County warned of potential $1.3M annual LTSS cost if state cost‑share takes effect

Clay County’s long‑term services director briefed the board July 14 on a potential state cost‑shift that would make counties partially responsible for certain Medicaid‑funded residential services beginning July 1, 2027.

Quinn explained the shift affects four residential service types — community residential services, integrated community supports, customized living and family residential services — that serve people with developmental disabilities, traumatic brain injury, physical disabilities and other significant long‑term care needs. Quinn said the 2025 Legislature created a contingent county cost share scheduled to begin 07/01/2027 and that the final county exposure depends on waiver rates, enrollment and any further legislative or federal changes.

Quinn provided planning estimates for Clay County: a six‑month exposure for the second half of 2027 of roughly $505,000–$543,000 and a possible full‑year impact in 2028 of about $1.3M–$1.4M or more, depending on waiver rate increases and service placements. He said the state is acting on some levers (for example, a tiered rate for adult foster homes effective April 1) but many cost reductions require legislative and federal approvals and may not be in place before July 2027.

Commissioners raised concerns about levy impacts and asked whether regional or statewide advocacy could alter the outcome. Quinn said counties are discussing options and some are budgeting conservatively for the full exposure while others are "rolling the dice" and budgeting less in hopes of legislative relief. Commissioner Baer asked what number staff should plug into the county budget; Quinn recommended $505,000 as a transparent, conservative planning figure.

No formal action was taken beyond direction to continue monitoring legislation and to fold the estimate into department budget planning.