How Utah pays for disability services

Waiver inventory

The Physical Disabilities Waiver is included because DSPD administers it alongside the four IDD-relevant waivers and it draws from the same waiting list infrastructure and rate sheet. The Technology Dependent Children Waiver, Medically Complex Children's Waiver, New Choices Waiver, and Aging Waiver are administered by other DHHS divisions and are excluded. Waiver control numbers (UT.xxxx) were not published on any Utah page or document retrieved, including the Utah Medicaid provider manual for the Community Supports Waiver, the DSPD site, and the Medicaid long-term care and waiver programs page.

State-only funded programs

• Non-Medicaid Waiver Services. DSPD provides services to people who meet division eligibility criteria but are not eligible for Medicaid, using the same service definitions and rate sheet with no federal match. 94 people served in FY2025. The FY2027 rate sheet carries a dedicated code for this: Support Coordination External, No Federal Participation (SCN), $91.45 per month for the WG eligibility group.
• Time-limited services for people on the waiting list, funded through a mix of ongoing and one-time state General Funds. FY2025: Supported Work Independence for competitive integrated employment, 76 families supported; Supported Living through caregiver compensation, which pays parents and guardians for care they provide to a family member, 316 families supported; Respite, 87 families supported.
• Recreational therapy: $250,000 one-time state General Fund, FY2025 general session, funding recreational therapy for an additional 106 people.
• Community Based Housing Allowance Program (HAP): $567.00 per month on the FY2027 DSPD rate sheet, service code HAP, eligibility codes SG BG TG. The fund source is not stated on the rate sheet.

Administering agency for all of the above: Utah Division of Services for People with Disabilities, Department of Health and Human Services. dspd.utah.gov and dspd.utah.gov

Two further FY2025 general session appropriations are state General Fund but function as Medicaid match rather than state-only spending: $5 million ongoing for waiting list funding, which brought 281 people into services, and $10.4 million ongoing for "mandated additional needs," under which 3,531 people received additional services and 845 more transitioned from one-time to ongoing supported living through the caregiver compensation model without requiring new service dollars.

County / regional / local funding

None identified. Utah runs a single state agency model. DSPD organizes statewide work through six functional teams (waiver services, individual budgets, service entry, business systems integration, regulatory development and support, and USDC), not through county authorities. Case management is delivered by contracted Support Coordination Entities selected by the person, not by geographic assignment. There is no county levy, county board, regional center allocation, or local mill levy for disability services. Checked the DSPD site structure, the FY2025 annual report budget overview, the Utah Medicaid long-term care and waiver programs page, and the DSPD legislative information page.

Funding scale

• DSPD operating budget FY2025: $669.6 million including state and federal funds. Composition: Home and community-based services $584.4 million; Utah State Developmental Center $68.2 million; service administration $17.0 million. Five-year trend: $426.9M FY2021, $464.7M FY2022, $568.1M FY2023, $625.5M FY2024, $669.6M FY2025. dspd.utah.gov
• State versus federal share. The FY2025 annual report states that "for FY25, all reported dollar amounts are based on the matching rate of 31.2%." The report does not specify whether 31.2% is the state share or a division-specific blended rate, and it does not reconcile to the published Utah FMAP. Treat this figure as unresolved.
• FMAP: 62.46% FFY2026 (https://public-inspection.federalregister.gov/2024-27910.pdf), 61.95% FFY2027 (https://www.govinfo.gov/content/pkg/FR-2025-11-28/pdf/2025-21351.pdf).
• People served FY2025: 7,472 in services (the report's highlights page cites 7,492). Trend: 5,334 in 2016 to 7,472 in 2025.
• Spending per participant: $584.4 million HCBS divided by 7,472 people served is approximately $78,200 per person per year, a derived figure not published as such. New enrollees carry much smaller partial-year budgets: 281 people entering through appropriation funding at $2.1 million state and $5.9 million total budget (approximately $21,000 total per person); 182 through attrition funding at $1.6 million state and $4.4 million total; 26 through transfer funding at $222,786 state and $631,928 total. 489 people enrolled in FY2025 across all three funding channels; 32 of them transitioned from a private ICF to HCBS.
• Waiting list FY2025: 5,950 people. Trend: 2,510 in 2016, 3,286 in 2019, 4,589 in 2022, 5,345 in 2024, 5,950 in 2025. Waiting list has grown faster than the served population.
• Time waiting (current list, FY2025 annual report): under 1 year 1,205 people (20%); 1 to 4 years 2,585 (43%); 5 to 9 years 1,426 (24%); 10 to 19 years 523 (9%); 20 or more years 211 (4%).
• Waiting list by qualifying disability: related conditions 50.3%; intellectual disability 45.8%; acquired brain injury 3.2%; physical disabilities 0.7%.
• Service utilization FY2025: in-home services 3,711 people (2,091 self-administered, 2,105 provider-based; 3,165 receiving supported living, of whom 1,643 through caregiver compensation); out-of-home services 3,605 people (Residential Habilitation Supports 2,785, Host Home Supports 850, Professional Parent Services 111); transportation 4,380; behavior consultation 3,128; employment 895.

Residential funding detail

Utah's residential model is unusual in that the group home rate is not a fixed per diem but an individually constructed daily rate.

• Residential Habilitation Supports (RHS, T2031), facility-based group homes. 2,785 people FY2025. The daily rate is built for each person on the RHS Residential Habilitation Worksheet, which takes hours per day (not to exceed 24, or 18 if the person attends a 6-hour school or day program), additional weekend hours (not to exceed 12), staffing ratios attached to each hour block, an anticipated absentee count fixed at the start of the plan cycle, and 16 built-in hours covering sick, holiday, and day service vacation reimbursement. The worksheet calculates Average Daily Hours, which is entered into USTEPS. The FY2027 rate sheet lists RHS at $601.83 per day as the ceiling. A separate code exists for children in DCFS custody at the same rate. dspdmanuals.hs.utah.gov
• Host Home Supports (HHS, S5140): $378.92 per day. 850 people FY2025.
• Professional Parent Supports (PPS, S5145), for children in DCFS custody: $378.92 per day. 111 people FY2025.
• Supported Living, hourly and flexible, delivered in the person's own home. Provider-based hourly (SLH) $9.31 per quarter hour, equal to $37.24 per hour. Natural supports model (SLN) $8.40 per quarter hour. Self-administered (SL1) $6.33 per quarter hour, $9.50 overtime; the corresponding maximum employee wage for SL1 is $21.94 per hour, or $23.97 where a qualifying relationship exemption is documented. 3,165 people FY2025.
• Caregiver compensation, paying parents, step-parents, legal guardians, and spouses: provider model CMP and CMS $6.96 per quarter hour; self-administered CM2 and CM3 $6.33 per quarter hour. 1,643 people received supported living this way in FY2025.
• Extended Community Living Supports (ELS) $6.35 per quarter hour; Integrated Community Learning group service (ICL) $331.64 per day.
• Residential Start-Up Costs (STC): $1,500.00 per instance plus $75.00 per item.
• USDC is Utah's only state-run intermediate care facility, funded at $68.2 million in FY2025 for 170 people served and an average daily residence of 158.

Room and board. Not funded by the waiver. The rate sheet distinguishes respite codes with and without room and board (RP4 Provider Basic with room and board $125.94 per day versus RP2 Provider Basic $112.20 per day; RP5 Provider Intensive with room and board $153.00 per day; RP6 and RP8 self-administered with room and board), which is the narrow federal exception permitting FFP for room and board in facility respite. For ongoing residential settings, room and board falls to the person's own income, principally SSI. The Community Based Housing Allowance Program at $567.00 per month is the only housing payment line on the DSPD rate sheet.

Comparable service rates

All rates from the FY2027 DSPD Rate Sheet, effective July 1, 2026. "QH" is a quarter hour; hourly equivalents are shown in parentheses.

Official rate schedule links

• FY2027 DSPD Rate Sheet, effective July 1, 2026 (Rate Sheet and SAS Limit and LSW Cap tabs): dspd.utah.gov
• DSPD provider forms page carrying the current rate master and budget worksheets: dspd.utah.gov
• FY2027 Budget Worksheets: dspd.utah.gov
• FY2027 Integrated Community Learning Budget Worksheet: dspd.utah.gov
• HMA final recommended rate models, December 1, 2025 (recommendations, not adopted rates): healthmanagement.com
• HMA working rate models, September 3, 2025: healthmanagement.com
• DSPD provider rate study landing page: dspd.utah.gov
• Utah Medicaid provider manual, HCBS Waiver for Individuals with Intellectual Disabilities or other Related Conditions, updated November 2025, including the full service code and unit table: medicaid-documents.dhhs.utah.gov
• DSPD FY2025 Annual Report: dspd.utah.gov
• SAS pay rate reference, July 1, 2025 to June 30, 2026 (secondary, fiscal agent published): acumenfiscalagent.com

Notable features and flags

• December 1, 2025. Health Management Associates delivered final recommended rate models from a rate study covering about 15% of providers representing over 50% of annual expenses. The recommendations restructure residential from a single ceiling into per-diem bands by home size: 3-bed homes $348.20 to $691.78 per day, 4-bed $269.59 to $585.25, 5-bed $222.43 to $521.33, 6-bed and larger $191.08 to $478.83. Also recommended: supported living 1:1 at $11.88 per 15 minutes, 1:2 $6.73, 1:3 $4.92, 2:1 $20.79; host home standard $245.57 per day and exception $293.79; support coordination $304.25 per month. None of these are in the FY2027 rate sheet effective July 1, 2026, so the study is pending adoption. Note that some recommendations are below current rates (individual day support $12.89 recommended against $13.75 current), so this is a restructuring rather than a uniform increase.
• July 1, 2026. The FY2027 rate sheet took effect and is the current schedule as of August 29, 2026.
• The waiting list is a funding-per-person model, not a slot model. People are ranked by a standardized Needs Assessment Questionnaire scored at 50% severity of need (personal care, daily living, personal safety, behavioral, medical), 30% caregiver support (availability and ability of family or caregiver), and 20% time on the waiting list. Rank can fall as well as rise when higher-need people are added. For the Limited Supports Waiver, selection is instead based on lower service needs plus time on the list. People move into services only when a specific amount of funding becomes available through one of three channels: legislative appropriation, attrition (funding released when someone leaves services, reinvested in emergency and court-ordered enrollments), or transfer (coordination with the Division of Child and Family Services, Division of Juvenile Justice and Youth Services, Division of Integrated Healthcare, and USDC). dspd.utah.gov
• FY2025. 16 people aged out of DCFS and DJJYS custody into DSPD services through the mandated additional needs appropriation. Day services, transportation, and residential services were the most common additional service requests.
• FY2025. DSPD renewed the Community Transitions and Community Supports waivers with CMS on the standard five-year cycle, and worked with the Utah Office of the Inspector General to strengthen payment procedures for contracted providers, which the annual report ties to more accurate billing and more consistent enrollment practices.
• December 2025. A two-year DHHS-funded LTSS research study by the Human Services Research Institute with Burns and Associates and the Utah State University Institute for Disability Research, Policy, and Practice concluded, including a dedicated research brief on addressing or eliminating the DSPD waitlist that identified waitlist needs analysis and strategic planning, waitlist management, and waitlist funding sources as the three levers. dspd.utah.gov and dspd.utah.gov
• Self-direction is deeply embedded. 2,091 of 3,711 people receiving in-home services used the self-administered services model, in which the person or family hires and trains their own staff with a fiscal agent handling payroll. Financial Management Service (FMS) is $101.61 per month. SAS rates are published with both a base and an overtime rate, and overtime consumes 1.5 units per quarter hour against the person's budget.

Confidence

Solid: the complete FY2027 rate sheet effective July 1, 2026 pulled directly from the DSPD file, verified against a fiscal agent wage table to confirm quarter-hour units; waiver-level people-served counts, waiting list size, and time-waiting distribution from the DSPD FY2025 annual report; the DSPD operating budget by fiscal year and its three-way split; the RHS individually constructed rate methodology; the three-channel enrollment funding model with dollar amounts; the HMA recommended rate models; FMAP. Estimated or derived: the approximately $78,200 per person per year figure, which I calculated from $584.4 million HCBS divided by 7,472 people and which the state does not publish; the hourly equivalents of quarter-hour rates. Could not find: CMS waiver control numbers for any of the five DSPD waivers, absent from the Utah Medicaid provider manual, the DSPD site, and the Medicaid long-term care and waiver programs page; FY2026 and FY2027 legislative appropriation increments for the waiting list, because the Compendium of Budget Information is a JavaScript application that could not be read; a reconciliation of the annual report's stated 31.2% matching rate against the published Utah FMAP; the fund source for the Community Based Housing Allowance Program; and any published enrollment figure for Utah's ASD-related services benefit.

I have enough data. Writing the three profiles now.