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Wyoming officials outline DD waiver wait list, costs and pending rate study
Summary
Legislative staff and Department of Health briefed the committee on Wyoming’s developmental-disability (DD) Medicaid waivers: enrollment trends, a 335‑person wait list, statutory rebasing requirements and a recent consultant study that recommends higher provider rates.
Legislative Service Office analyst Elizabeth Martineau told the Joint Appropriations Committee that Wyoming administers two Medicaid home- and community-based programs commonly referred to as DD waivers: the Comprehensive Waiver and the Supports Waiver. The programs serve people with intellectual or developmental disabilities (and adults with acquired brain injury) and provide services such as case management, respite, habilitation, crisis intervention and specialized equipment.
Why it matters: The programs are large Medicaid line items with significant state and federal funding; changes in provider reimbursement or expansion of services to cover the wait list have sizeable budget implications.
Key points from the briefing
- Current enrollments and wait list: Martineau reported 335 individuals on the DD-waiver wait list. The transcript contains some inconsistent numeric mentions during questioning about adult/child breakdowns; the department confirmed the 335 total but members asked for a clear breakdown by waiver and age group. - Appropriations and funding mix: For the current biennium (25‑26) the LSO memo cited roughly $296 million for the Comprehensive Waiver and $23 million for the Supports Waiver; historically the state/federal mix has trended toward about 50/50 in recent years. - Rebase (rate) study: A consultant (Guidehouse Inc.) completed a rebasing study issued in September 2024. The steering committee released the report but did not endorse immediate rebasing because committee members requested more cost-survey data. The rebasing recommendation in the report carried an estimated fiscal impact of roughly $12 million general fund annually (about $24 million GF on the biennial basis) — approximately $48 million once matched with federal funds on a biennium basis; the department emphasized the legislature has discretion whether to fund all, some or none of the recommendation. - Service budgets: Comprehensive-waiver budgets are individualized and driven by a level-of-service score, living situation and age; supports-waiver budgets are a fixed maximum (cited figures were $22,712 annual max for participants birth through 21 and $26,511 for participants 21 and older).
Department of Health overview and operational points
Director Stefan Johansson and state Medicaid agent Lee Grossman said the department handles enrollment, eligibility and oversight. They described three policy tensions for appropriators: (1) funding people off the wait list, (2) funding provider rates/rebasing, and (3) focusing limited resources on the highest-acuity cases (emergencies or people at risk of institutional placement). The department said it will provide cost modeling at the committee’s request.
Wait-list handling and emergency cases
The department said the average time on the wait list at the time of testimony was roughly 14–15 months (no one was reported as waiting longer than 18 months). Wyoming has an “extraordinary care” committee that can consider emergent placements for individuals whose health, safety or welfare is at risk; that pathway is for urgent, high-acuity cases and is separate from the normal wait-list process. While waiting for waiver funds, many applicants receive limited supports through targeted case management.
What lawmakers asked for
Committee members requested clearer breakout of the 335 wait-list cases by age and by which waiver (supports vs. comprehensive), and asked the department to model at least three scenarios: (a) funding provider-rate rebasing as recommended in the Guidehouse report; (b) funding a defined number of wait-list participants; and (c) the cost of prioritizing level‑5/6 (highest-acuity) participants. The department agreed to provide the requested cost estimates and clarifying data for the committee’s next meeting.
Ending note
No formal vote or policy action was taken in the hearing. Department of Health staff said they will supply additional breakdowns (wait-list age and waiver assignment), provide modeling for the rebasing recommendation and quantify costs for various funding scenarios.
