Providers, families urge full funding for Wyoming DD waiver; committee asks Department of Health for options

Providers of Wyoming’s developmental disabilities waiver and family members told the Wyoming Legislature’s Appropriations Committee that current Medicaid reimbursement rates are not covering the actual cost of home- and community-based services (HCBS) and urged the legislature to fund a statutorily required cost rebasing.

"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," said Bob Sell, president and CEO of ARC Regional Services in Laramie. Sell and other provider witnesses cited a cost study released this fall that they say supports increased reimbursement levels.

The funding matter matters because Wyoming’s DD waiver supports thousands of people with developmental disabilities, acquired brain injuries and related conditions in community settings rather than institutions. Witnesses said community-based care is less costly than institutional care and that current rates limit providers’ ability to recruit and retain staff, in turn constraining capacity to serve people on the waiting list.

Jeff Gardner, executive director of Wyoming Community Service Providers, told the committee that the state’s reimbursement is a cost-based model but currently “it’s not even paying the cost.” Gardner said the cost study would move average direct support professional (DSP) wages closer to $20–$21 an hour from current averages and that the study’s recommended funding increase would be roughly $12,000,000 per year (about $24,000,000 per biennium).

Sean Griffin, CEO of Community Entry Services, said the study is driven primarily by direct labor costs and that increased funding would go to frontline DSP wages. "We're not asking for the sky or the moon. We're asking for our cost to be covered and that's all," Griffin said.

Providers and agency leaders described operational pressures they say are caused by low pay and high turnover. Daryl Skinner, executive director of Lincoln Self Reliance, said turnover for frontline staff averages about six months and his organization’s average DSP wage is roughly $16.81 per hour; he noted competition from nearby Jackson Hole where employers pay substantially more.

Family members gave personal testimony about the consequences of insufficient services. Timmy Park and Tammy Park spoke about their adult son’s and client’s complex needs (identified in testimony as level-5 care), explaining that 24-hour supports, incontinence care and medical needs make continuity of staff important for safety and quality of life. Representative Pendergraft and other legislators described long personal involvement with care of people with severe disabilities.

Witnesses and providers also discussed the scope of the program and comparative costs. Providers said the DD/HCBS waivers support about 2,900 Wyoming residents statewide. They cited an approximate average annual cost of $77,000 per person for 24-hour community-based supports versus more than $600,000 per person annually at the Wyoming Life Resource Center when the institution’s broader budget is allocated per resident, numbers the witnesses introduced for committee context.

Committee members pressed for details. Senator Smith and others asked the Department of Health for breakdowns by service level, counts in each reimbursement tier, and historic data on how the study’s recommendations were formed. The Department said tables showing costs, counts by service level and scenario estimates are available and committed to providing those to the committee in advance of the committee’s August meeting in Dubois.

Committee members also sought information about oversight and program integrity. The director of the Wyoming Department of Health described the department’s program-integrity functions, the Medicaid Fraud Control Unit housed in the attorney general’s office, and federal-state monitoring processes, and offered to provide a recent summary of investigations and outcomes where publicly shareable.

Legislators asked for operational details on the Extraordinary Care Committee (ECC), the process used to consider emergency funding requests for people with immediate, severe needs. Elizabeth Forrester (Department staff who described the ECC process) said the ECC reviews applications supported by clinical documentation and that ECC-approved funding typically totals about $3,000,000 annually; the department said it is trying to reduce front-end delays by helping families and case managers gather complete documentation before ECC review.

No formal funding decision or vote was taken. The committee directed the Department of Health to prepare cost tables, disaggregate enrollments and expenditures by service level, furnish data about program-integrity investigations (subject to confidentiality constraints), and provide a briefing on ECC caseloads and turnaround times. The committee also requested follow-up materials that model different funding and staffing scenarios (for example, partial funding options that would reduce the waiting list incrementally) and scheduled an August committee meeting in Dubois to continue the work.

"We’ll look to provide tables that show what options would look like for actions on the wait list or provider rates," the Department director said.

The hearing highlighted trade-offs the committee faces: committee members repeatedly framed this as a prioritization decision given finite state budget resources. The Department of Health said its top five line items account for roughly 90% of the department budget and offered to work with the committee to identify offsets or re-prioritization options.

The Appropriations Committee did not adopt legislation at the hearing; staff and agencies will return with additional data and modeling for the August meeting in Dubois, including potential draft language if the committee elects to pursue statutory changes or appropriation requests.