IDD Medicaid rates in Wyoming put the state last in the country for job coaching. Wyoming pays $3.09 per 15 minutes for supported employment on code T2019 with modifier UQ, or $12.36 an hour, effective July 22, 2026. That ranks 39th of 39 states and is 69.7% below the national median of $40.84 an hour.
Wyoming is also in the national bottom three for community integration. Yet its in-home supports rate sits just below the national median. The state's IDD schedule pays for one-to-one in-home time far better than it pays for supports delivered out in the community or at work, and that difference should drive how a Wyoming provider builds its service mix.
Wyoming's DD waivers, Comprehensive and Supports, are paid fee-for-service by the Wyoming Department of Health. Agency-provider rates:
| Service | Code | Rate | Rank | vs median |
|---|---|---|---|---|
| In-home and community living supports | T2038 | $33.36/hour | 16 of 29 | -4.5% |
| Residential habilitation | T2016 (U7) | $198.22/day | 25 of 31 | -29.3% |
| Community integration | T2027 | $16.60/hour | 20 of 22 | -37.8% |
| Supported employment | T2019 (UQ) | $12.36/hour | 39 of 39 | -69.7% |
Day habilitation on T2020 is paid at $67.70 a day, effective October 1, 2023. In-home supports and community integration are effective April 1, 2024; residential habilitation and supported employment July 22, 2026.
Wyoming runs two 1915(c) DD waivers. The Comprehensive waiver and the Supports waiver share one fee schedule, published by the Department of Health as the DD Waiver Fee Schedule, most recently effective July 22, 2026, with an earlier edition effective September 1, 2025. The two waivers together carry 98 current rates in our dataset.
The schedule mixes units. In-home supports, community integration and supported employment are billed in 15-minute units, residential habilitation by the day, and day habilitation as a daily rate. That matters for comparison: a daily day habilitation rate cannot be ranked against hourly rates in other states, and a provider has to divide it by actual program hours to see its hourly value. A longer program day lowers the effective hourly rate; a shorter one raises it.
Wyoming's $12.36 hourly supported employment rate is just below West Virginia ($12.80) and Tennessee ($14.96). At the top, New York pays $141.64, Arkansas $102.36, the District of Columbia $97.08, Iowa $79.82 and Missouri $77.80.
The economics do not work for one-to-one job coaching. Wyoming's median direct support wage is $21.77 an hour, close to the national $22.08, and the loaded wage is 243.5% of the T2019 rate, a loss of $17.74 an hour of individual coaching. Supported employment in Wyoming is viable only in group settings or as a service an agency subsidizes from other lines.
T2019 also carries 3 prior authorization rules with a yearly limit.
What that means for employment outcomes
When job coaching loses money on every hour, providers have little reason to grow it, even when people on the waiver want competitive jobs. Agencies committed to employment in Wyoming typically keep coaching hours lean, focus on placements that need limited ongoing support, and use group or enclave models where they fit the person. Providers should document the gap between cost and rate carefully; it is the evidence most likely to move a future budget footnote.
In-home and community living supports pay $8.34 per 15 minutes on T2038, or $33.36 an hour, 16th of 29 and only 4.5% below the national median of $34.92. The loaded direct support wage is 90.2% of the rate, leaving $3.26 an hour. That margin is thin, but positive, and it makes in-home supports the one Wyoming IDD service where an agency paying the median wage can cover its direct support hour.
The national range runs from South Carolina ($85.96 on T2017) and South Dakota ($69.28) to Idaho ($15.44), West Virginia ($13.52) and Louisiana ($12.40). Wyoming sits in the middle of the field.
A $3.26 hourly margin does not leave much for travel, and Wyoming distances are long. Agencies protect it by keeping caseloads geographically tight, scheduling longer visits where the plan allows, and limiting unbilled drive time between clients. T2038 carries 2 prior authorization rules.
Community integration on T2027 pays $4.15 per 15 minutes, or $16.60 an hour, 20th of 22. Only Louisiana ($16.00) and Georgia ($14.60) pay less. Virginia leads at $140.64. The loaded wage is 181.3% of the rate, a loss of $13.50 an hour on a one-to-one hour.
At that rate, community integration only works in small groups. Providers that deliver it one-to-one, often because a person's support needs require it, are effectively funding it from other services. T2027 carries 2 prior authorization rules with a yearly limit, so the authorized annual amount should be tracked against delivery throughout the year.
Residential habilitation on T2016 with modifier U7 pays $198.22 a day, 25th of 31 and 29.3% below the national median of $280.27. Minnesota ($999.00), the District of Columbia ($567.62) and New York ($564.22) lead; Iowa ($140.81), Illinois ($108.00) and Oklahoma ($88.66) are lowest. T2016 carries 5 prior authorization rules, the most of any Wyoming IDD code.
Residential advisors in Wyoming earn $16.59 an hour against $20.31 nationally, which softens the impact of the below-median residential rate somewhat. Even so, group home operators depend on stable occupancy, because each vacancy removes a full daily rate while staffing costs continue.
Day habilitation pays $67.70 a day on T2020, effective October 1, 2023, with no prior authorization rules. It is the oldest of the Wyoming IDD rates shown here, so day program operators should check each new fee schedule edition for changes.
Federal occupational wage data for May 2025 puts Wyoming's direct support professional median at $21.77 an hour, versus $22.08 nationally (based on the closest comparable occupation). Residential advisors earn $16.59 against $20.31, home health and personal care aides $15.96 against $17.21, and licensed practical nurses $30.51 against $30.96.
The direct support wage is near the national median, which is why Wyoming's low community and employment rates bite so hard: there is no wage discount to offset them. In states like West Virginia, low rates sit alongside low wages; in Wyoming, low rates sit alongside typical wages.
- 2026 Budget Session, SF0001 (Enrolled Act 27). A Department of Health footnote on DD/ID/ABI provider rates, effective July 1, 2026.
- Waiver Services rate history, Comprehensive and Supports, SFY 2024. A 12.5% rate change effective March 31, 2025, recorded in the benchmarking appendix.
- Provider Rate Changes Effective July 1, 2026. A bulletin issued September 23, 2026.
The residential and supported employment rates carry a July 22, 2026 effective date, shortly after the budget act took effect. Providers should watch whether future budget footnotes address the employment and community integration rates, where Wyoming trails nearly every state.
The 12.5% increase in 2025 shows the state can move rates substantially when the legislature funds it. Because Wyoming changes DD rates through budget footnotes and new fee schedule editions, the practical calendar for providers is the budget session: cost data presented before and during the session has the best chance of shaping the next footnote. Providers should also read each new fee schedule edition line by line, since increases have not been applied evenly across services and effective dates differ by code.
Wyoming Medicaid is fee-for-service, and its landscape of 18 plans and coverage groups includes care management programs such as WYhealth Health Management. None of them pays DD waiver services. DD waiver services are paid on the Department of Health's published rates, so there is no plan contract to negotiate and one rate applies statewide. T2017 carries 4 prior authorization rules with a yearly limit; H2023 and T2020 carry none. The Wyoming managed care page has the details.
Wyoming's Mountain-region neighbors pay very differently. Utah ranks 3rd nationally on prevocational services and 14th on supported employment, Colorado ranks among the top states for in-home supports at $51.28 an hour, and Idaho sits near the bottom for in-home supports at $15.44. For employment and community services, Wyoming is the lowest-paying state in the region. For in-home supports, it sits near the middle, which is why agencies on the Wyoming side of a border tend to build around in-home work.
- Service mix. In-home supports carry Wyoming's only positive one-to-one margin; plan employment and community integration as subsidized lines.
- Day programs. Convert the daily day habilitation rate to an hourly figure using real program hours.
- Authorization. Track yearly limits on T2017, T2019 and T2027 throughout the year.
- Advocacy. Document losses on T2019 and T2027 ahead of the next budget session.
The Wyoming Medicaid rates hub covers all 47,114 current Wyoming Medicaid rates, including every DD waiver rate, and IDD Medicaid rates by state compares every IDD service.
Rates are compiled from official state Medicaid publications, including the Wyoming Department of Health DD Waiver Fee Schedule effective July 22, 2026 and the Comprehensive and Supports Waivers Fee Schedule effective September 1, 2025. Each rate links to its source document and carries its effective date. Hourly figures convert 15-minute units by four. See our methodology.