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I never dreamed I would hear a conservative Wyoming lawmaker boldly proclaim that a social safety net program is “one of the reasons why we have government.”
Such enthusiasm in the Wyoming Legislature is generally reserved for subsidizing the fossil fuel industry or bringing an expensive project to a legislator’s district. A favorite tactic of far-right politicians is to portray themselves as budget hawks by railing about social programs that the state and federal government shouldn’t waste taxpayers’ money on.
So when Rep. Ken Pendergraft, R-Sheridan, strongly came out in favor of the state significantly boosting the budget of the Medicaid developmental disabilities waiver program last week at a Joint Appropriations Committee meeting in Gillette, it genuinely startled me. I’m on the opposite end of the political spectrum, but he’s spot on in his assessment that the program “is something that’s absolutely worthy of supporting and worthy of doing right.”
A state study last year recommended adding $12 million to the Department of Health’s budget to increase the reimbursement rate for more than 570 providers who care for about 2,500 people with intellectual and developmental disabilities or acquired brain injuries in home and community-based alternatives to an institution.
Unfortunately, while a steering committee published the report, it didn’t recommend forwarding the funding request to the Legislature. The committee said a low response rate to a provider survey resulted in the decision.
The Department of Health, the Legislative Service Office and many providers are correcting that problem, giving the Appropriations Committee stacks of white papers and promising to compile more.
The Legislature’s Management Council approved Appropriations’ request to make the issue a priority during the interim. The committee will meet Aug. 19-20 in Dubois, with a trip to a developmental disabilities provider tentatively on the agenda.
Pendergraft could have played it safe and tried to please the Freedom Caucus, which endorsed his candidacy last year. But he chose to speak his mind on an issue he obviously feels passionate about.
I don’t know if the Freedom Caucus will take an official position on the disability waiver program in 2026, but I do know that after it took control of the House earlier this year, the caucus killed a $2.4 million a year raise in the Medicaid reimbursement rate for maternity health care requested by Gov. Mark Gordon and the Department of Health. The proposed higher disability waiver reimbursement rate is a similar issue for a vulnerable population that’s about five times more expensive.
Pendergraft, like the majority of Republicans in the House, voted against the rate increase for maternity care.
Pendergraft has a very personal reason for his position on the waiver issue. He explained that a man who belonged to his church suffered a traumatic brain injury in a car accident when he stopped to help a stalled motorist. The family lost its income and had astronomical medical bills, he said, so about a dozen church families helped his wife start a business.
“[The congregation] made tremendous sacrifices,” he recalled. “We paid the bills, we provided care for this individual, who needed constant care day and night.”
Jaded from years of hearing lawmakers contend almost every social problem, from juvenile delinquency to teen pregnancies, can be solved by putting it in the hands of churches instead of throwing public money at it, I wondered if Pendergraft was going down that well-traveled road. But he didn’t.
The legislator told the committee he and his wife provided care for a relative at their home for several years until she moved to a group home, and a co-worker who had a developmentally disabled child needed more help than the state could provide.
Citing his experience working at a nursing home and the long hours he spent helping the three families, Pendergraft said that state and federal governments, which split the costs, should reimburse providers at a level that will help them pay private caregivers competitive wages.
Daryl Skinner, executive director of Lincoln Self Reliance, agreed. He said staff turnover hurts the quality of care.
“The average length of time for direct care staff is six months,” he said. “Can you imagine having to retrain employees every six months? It’s a revolving door.”
Skinner said caregivers have to pass a medication training program, and medication errors increase with staff turnover. He added it takes time for new workers to learn how to interact and communicate with individuals who may be nonverbal and aggressive.
“People say, ‘I love this work, it’s the most meaningful experience I’ve ever had, but I can’t afford to pay my living expenses,'” Skinner said. “We pay an average wage of $16.81 an hour. Fifty percent of our workforce commutes to Jackson Hole, where dishwashers are paid $25 an hour.”
Though Pendergraft said he definitely wants to see waiver reimbursement rates raised, he also showed he’s not above playing some political games to accomplish that goal.
“Before I sit down and authorize a $20-or-$30-or-$40 million check, knowing that taxpayers are already sacrificing, I want to look across the breadth of the Department of Health,” Pendergraft said. ” If it considers this to be a high priority, what’s it willing to sacrifice to pay for it?”
Pendergraft said the state only has a limited amount of money. “If you’re going to fund [higher DD waiver rates] you do it right, and you pay people what they should be paid,” he said. “And when you run out of money, you stop the spending.”
Stefan Johansson, the Department of Health’s director, had a diplomatic response. While he said he’s always open to looking at places to trim, his department had three rounds of budget cuts in the past dozen years that were “all north of $100 million.”
The state has increased funds when it could, like in 2023, when the Legislature added $6.3 million for higher reimbursement rates for providers and $7.4 million to reduce wait times for people who need disability waivers. Currently, the average wait to obtain services is about 14 months.
Johansson didn’t spell it out directly, but I detected a clear message: The state has made a lot of budget cuts in main programs, including Medicaid waivers, developmental preschools, mental health and substance abuse services at community mental health centers, and 24/7 facilities like the Wyoming State Hospital and Wyoming’s Life Resource Center.
These programs are either required to be offered under federal law or part of lawsuit settlements. They account for more than 90% of the department’s biennial budget. If someone wants to cut a lot of “fat,” there aren’t many places to look.
Appropriations Committee Co-chair Sen. Tim Salazar, R-Riverton, had some encouraging words for Johansson.
“I know the challenges you face with limited dollars. I believe you’re doing everything you possibly can on this issue, given the budget that you have, and so I appreciate your efforts; I appreciate your attention,” Salazar said. “I’m not positive, but I tend to think help is on the way.”
That’s not a promise, but given the Legislature’s desire to cut budgets, it’s about as hopeful a sign as can be expected six months before the next session.
