high school diploma or equivalent verifications, and professional development records
• Proof of general liability, professional liability, and specialized business vehicle insurance (if transporting participants)

7. Timeline for Approval

The exact timeline for approval fluctuates based on agency capacity. The provider enrollment application and state readiness evaluation process typically takes approximately 60 to 90 days once a complete package is submitted.

8. Pre-Application Process

Prospective providers must complete specific foundation tasks before applying. They must establish their business entity with the New Mexico Secretary of State, secure necessary federal identification numbers (such as an EIN and an applicable Type 2 NPI), and create a formal caregiver vetting template.

9. Pre-Application Training

The state hosts mandatory administrative and compliance training sessions online. Access details are sent to qualified applicants once preliminary paperwork is reviewed through the state's provider learning management system.

10. Additional Notes

• Providers must ensure that administrative offices, caregiver orientation hubs, and individual client residential spaces meet all state accessibility, privacy (HIPAA), and environmental safety guidelines.
• In-Home Personal Care elements (such as face-to-face developmental coaching or medication tracking) must be monitored regularly by the certified agency's professional oversight personnel.
• All primary family caregivers, direct support professionals, and administrative staff must complete mandatory background clearances through the New Mexico Caregivers Criminal History Screening (CCHS) program.
• Providers must maintain detailed records of daily service delivery logs, individual service plans (ISP), medication administration records (MAR), and quarterly safety inspections for Medicaid documentation and billing.

Why Choose Waiver Consulting Group?

Starting or expanding your Medicaid waiver-funded agency can feel overwhelming, but it doesn't have to be. At Waiver Consulting Group, we simplify the process by guiding you through licensing, compliance, provider enrollment, policies & procedures, and regulatory approvals in any state.

With proven expertise, a structured process, and ongoing support, we take the guesswork out of launching your healthcare business. Whether you're a first-time entrepreneur or an established provider looking to expand, our team ensures you stay compliant, competitive, and fully operational.

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