Wyoming DD Waiver Emergency Priority and the Extraordinary Care Committee

When Emergency Priority Applies

Emergency priority in Wyoming's DD waiver system isn't a fast-track application. It's a crisis response mechanism governed by Chapter 46, Sections 14 and 15 of the state's Medicaid rules. It exists for situations where an individual's life or health is in immediate jeopardy and no existing community resource can address the danger.

Two scenarios trigger the emergency priority pathway:

Supports Waiver participants whose needs exceed the budget cap. If your adult child is already on the Supports Waiver but their clinical or behavioral situation has deteriorated to the point where the individualized budget can't cover necessary services, escalation to the Comprehensive Waiver is the path — and that path goes through the Extraordinary Care Committee.

Individuals not currently on any waiver who face an acute crisis meeting the emergency criteria. This could involve the death or incapacitation of a sole caregiver, homelessness, documented abuse or neglect, or a medical/behavioral emergency that creates immediate risk of harm.

The Extraordinary Care Committee

The ECC is a four-member body: a Division waiver manager, a Medicaid manager, a Participant Support Specialist, and a fiscal unit representative. They meet to evaluate requests for Comprehensive Waiver funding outside the normal reserved-capacity pathways.

The committee doesn't accept requests directly from families. The entire plan of care team must reach consensus that escalation is necessary. The case manager then assembles and submits the formal packet.

What Goes in the ECC Packet

The documentation requirements are specific and evidence-heavy:

Cross-agency incident documentation. Written statements from law enforcement, school districts, emergency responders, or regional crisis centers. Each statement must describe specific incidents — dates, what happened, who was involved, what the outcome was. Generic letters saying "this person needs more help" won't pass the committee's review.

Clinical assessment of changed need. A signed report from a credentialed professional (psychologist, psychiatrist, or physician) explaining the significant change in the individual's functional limitations. The report must establish that their life or health is in immediate jeopardy without additional funding. This isn't a routine reassessment — it needs to document a material deterioration from the baseline that the Supports Waiver budget was calculated against.

Exhaustion of alternatives. Evidence that the individual doesn't qualify for funding through any other public or private agency. If Medicaid state plan services, community mental health resources, or other programs could address the need, document why they are unavailable or insufficient.

Housing instability verification (when applicable). For requests based on homelessness or unsafe living situations, proof that local victim shelters, emergency housing programs, and temporary residences are unavailable or insufficient to ensure physical safety.

The Decision and Appeal Process

The ECC votes by majority and issues its decision within 20 business days of review. Approvals result in a Comprehensive Waiver funding allocation. For a person already on the Supports Waiver, approval can replace that slot with a funded Comprehensive Waiver slot with a higher service budget.

If denied, the family has 30 days to request a formal administrative review under Chapter 4 of the Department of Health's Medicaid Rules. This is a contested-case proceeding before a State Hearing Officer. The family can present clinical evidence, call witnesses, and challenge the committee's factual findings.

Given the formal nature of these hearings, families should consider representation. Wyoming Protection and Advocacy System (307-632-3496) provides free advocacy for individuals with disabilities. A special needs planning attorney can also handle the hearing — the stakes (continued community living versus potential institutionalization) justify the legal cost.

Budget Cap Versus Emergency Priority

These are related but distinct situations. A budget cap issue means the current Supports Waiver allocation isn't enough to cover authorized services — the individual's needs grew or the cost of services increased. An emergency priority request means the individual faces immediate danger.

Budget cap issues should first be addressed within the Supports Waiver framework. The case manager can request a budget reassessment based on a new ICAP evaluation and updated Level of Service score. If the reassessment confirms that needs exceed the Supports Waiver's maximum, that becomes part of the ECC packet.

The Wyoming SSI at 18 & Adult Disability Benefits Guide includes the ECC documentation checklist and the Chapter 46 cross-references you need to build a complete escalation packet.

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