How Wyoming pays for disability services

Waiver inventory

Excluded per scope: the Community Choices Waiver (1915(c), WY.0236.R07.00, renewed effective July 1, 2026), which serves adults 65+ and adults 19-64 with disabilities at nursing facility level of care and had 2,369 participants on July 31, 2026. It is not Wyoming's vehicle for people with IDD. Also excluded: the Children's Mental Health Waiver (1915(b)(1),(b)(3),(b)(4), WY.0451.R04.00). Wyoming has no 1915(i), no 1915(k)/Community First Choice, and no 1115 demonstration covering IDD. Waiver authority list: medicaid.gov

State-only funded programs

None identified as a purely state-funded IDD service program with no federal match. What I found instead:

• Wyoming Life Resource Center (WLRC), Lander. State-operated facility with two components: the Canyons Intermediate Care Facility for people with intellectual disabilities (an ICF/IID) and the Mountain View Skilled Nursing Community. It serves people who are "hard to place, have high medical needs or with exceptionally difficult behaviors." Funded through a combination of Medicaid and state general fund; the split, census, and appropriation are not disclosed on the WDH page. Administering agency: WDH Behavioral Health Division. health.wyo.gov
• Early Intervention and Education Program (EIEP). WDH Behavioral Health Division program providing free developmental screenings and services to children ages 0-5 through fourteen regional child development centers under biennial contracts. It blends state funds with federal IDEA Part C and Part B/619 funds, so it is not purely state-funded, and it carries no Medicaid match. Appropriation and children served: not found. health.wyo.gov ; biennial contracting health.wyo.gov

Checked: WDH HCBS Section pages, the HCBS Statistics and Reports page, the HCBS Document Library, the HCBS public notices page, and the Behavioral Health Division program list. No state-only DD service appropriation is described on any of them.

County / regional / local funding

None identified. Wyoming has no county developmental disability boards, county mill levies for DD services, or regional center allocations. The state operates a single centralized HCBS Section within the Division of Healthcare Financing, with statewide provider certification and a single statewide fee schedule; the only regional structure in the state's disability system is the fourteen EIEP child development centers, which are state-contracted rather than locally funded. Sources checked: health.wyo.gov ; health.wyo.gov ; health.wyo.gov

Funding scale

• DD Waivers (Comprehensive plus Supports) biennial appropriation, BFY 2023-2024: $243,134,569, roughly $121.6 million per year. health.wyo.gov
• Community Choices Waiver biennial appropriation, BFY 2023-2024: $80,434,622, for context. Same source.
• DD Waiver participants, SFY2024: 2,935 unduplicated (1,588 Comprehensive, 643 Supports, 794 children). Total HCBS participants across both DD waivers and CCW: 4,549. Same source.
• Spending per participant (computed): approximately $41,400 per DD waiver participant per year, dividing the annualized biennial appropriation by SFY2024 unduplicated participants. Computed, not published. Published comparison points from the same report: Community Living Services averaged $77,187 per participant in SFY2024, and CCW averaged $18,602 per participant.
• Service mix: Community Living Services is the dominant DD waiver expense, at 56.74% of utilization, serving 862 participants through 217 providers in SFY2024. Same source.
• Current enrollment, July 31, 2026: 5,268 active HCBS participants across all three waivers, of whom 2,899 are in the DD waivers (1,684 Comprehensive, 1,215 Supports). health.wyo.gov
• Waiting list, July 31, 2026: 556 people, all on the Supports Waiver (129 adult, 421 child, 6 acquired brain injury). The monthly report states plainly that "there is no Comprehensive or CCW Wait list." Average wait time: not published. Same source. Trend: 282 people were waiting for DD waiver services on June 30, 2024, down from 362 in SFY2023, so the Supports Waiver list has roughly doubled since mid-2024. health.wyo.gov
• Provider capacity, SFY2024: 555 certified DD waiver providers and case managers; 122 for CCW. Same source.
• FMAP: 50.00% for FY2027, the federal floor. Wyoming therefore carries a 50% state share, the highest state share of the three states in this set. kff.org
• State vs federal share (computed): at a 50% FMAP, roughly $60.8 million per year of the DD waiver appropriation is state general fund. Computed.

Residential funding detail

Wyoming is the most explicitly tiered of the three states. Residential support is funded through Community Living Services (CLS), priced as a daily per diem stepped by a Level of Service (LOS) score, with a separate 15-minute rate at the Basic level for people who need only intermittent support. Rates differ for agency providers versus independent (participant-directed) providers.

Service architecture, from the DD Waiver Service Index effective July 22, 2026:

• CLS Basic: for people with high independence and minimal behavioral needs; "periodic face-to-face staff availability during awake hours" with on-call emergency backup. Billed in 15-minute units, not per diem. This is the level available to people living with family.
• CLS Level 3: moderate functional limitations; staff within hearing distance with overnight availability. $161.71 per day agency.
• CLS Level 4: full-time staffing, nighttime support per the plan of care. $198.22 per day agency.
• CLS Level 5: staff in close proximity most waking hours, in-person nighttime availability; remote monitoring prohibited. $350.69 per day agency.
• CLS Level 6: staff "within immediate proximity" most waking hours, in-person nighttime support, occasional 2:1 staffing included in the rate. $520.61 per day agency.
• Host Home: one sponsor supporting one participant in the sponsor's own residence. The sponsor must be an independent certified provider and cannot employ staff or subcontract. $295.82 per day agency, $260.11 independent. Host Home is closed to new participants absent Extraordinary Care Committee approval for an out-of-home placement, and it cannot be participant-directed.
• Individual Habilitation Training: 1:1 skill training for participants ages 0-20 living with unpaid caregivers or receiving less than 24-hour paid support, capped at 4 hours per day, non-concurrent with other waiver services. $8.34 per 15 minutes agency.
• ICF/IID: the state-operated Canyons Intermediate Care Facility at the Wyoming Life Resource Center in Lander serves people who cannot be placed in community settings. health.wyo.gov

CLS is a habilitation service, not a maintenance service: it requires documented skill training objectives and monthly progress reports, plus 24-hour on-call support.

Individual budgets. On top of the fee schedule, the Comprehensive Waiver sets a hard Individual Budget Amount (IBA) by LOS score and living arrangement, effective July 1, 2026: living with family ages 0-21, $21,718.13 to $50,866.56; living with family 21+, $22,408.78 to $70,041.19; living independently ages 18-20, $22,382.99 to $107,395.45; living independently 21+, $56,878.56 to $149,950.60; living in a congregate setting with roommates ages 18-20, $48,401.83 to $165,858.41; living in a congregate setting with roommates 21+, $56,878.56 to $210,848.81. health.wyo.gov ; methodology health.wyo.gov

The Supports Waiver caps the annual budget at $27,010 for adults and $23,171 for children, which structurally excludes 24-hour residential support. health.wyo.gov

Room and board: "CLS explicitly excludes room and board costs from reimbursement." Room and board falls to the participant's own income, principally SSI. I could not find any Wyoming optional state supplementary payment for congregate residential settings.

Rate structure link: health.wyo.gov

Comparable service rates

All from the DD Waiver Fee Schedule effective July 22, 2026. Wyoming publishes two rates for most services: agency provider and independent (participant-directed) provider.

Official rate schedule links

• DD Waiver Fee Schedule, effective July 22, 2026: health.wyo.gov
• DD Waiver Service Index, effective July 2026: health.wyo.gov
• Comprehensive Waiver LOS / Individual Budget Amount matrix, effective July 1, 2026: health.wyo.gov
• Comprehensive Waiver IBA methodology: health.wyo.gov
• DD Waivers Provider Rate Study, SFY2027 (Guidehouse): health.wyo.gov
• Services and Regulations index: health.wyo.gov
• Medicaid Rule Chapter 46, Supports and Comprehensive Waivers: health.wyo.gov
• Medicaid Rule Chapter 45, DD Waiver Provider Standards and Certification: health.wyo.gov
• CCW Waiver Fee Schedule, effective July 1, 2026: health.wyo.gov
• HCBS monthly summary reports and rate studies index: health.wyo.gov

Notable features and flags

• September 2024 DD rate study recommended benchmark rates the state declined to fund. Guidehouse used an independent rate build-up with 75th percentile Bureau of Labor Statistics wages for direct care workers, inflating a $16.54 baseline direct care wage to $20.28 by SFY2027 using a 4.63% annual factor. Recommended changes across fifteen services ranged from decreases for some group services to increases of up to 38%, at a cost of about $24 million annually, half federally matched, so roughly $12 million in state funds, with the largest increases in Adult Day Services, Community Living Services, Respite, and Case Management. The Steering Committee voted against funding the proposed rate model, citing the 40% provider survey response rate and asking for more robust cost data first. health.wyo.gov
• July 22, 2026: a new DD Waiver fee schedule and service index took effect anyway, alongside a new IBA/LOS matrix effective July 1, 2026, so rates and budgets did move even though the full benchmark model was rejected. Reconciling the two is the single most important open question in Wyoming's rate picture. health.wyo.gov
• The Supports Waiver waiting list has roughly doubled since mid-2024, from 282 people waiting for DD waiver services on June 30, 2024 to 556 on July 31, 2026, and 421 of those waiting are children. There is still no Comprehensive Waiver waiting list, which is unusual nationally: Wyoming rations by capping the low-intensity waiver rather than by queuing people who need 24-hour support. health.wyo.gov ; health.wyo.gov
• Host Home is closed to new participants absent Extraordinary Care Committee approval for out-of-home placement, and it cannot be participant-directed. This forecloses the shared-living model that many states are expanding. health.wyo.gov
• Participant direction is available across the DD waivers, with a distinct, lower independent-provider rate published for nearly every service (typically 6% to 15% below the agency rate). health.wyo.gov ; fee schedule above
• July 1, 2026: Community Choices Waiver renewal approved by CMS with new services, new definitions and limitations, new provider types and performance measures, plus a separate SFY2027 CCW rate study. Training sessions ran June 18, August 18, and September 1, 2026. This matters to the DD system because CCW is the adjacent adult waiver and shares the certification and case management infrastructure. health.wyo.gov ; renewal application health.wyo.gov
• Workforce data is published annually through the National Core Indicators State of the Workforce survey, most recently the 2024 report released in 2026. health.wyo.gov

Confidence

Solid: enrollment and waitlist counts as of July 31, 2026 from the WDH monthly summary report; the complete DD fee schedule and service index effective July 22, 2026; the IBA/LOS budget matrix effective July 1, 2026; Supports Waiver budget caps; waiver authorities and control numbers; SFY2024 participant counts, provider counts, service-mix percentages, and biennial appropriations; and the rate study methodology and its rejection by the Steering Committee. Estimated by me and clearly labeled: the ~$121.6 million annual and ~$41,400 per-participant figures, both derived from the BFY2023-2024 biennial appropriation divided across two years and SFY2024 unduplicated participants, and the ~$60.8 million state share derived from the 50% FMAP. Could not find: SFY2025 or SFY2026 DD waiver expenditure actuals (the SFY2024 annual report is the most recent published, and the SFY2025 report was not posted as of this research); an average wait time for the Supports Waiver list; the WLRC census, appropriation, and Medicaid/state general fund split; the EIEP appropriation and children served; and whether the July 22, 2026 fee schedule represents an increase, a decrease, or a hold relative to the prior schedule, since the prior version was not posted alongside it.

I have enough to write the three profiles.