Providers and families urge $12 million annual increase to Wyoming DD waiver rates to cover costs and raise direct‑support wages

Statewide providers, families and Department of Health officials told the Wyoming Legislature’s Appropriations Committee that the state should fund a legislatively required cost rebasing for the Developmental Disabilities (DD) Medicaid waiver and that funding the study’s recommendation would require about $12 million a year (roughly $24 million per biennium).

The request, made during public comment and a question-and-answer session, was driven by providers’ claims that current Medicaid reimbursement rates do not cover operating costs and that low wages are causing high turnover among direct support professionals (DSPs), limiting the system’s capacity to serve people on the waiver wait list.

The DD waiver provides home‑and‑community‑based services to people with developmental disabilities and some people with acquired brain injuries. Bob Sell, president and CEO of ARC Regional Services in Laramie, said, “We are not advocating for a random increase in funding or an expansion of the program. We are simply asking that the program be funded at what it actually costs.” Jeff Gardner, executive director of Wyoming Community Service Providers, told the committee “providers right now are hurting financially.”

Providers said the cost‑rebasing study — which they described as focused on the wage and labor costs of DSPs — recommends raising DSP pay. Sean Griffin, CEO of Community Entry Services, summarized providers’ view: “We’re not asking for the sky or the moon. We’re asking for our cost to be covered, and that’s all.” Committee members asked how the increased funding would be spent; providers said most of the proposed increase would go to direct wages to reduce turnover and expand capacity.

Key factual points raised during testimony: - Requested increase: witnesses repeatedly cited $12,000,000 per year based on the cost study released in the fall, which providers equated to about $24,000,000 per biennium. (Testimony attributing the dollar figure: Bob Sell; Jeff Gardner.) - People served: Department testimony earlier in the day cited more than 2,600 people on waiver programs; provider testimony described the program as supporting roughly 2,900 people statewide. (Attributions in transcript vary.) - Wait list: providers and committee members discussed roughly 330 people on the wait list; in committee exchange Sell said the list includes about 260 children and 60 adults. (Sell; committee questioning.) - Wages and staffing: witnesses said the average DSP wage cited in testimony was about $15.10 per hour and noted a Massachusetts Institute of Technology living‑wage estimate of $21.07 for one adult in Wyoming. Providers said the cost study would raise average DSP wages to roughly $20.70 per hour (testimony attributed to providers discussing the study). Daryl Skinner, executive director of Lincoln Self Reliance, said his program’s average wage is about $16.81 and described local wage competition in areas such as Jackson Hole. - Cost comparisons: a provider said average annual cost per person for 24‑hour waiver care is about $77,000, while the Wyoming Life Resource Center’s per‑person budget when divided by its census was described in testimony as “over $600,000 per person” (attributed to provider testimony emphasizing institutional costs are higher than community care).

Providers and family members described operational impacts: they said high turnover among DSPs (testimony noted an average tenure of about six months in some programs) increases training needs and medication‑error risk, reduces continuity of care and limits providers’ ability to accept people coming off the wait list. Parent and family testimony described intensive daily care needs for people at higher levels of need and the practical strain on families.

Providers also addressed the cost‑study process itself. Witnesses told the committee that a steering committee declined to forward the study to the legislature because of a perceived low response rate from certain providers; provider witnesses said the study nonetheless represented a valid sample and provided the committee a letter from Dr. Eric Moody of the University of Wyoming attesting to the study’s validity. Providers said many nonparticipating providers are small operations serving three or fewer people and may not have had staff time to complete the survey.

The Department of Health described existing oversight and program integrity measures and offered to provide additional information at the committee’s request. The department said it can supply tables showing current rates, the number of people in each service‑level bucket, and cost estimates for options such as actions on the wait list or provider rate changes. The director also agreed to provide data on extraordinary care committee (ECC) approvals and on recent program‑integrity cases where that is not part of an ongoing investigation.

Committee members and the director discussed ECC procedures, which the department said meets weekly to consider emergency or extraordinary care funding and that ECC approvals typically account for about $3 million annually in additional costs. Department staff told the committee ECC decisions require medical documentation and case evidence and that improving front‑end documentation is a priority to reduce delay.

No formal legislative action or vote occurred during the hearing. Committee members directed the Department of Health to return with cost tables and options and requested follow‑up materials, including: breakdowns of current spending by service level, ECC case counts and outcomes, historical information about fraud/waste investigations where available, and scenarios showing the fiscal effect of partial or phased funding increases. The committee scheduled additional interim work, including an August meeting in Dubois and a planned site visit to a waiver provider.

Sources and on‑the‑record quotes are from provider witnesses and Department of Health staff appearing at the Appropriations Committee hearing (transcript excerpts provided to the committee). The committee asked agencies and the Legislative Service Office to supply the requested tables and scenarios before the next meeting.

The committee’s follow‑up direction leaves open multiple policy choices: whether to appropriate the full amount the study recommends, to phase increases, or to target the funding to recruitment and retention incentives for DSPs or to wait‑list reduction. Providers urged the committee to treat the rebasing as a cost‑coverage exercise rather than program expansion.