Wilson County Social Services Reports Rising Medicaid caseload, Flags Growth in Assisted-Living Boarding Houses

Kimberly Irvin, director of the Wilson County Department of Social Services, told commissioners the agency is preparing a fiscal 2026 budget request and outlined program trends and operational needs.

Irvin said Medicaid-related spending is a major driver of county and state expenditures. “Adult Medicaid is the most expensive program area and that's mainly due to end of life care,” she said, describing national and state-level shares of long-term care costs. For Wilson County she cited an estimated expenditures figure of “283,408,054” for the fiscal year that ends in June and said case counts have risen; the department reported an increase of about 2,300 cases between the referenced periods and described a substantial rise in adult Medicaid caseloads.

Irvin said state-and-county special assistance for in‑home residents has grown after the removal of a previous slot cap; that program’s funding is roughly 50% state and 50% local, and the department reported approximately a 176‑case increase in those slots year over year. She also said Child Protective Services (CPS) complaints are up by about 11% while foster care caseloads have seen a recent decrease but remain variable; the department admitted five children into foster care in a single recent week. Irvin said 28% of youth in the department’s programs are ages 18 to 21 and participating in independent‑living programs.

On staffing and operations, Irvin said the department currently has about 236 positions and is pursuing efficiency through internal recruitment and management reductions. Operational increases include a new requirement to file court documents electronically (with associated fees), expanded nationwide criminal background checks, paving for the department parking lot and replacement of a boiler.

Several commissioners pressed Irvin on a growing number of small boarding‑house style assisted‑living residences in Wilson County. Irvin said some of those homes “look like your regular residential homes, so you wouldn't know that it is a ... independent living” facility, and that the county has a high number of registered locations—“30 some,” she said, which she characterized as the registered total and said there are likely additional unregistered homes. She explained owners must register with the Department of Health Regulations if they advertise as assisted living but that the settings are not otherwise licensed and are not uniformly inspected. Irvin said the department evaluates home environments for safety and accessibility during special‑assistance assessments and noted that the county is seeing related impacts on emergency departments and other services.

Commissioners discussed potential zoning or ordinance options to address concentration of these residences; Irvin and other county staff suggested zoning/UDO language and local permitting as possible tools while noting the county’s regulatory authority is limited and that some counties have adopted ordinances in partnership with local officials.

Irvin said the department will increase Medicaid billing for clinical services this year to maximize federal and state revenue and reported a requested total budget near $28.3 million with a small increase in local funding requested (about $145,000). She closed by noting the department’s intent to monitor caseload trends and continue internal staffing adjustments.

No formal action was taken during the presentation; commissioners asked questions and received data and program clarifications from the director.