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Wyoming DD‑waiver wait list, rebasing study drive budget questions; 335 people remain on wait list
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Summary
Legislative staff and the Wyoming Department of Health told the Joint Appropriations Committee that 335 people remain on the DD waiver wait list and that a recent rate rebasing report would materially increase state costs if fully funded.
The Joint Appropriations Committee received a technical briefing on Wyoming’s developmental disabilities (DD) home‑and‑community‑based waivers and the program’s waiting list, with agency and LSO staff asking the committee to weigh tradeoffs between funding rates and funding people on the wait list.
LSO senior fiscal analyst Elizabeth Martineau told the committee that Wyoming administers two Medicaid waiver programs for people with intellectual and developmental disabilities — the comprehensive waiver and the supports waiver — and that each participant receives an individual budget calculated by formula. She explained the supports waiver is a smaller, more flexible budget (annual maximums cited in testimony: $22,712 for participants birth through age 21; $26,511 for participants age 21 and older). The comprehensive waiver budget is calculated from three factors: the level‑of‑service score, living situation and age; budgets can range from roughly $21,000 to $210,000 depending on assessed need.
The wait list and emergencies: Martineau and Department of Health staff reported 335 individuals on the DD waiver wait list; later in questioning the committee clarified that 260 of those are children and 60 are adults (the transcript numbers provided during questioning). Department staff said the average wait time has recently averaged about 14–15 months (committee discussion noted a previously used policy threshold of 18 months as a pressure point). The department has an “extraordinary care” process for emergent cases that can move an application to the front of the queue when health, safety or welfare considerations apply.
Rebasing study and provider rates: the department contracted Guidehouse Inc. to perform a rate rebasing study, and the steering committee released the final report in September 2024. The steering committee voted to publish the report but did not endorse immediate rate rebasing because they wanted more cost‑survey data before committing to a multi‑million‑dollar, long‑term rate increase. Department Director Stefan Johansson and state Medicaid agent Lee Grossman told the committee rebasing recommendations would add materially to the state general fund requirement: the steering committee’s recommended benchmarks implied an approximate $12,000,000 annual general‑fund increase (about $24,000,000 on a biennial general‑fund basis) and, when matched with federal funds, an estimated biennial budgetary effect approaching $48,000,000.
Choices for the committee: Department of Health officials framed the policy decision as three competing priorities — (1) fund more people off the wait list, (2) increase provider rates to better align payment with provider costs, and (3) fund higher‑acuity cases whose needs may otherwise end up in nursing facilities, inpatient psychiatric settings or the state hospital. The department said states have different approaches — some states have eliminated wait lists by appropriating larger sums; others prioritize tighter rate alignment. The department offered to provide the committee with cost models showing the state cost to fund the entire current wait list or to implement partial or phased rate increases.
Administration details and eligibility: staff explained the Medicaid asset limit applied to long‑term services is $2,000 in Wyoming (applied through the Medicaid eligibility process; staff noted the limit is a state option that could be amended with federal approval). LSO noted participation has grown since the 1990s as community‑based services replaced institutional placements; the committee also heard that attrition from the program is low — most people served are lifetime participants — so new inflows commonly outpace natural attrition and cause a persistent wait list unless the legislature increases capacity.
Next steps: committee members asked the department for cost estimates to (a) fund the entire wait list immediately, (b) fund only level‑5 and level‑6 (higher acuity) wait‑list members, and (c) the state general‑fund effect of adopting the steering committee’s rebasing recommendations. Department staff committed to deliver modeling and to clarify current counts and average wait times for adults versus children.
Ending: the department stressed that precise cost estimates are available and recommended the committee consider tradeoffs—rate adequacy, access and emergency placements—when weighing a policy response in the next budget cycle.
