DD Waiver or Mi Via for a Child Under 18: How to Choose

When your allocation packet arrives, it includes a Primary Freedom of Choice form where you choose between the traditional DD Waiver and Mi Via. You have 45 calendar days to return it.

There is no wrong answer here. Both programs fund real support, and families do well on each. They are built differently, and for a child under 18 those differences land in specific places.

One thing surprises almost every family, so it is worth saying up front. For a child, neither waiver is the program that pays for hands-on personal care at home. That comes from Medicaid's EPSDT benefit, which covers home health and personal care services for anyone under 21. Both waivers are built around that. Chapter 7.1 of the DD Waiver Service Standards says waiver services for anyone under 21 are available only to the extent they do not duplicate EPSDT, and Mi Via's Appendix A limits Homemaker/Direct Support to participants 21 and older for the same reason. The waivers sit on top of EPSDT. Once you know that, the choice between them gets much clearer.

New to all of this? Start with our overview of New Mexico's Medicaid waiver programs.

Start here: EPSDT

For anyone under 21, Medicaid's Early and Periodic Screening, Diagnostic and Treatment benefit runs through your child's Turquoise Care managed care plan. Under NMAC 8.320.2, Medicaid covers medically necessary services for anyone under 21 to correct or lessen physical and behavioral health conditions, at no cost to the child. The state's Keeping Kids Healthy page lists what that includes: home health and personal care services, therapies, behavioral health, case management, medical supplies, and more.

This is why the waivers look the way they do for children. Chapter 7.1 of the DD Waiver Service Standards says Medicaid State Plan benefits are always considered before waiver services, and that waiver services for anyone under 21 are available only to the extent they do not duplicate EPSDT, Medicaid School Based Services, or services from the Public Education Department. NMAC 8.314.5.14 says the same for the birth-to-18 service category.

There is a second reason this matters. Under Letter of Direction #108, New Mexico has permanent federal authority for a legally responsible individual to be hired as a paid caregiver for personal care services under extraordinary circumstances, through the EPSDT and Agency Based Community Benefit programs. The request comes from a personal care agency and your managed care organization approves it. So EPSDT may be both the source of your child's in-home care and a way for you to be paid for providing it.

Ask your MCO care coordinator about this regardless of which waiver you choose.

What the DD Waiver offers a child under 18

The DD Waiver is agency-directed. A provider agency employs the caregivers and carries the training, compliance, payroll, and paperwork.

Agency-directed does not mean strangers in your home. At Lift New Mexico, our families typically choose a family member or close friend to provide the services, often a parent or a grandmother. We believe that is the best arrangement for most families, because you keep control over who cares for your loved one while we carry the paperwork.

Chapter 7.2.1 of the Service Standards lists the Children's Category services, birth to 18:

• Case Management
• Behavior Support Consultation
• Crisis Supports
• Customized Community Supports, Individual (CCS-I), outside of school hours
• Respite
• Non-Medical Transportation
• Nutritional Counseling
• Environmental Modifications
• Assistive Technology
• Remote Personal Support Technology
• Healthy Relationships and Personal Safety Education

There is no fixed annual budget by age on the DD Waiver. Services are authorized through the ISP and Budget Worksheet based on your child's assessed needs, so behavior and clinical services do not compete with everything else for the same dollars. For a family managing significant behavioral needs, Behavior Support Consultation and Crisis Supports are the standouts. New Mexico also runs a statewide crisis line at 505-250-4292, answered evenings and weekends.

Customized Community Supports, Individual is available at any age. For children it is provided outside of school hours, one caregiver to one participant, and delivered in the community to the fullest extent possible.

Two services you may have heard about are limited by age. Family Living, where a caregiver is paid a daily rate to have the participant live with them, falls under Living Supports, which Chapter 10.3 limits to people 18 and older absent a DDSD and Health Care Authority exception for extraordinary circumstances. Customized In-Home Supports carries the same exception language in Chapter 7.3.

What Mi Via offers a child under 18

Mi Via is self-directed. You build a Service and Support Plan with a consultant, a financial management agency handles payroll, and you choose and negotiate with the people who provide care. The SSP 2026 form and its instruction guide show exactly what you will be asked.

Here is the part families need to know early. Mi Via's Living Supports are for adults. The Mi Via Services and Supports page lists the ages alongside each one, and Appendix A explains why:

• Home Health Aide, ages 21 and older
• Homemaker/Direct Support, ages 21 and older, because personal care for waiver participants under 21 is covered under the Medicaid State Plan as an expanded EPSDT benefit
• In-Home Living Supports, ages 18 and older

Skilled Therapy for Adults and Private Duty Nursing for Adults are also 21 and older, for the same EPSDT reason.

What a child under 18 can use on Mi Via:

• Community Direct Support, which builds community connections and access to social, recreational, and leisure activities. Appendix A says it is provided outside the participant's residence and does not cover home schooling, tutoring, or academic instruction.
• Respite, short-term relief for the unpaid primary caregiver. It cannot be used as day care and cannot be provided to school-age children during school hours, including home school hours.
• Behavior Support Consultation, Specialized Therapies, Environmental Modifications, Transportation, Emergency Response Services, Nutritional Counseling, Related Goods, Customized Community Group Supports, and Employment Supports.

Every participant also has an Individual Budgetary Allotment (IBA), the annual funding amount set by age. The state's Mi Via Waiver FAQ, updated January 2026, lists:

Everything in the plan is paid from that amount. You can request funding above the IBA when documented needs call for it, and your consultant can explain that process.

Where the support happens

For a child under 18, neither waiver funds a paid caregiver sitting with your child at home all day. That is the EPSDT piece.

What each waiver adds is different in character. The DD Waiver's CCS-I is structured 1:1 time in the community, outside school hours. Mi Via's Community Direct Support is also outside the residence, focused on community connection. Both are built to get your child out and engaged, not to replace personal care at home.

Getting paid as your child's caregiver

Both programs allow it, with rules that come from the same place. The DDSD document Requirements for Services Provided by Legally Responsible Individuals, Relatives, and Legal Guardians, dated February 2026, reflects permanent CMS approval for these payments.

First, a term you will see on every form. A Legally Responsible Individual (LRI) is someone who has a duty under state law to care for another person. That means the parent, biological, legal, or adoptive, of a child under 18, a guardian who must provide care to a child under 18, or a spouse. If you are the parent of a minor, you are an LRI, and a specific set of rules applies to paying you. A grandparent, aunt, adult sibling, or family friend is a relative or a chosen caregiver rather than an LRI, and those rules are lighter.

On the DD Waiver, the LRI-payable services are Family Living (only if you are not an LRI), Customized In-Home Supports, Customized Community Supports, Community Integrated Employment, and Respite. For a child under 18, that comes down to CCS-I and Respite, since the other three are adult services.

On Mi Via, a parent can be paid for nearly every service. The exclusions are Consultant Services, Customized Group Supports, and Individual Directed Goods and Services. For a child, the practical options are Community Direct Support and Respite.

The shared requirements:

• The plan must show the parent is the best fit, not simply the default, and must include a backup plan.
• Where the service includes personal care, a parent can only be paid for extraordinary care, meaning care beyond what a parent ordinarily provides for a child of the same age without a disability.
• You sign an LRI Information Form annually, attesting that you understand no more than 40 hours in any 7-day period may be paid to an LRI.
• Units cannot be set to maximize payment to the parent at the cost of other services your child needs.

If you homeschool, ask your case manager and DDSD how "school hours" applies to your family. That answer shapes both CCS-I and Respite.

One Mi Via detail that catches families out: a minor cannot be their own Employer of Record, so another trusted adult takes that role. The state has been moving EOR toward a paid waiver service, so ask your consultant how it works now.

How the money works

The two programs are structured differently, so compare them on their own terms.

On Mi Via, you set the pay rate, and it comes out of your child's annual budget along with payroll taxes and everything else in the plan. Each service has a published minimum and maximum in the Range of Rates. The 2025 waiver renewal materials put Community Direct Support at $1.98 to $16.30 per hour and Homemaker/Direct Support at $7.90 to $15.38 per hour. A rate above the range can be requested with written justification, decided mainly on the participant's condition and need.

On the DD Waiver, the agency is the employer and sets the rate. Lift New Mexico pays $30 per hour for CCS-I, and pay follows approved CCS-I hours. At that rate:

That table is specific to DD Waiver CCS-I through Lift. Every agency sets its own CCS-I pay rate, and other agencies pay more or less than we do, so ask any agency you are considering what they pay per hour for CCS-I. The table also does not carry over to Mi Via, where the rate is yours to set inside the published range and the annual budget is the ceiling.

Set the two side by side with your own numbers. Families who want maximum control over who provides support, when, and at what rate often prefer Mi Via. Families who want someone else carrying the employer role, and behavior and crisis supports funded outside the budget, often prefer the DD Waiver. Pay is not automatically higher on the DD Waiver. Because each agency sets its own rate, the comparison only holds once you know what a specific agency pays.

Questions to ask before you send the form back

1. What is our child already getting through EPSDT, the school district, or Medicaid State Plan, and what gaps are left?
2. Could we be paid for personal care hours through EPSDT, separate from the waiver?
3. If we homeschool, what counts as "outside of school hours" for CCS-I and Respite?
4. Realistically, how many community hours would our child's assessed needs support?
5. Does our child need Behavior Support Consultation or Crisis Supports, and how would each program fund them?
6. How much of the employer role do we want to take on, versus having an agency handle it?
7. Who would serve as Employer of Record if we go with Mi Via?

If your child is 18 or older

The options shift at 18, and several services described here work differently for adults. If your child is already 18 or older, see our Mi Via vs. DD Waiver guide for adults 18+ instead.

You can change your mind later

Choosing one program now does not lock you in, and you will not lose your allocation by switching. To move between the DD Waiver and Mi Via you complete a Waiver Change Form, available from the DDSD Mi Via Unit or your DDSD regional office. Your case manager or consultant can walk you through it.

Also worth exploring

• School services. Your child has rights under IDEA regardless of where they are educated. Ask your district what is available.
• Family support. Parents Reaching Out is a free New Mexico organization with family liaisons who help parents work through exactly these decisions.

A few acronyms you will hear

• PFOC, Primary Freedom of Choice. The form that comes with your allocation, used to choose between an ICF/IID, the DD Waiver with a Case Management Agency, or Mi Via with a Consultant Agency, or to place your allocation on hold or decline it. You have 45 calendar days to return it. Chapters 1.3 and 1.4 of the DD Waiver Service Standards.
• SFOC, Secondary Freedom of Choice. The form you use afterward, on the DD Waiver, to choose the provider agency for each service other than case management. You have the right to review it at least annually and to change agencies at any time without retaliation. Chapter 4.4.
• IBA, Individual Budgetary Allotment. On Mi Via, the annual funding amount set by age.
• SSP and ISP. The Mi Via Service and Support Plan, and the DD Waiver Individual Service Plan.
• EOR, Employer of Record. On Mi Via, the person who directs the paid supports. A minor cannot be their own EOR.
• TPA and FMA. The Third Party Assessor reviews and approves Mi Via plans and budgets. The Financial Management Agency handles payroll and employer paperwork.
• EPSDT. Medicaid's benefit for anyone under 21, covering medically necessary care through your managed care plan.
• CCS-I, Customized Community Supports Individual. DD Waiver service, any age, 1:1 in the community, outside school hours for children.
• CDS, Community Direct Support. The Mi Via service for community connection, provided outside the residence.
• LRI, Legally Responsible Individual. A parent or guardian of a minor, or a spouse. Extra approval and an annual form are required for an LRI to be paid.

Sources

• DD Waiver Service Standards: Chapter 7.1 (services that may not duplicate EPSDT), Chapter 7.2.1 (Children's Category), Chapter 7.3 and Chapter 10.3 (age requirements for Customized In-Home Supports and Living Supports), Chapters 1.3, 1.4, and 4.4 (PFOC and SFOC).
• NMAC 8.314.5, Developmental Disabilities Home and Community-Based Services Waiver, including 8.314.5.14 on covered services for the population under 18.
• Mi Via Services and Supports, NM Health Care Authority: service list with age requirements, Service Standards, and appendices.
• Mi Via Service Standards Appendix A: Service Descriptions in Detail: age limits, service scopes, and LRI qualifications.
• Mi Via Service Standards: planning, budgeting, Range of Rates, and the 40-hour limit.
• Mi Via Waiver Frequently Asked Questions, January 2026: resource allocation by age, the Employer of Record role, and the Waiver Change Form.
• Mi Via Waiver Renewal 2025: IBA increases effective July 1, 2024 and rate ranges by service.
• Mi Via Service and Support Plan 2026 and SSP 2026 Instruction Guide.
• Mi Via Employer of Record Fact Sheet and Mi Via Self-Direction Fact Sheet.
• Requirements for Services Provided by Legally Responsible Individuals, Relatives, and Legal Guardians and the LRI Information Form, DDSD.
• NMAC 8.320.2, EPSDT services, and Keeping Kids Healthy, NM Health Care Authority.
• NM Human Services Department Letter of Direction #108, November 2023.

This guide summarizes state rules for families and is not legal or benefits advice. Program rules change. Confirm current details with DDSD or with us before making decisions.