Wyoming’s recent decision to deny a proposed funding increase for the Community Choices Waiver deserves more public attention, not because it is dramatic, but because it is quietly consequential.
Opinion
The Community Choices Waiver is a Medicaid home- and community-based services program administered by the Wyoming Department of Health that allows seniors and adults with disabilities to receive long-term care in their own homes instead of in nursing facilities. It pays for practical, everyday supports: help with bathing and dressing, meal preparation, medication management, light housekeeping, transportation and caregiver support. These are not luxuries. These are the services that make the difference between remaining safely at home and being placed in an institution.
It is also important to be clear about who this program serves. This waiver is a Medicaid program, which means it supports the poorest and most medically vulnerable Wyomingites — people who have already spent down their life savings, who do not have long-term care insurance and who cannot afford to pay privately for care. For them, this is not a convenience or a supplement. It is the last safety net.
The funding increase recently denied by the Joint Appropriations Committee totals about $11.24 million in state funds. Because this is a Medicaid program, that decision also blocks about $16.4 million in federal matching funds. In total, roughly $27.6 million that could have supported Wyoming residents in their homes and communities will not be available.
Supporters of budget cuts often frame decisions like this as fiscal restraint. But in this case, Wyoming-specific cost data tells a different story.
In Wyoming, the cost of long-term care is already high. According to widely used cost-of-care surveys, home-based supports such as homemaker services and home health aides typically cost tens of thousands of dollars per year, and assisted living often exceeds $50,000 annually. Nursing facility care, by contrast, routinely exceeds $100,000 per year per person.
Even in Wyoming’s own cost environment, institutional care is substantially more expensive than supporting people at home.
When community services are underfunded, people do not suddenly become less needy or more independent. They simply enter more expensive settings — and Medicaid pays the bill anyway, only now at a much higher rate. This is not a choice between spending and not spending. It is a choice between spending earlier, more strategically and at lower cost, or spending later, reactively and at much higher cost.
There are also system-level consequences that do not show up neatly in budget spreadsheets. Wyoming already faces serious workforce shortages in home- and community-based care, especially in rural areas. When reimbursement rates do not keep pace with real-world costs, agencies cannot hire or retain workers. When agencies cannot staff services, services cannot be delivered. When services cannot be delivered, people cannot remain at home — even if home is where they want to be and where they would be safest and most stable.
Once someone enters an institution, it is both difficult and expensive to transition them back to the community. Housing is often lost. Support networks are disrupted. Functional abilities frequently decline. What might have been a manageable level of support at home becomes a much more complex and much more expensive system of care.
This is not just a policy issue. It is a trust issue.
There is also a generational dimension to this conversation that deserves attention. Many of the people now relying on programs like the Community Choices Waiver were told throughout their working lives that if they worked, paid into the system and played by the rules, Social Security, Medicare and related supports would be there when they needed them. They planned their futures around that promise. Now, when they need relatively modest help to remain in their own homes, the system is tightening around them.
This is not just a policy issue. It is a trust issue.
It is also a family issue. When home- and community-based services are underfunded or unavailable, the burden does not disappear. It shifts to spouses in their 70s caring for partners with complex medical needs, to adult children trying to juggle jobs and caregiving responsibilities, or to families who eventually face an impossible choice between burnout and institutional placement.
None of this is to suggest that Wyoming should not care about budgets. Of course it should. But smart budgeting is not just about cutting line items. It is about understanding which investments prevent crises, reduce long-term costs and stabilize systems before they break.
The Community Choices Waiver is not an experimental program. It is not a luxury. It is one of the most cost-effective tools Wyoming has to support aging adults and people with disabilities while also protecting taxpayers from the far higher costs of institutional care.
There is also a federal funding reality that should matter to anyone concerned about Wyoming’s fiscal position. When the state declines to fund its share of a Medicaid program like CCW, it also walks away from federal matching dollars — money Wyoming residents already pay into through federal taxes. In this case, that means leaving more than $16 million in federal funds on the table while still facing the same long-term care needs.
That is not fiscal restraint. It is a false economy.
The real question facing Wyoming is not whether we will pay for long-term care. An aging population makes that unavoidable.
The real question is whether we will pay less, earlier and more wisely, by supporting people in their homes, or more, later and in crisis, by relying on institutional care after families and systems have already been pushed to the breaking point.
The Community Choices Waiver sits right at the center of that choice.