Trustees hear that developmental-disability waiver waiting list tops about 1,800; staffing and costs strain providers

Associate Commissioner Kathy Sawyer told the Alabama Department of Mental Health Board of Trustees on May 16 that the state's three waiver programs the Intellectual Disability (ID) Waiver, the Living at Home (LH) Waiver and the Community Waiver Program now face a waiting list of about 1,800 people.

Sawyer said staffing this quarter involved 105 complex cases across Alabama and that the department was able to provide services for 52 of those cases. She said approximately 400 individuals in the system currently receive special-level staffing that can range from one-to-one to three-to-one support, creating substantial cost and workforce challenges for providers.

The associate commissioner described the current population as increasingly "dually diagnosed," noting higher rates of autism and challenging behavioral needs that require special-level staffing and intensive supports. She said many providers are unwilling to accept such placements because of the extreme costs and staffing demands, and that ADMH is working to redesign parts of the system to better meet those needs.

Board members discussed the potential costs associated with these complex placements but did not take formal action at the meeting. The board recorded no vote related to waiver policy during this session; discussion was presented as an informational update.

Next steps identified by staff include continued system redesign work and further development of approaches to support providers serving individuals with high-intensity needs. No specific timetable or legislative proposal for those changes was included in the report.