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County staff: state mandate removed in‑home wait list, caseloads jumped and staffing is strained
Summary
Wake County social services staff told commissioners that a state mandate to remove the Special Assistance In‑Home wait list increased caseloads and administrative workload; staff said client services are covered by Medicaid but county administrative staffing has been pressured. Commissioners pressed on provider reimbursement cuts and staffing implications.
Antonio (Tony) Pedroza, director of Wake County Social Services, gave an overview of adult Medicaid programs and said a state mandate made Special Assistance In‑Home a required Medicaid service, eliminating the county’s wait list and increasing caseloads.
"So basically, anyone who applies who is eligible must receive the program now because it is now mandated that we provide this without a wait list," Pedroza said, explaining the state decision took effect in July and caseloads rose from FY21 to FY25. Pedroza told commissioners that while the state provided funding to cover client payments, it did not provide additional staffing funds for county administration, leaving the county to absorb higher administrative costs and to request more staff to handle the caseload growth.
Commissioners asked about which programs might be at risk amid state and federal budget uncertainty. Pedroza said the legislative proposal discussed by some lawmakers primarily targets Medicaid expansion and not the core adult services described, but noted the county is seeing provider reimbursement cuts that could endanger provider capacity. "They've cut the reimbursements… like 3 to 10%, and they're probably gonna lose a lot of providers with that," Commissioner Adamson said during the exchange, flagging workforce vulnerabilities in behavioral health and long‑term care.
Pedroza walked commissioners through program details — private-living Medicaid, limited Medicaid that can defray Medicare Part B premiums, PACE, CAP/DA waivers, long-term care asset‑lookback rules and placement assistance — providing concrete eligibility numbers that shape program access, including a cited 100% FPL figure ($15,650 for one person) and resource limits referenced in the presentation.
County staff said administrative costs were partially offset by federal reimbursement for some positions (a 50/50 cost‑share), but that rising caseloads mean the county has requested additional staff to manage casework and redeterminations. Commissioners suggested a longer-term county aging plan to anticipate demand and nursing‑home capacity as Wake County’s population ages.
