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ADSD: home- and community-based services facing long wait lists after rate changes; agency cites staffing limits
Summary
ADSD told legislators that rate increases and a freeze in enrollments have driven up utilization and wait lists for in-home programs. Officials said lack of case managers and capacity, not only provider willingness, limits service expansion despite prior wage increases.
The Aging and Disability Services Division told the Joint Subcommittee on Human Services that Nevada’s home- and community-based programs are seeing larger-than-expected demand, long wait lists and increased per-person costs after a provider rate increase earlier this year.
ADSD officials said the state’s Personal Assistance Services (PAS) and Community Options Program for the Elderly (COPE) experienced a utilization surge after a Jan. 2024 rate increase, and that the division froze enrollment in those state programs when it projected a shortfall for fiscal 2024. ADSD said it is requesting funding and caseload positions in the governor’s budget for the next biennium but did not include projected wait lists in the baseline funding for some programs because enrollment capacity is constrained by staffing.
Why it matters: Committee members and callers warned that leaving wait lists unfunded may shift costs to more expensive institutional settings. ADSD told the committee it prioritizes enrollment by level of need and is pursuing private case-management options and other recruitment steps to reduce vacancies in state case-management roles.
ADSD’s Jeff Duncan gave specific wait-list figures: for supported living arrangement (SLA) services, Desert Regional Center had 430 people waiting with an average wait time of about 361 days, Rural Regional Center had 75 people waiting (about 215 days) and Sierra Regional Center had 174 people waiting (about 343 days). For jobs-and-day-training programs his numbers showed 651 people waiting at Desert Regional Center (average wait ~446 days), 35 waiting at Rural Regional Center (~127 days) and 114 waiting at Sierra Regional Center (~337 days).
Duncan also told the committee that cost-per-person estimates have risen. He said the executive budget’s assumed per-person service costs are $1,947 for PAS and $1,153 for COPE, but that ADSD’s current estimates based on recent utilization are about $2,400 per PAS client and roughly $1,300 per COPE client in the current fiscal year. He said the agency will continue to refine those projections as caseloads change.
On staffing, ADSD officials told the committee they are pursuing recruitment efforts including job fairs and partnering with other state programs; they also said Medicaid has opened private case management so third-party managers can take some caseloads. Assembly members asked whether delaying start dates for some new positions (from October/December to January) would worsen wait times; ADSD replied that due to existing vacancy rates most hires traditionally occur around January, so the change aligns with practical hiring timelines and should not materially change service delivery timing.
Public commenters supported expanded respite funding and highlighted the programs’ effect on caregivers. Benjamin Chaloner of the Alzheimer’s Association and callers described the importance of the Best Dementia Respite program and urged increased general-fund support to raise a per-person cap on vouchers.
Ending note: Lawmakers asked ADSD for more precise projections tying caseload, hiring timelines and service costs. ADSD said it will provide follow-up information on how recruitment, private case-management expansion and budget amendments will affect wait lists and per-person costs.
