Consumer Directed Care in Wyoming: How Self-Directed Medicaid Works

Most families picture Medicaid home care as an agency sending a stranger to their parent's house on a fixed schedule. In Wyoming's Community Choices Waiver, there is another option: participant-directed services. Your parent — or you, acting as their designated representative — becomes the employer. You choose who provides the care, set their schedule, and manage their work directly.

For families in rural Wyoming counties where home care agencies are scarce or nonexistent, participant direction is not just a preference. It is often the only practical way to get consistent care.

How the Employer Model Works

Under the CCW's participant-directed option, the waiver participant (or their representative, typically an adult child with power of attorney) takes on the legal role of employer. This means:

Recruiting and hiring: You find your own caregivers. They can be friends, neighbors, church members, or family members — including adult children, siblings, nieces, and nephews. The pool of potential caregivers expands dramatically compared to agency-based care, which is critical in counties where the nearest home care agency may be an hour away.

Setting wages and schedules: You determine the caregiver's hourly rate within state-approved ranges and build a schedule that matches your parent's actual needs — not an agency's availability. Night shifts, weekend coverage, and split shifts are all within your control.

Managing performance: You train the caregiver on your parent's specific routines, preferences, and medical needs. You approve their timesheets and can terminate the arrangement if the fit is not right.

Who Cannot Be Hired

Wyoming enforces specific exclusions under the CCW participant-directed model:

• Spouses of the participant cannot be paid caregivers
• Legal guardians are excluded
• Anyone holding the participant's financial or healthcare power of attorney is barred from serving as a paid caregiver

These exclusions exist to prevent conflicts of interest — the person controlling the participant's finances or medical decisions should not also be the person billing for their care.

Other family members — adult children (who are not the designated POA), siblings, in-laws, and extended relatives — are eligible to be hired and compensated as caregivers.

The Fiscal Management Service

Being an employer means payroll taxes, W-2 forms, workers' compensation, and federal labor compliance. Wyoming does not expect families to handle this themselves. The state contracts with a Fiscal Management Service (FMS) that acts as the fiscal intermediary.

The FMS handles:

• Federal and state tax withholding and payroll processing
• W-2 issuance for each caregiver
• Criminal background check facilitation and tracking
• Workers' compensation insurance
• Compliance with the federal Electronic Visit Verification (EVV) mandate

EVV is a federal requirement that tracks the caregiver's location, the start and end time of each visit, and the specific services delivered — all through a digital system. The FMS provides the EVV platform and trains both families and caregivers on its use.

Caregiver Requirements

Every caregiver hired under participant direction must meet baseline requirements:

• Be at least 18 years old
• Pass an initial criminal background screening (which may include fingerprinting)
• Complete state-mandated training covering client dignity, infection control, and mandatory reporting of abuse, neglect, and exploitation
• Maintain current CPR and first aid certification (required for some service categories)
• Submit to ongoing background re-checks as required by the state

The training requirements are not onerous — they can typically be completed in a single day — but they must be finished before the caregiver begins providing billable services.

Why Families Choose Participant Direction

In a state where private-pay home care costs $46 per hour and agency waitlists in rural counties can stretch for weeks, participant direction offers three practical advantages:

Continuity: Your parent is cared for by someone they know and trust, not a rotating cast of agency staff. This matters enormously for seniors with dementia or anxiety about strangers in their home.

Rural access: When the nearest home care agency is in Casper or Cheyenne and your parent lives in Thermopolis or Lander, agency-based care may simply not be available. Participant direction lets you hire locally.

Cost control: Caregiver wages under participant direction are typically lower than agency billing rates because there is no agency overhead markup. The savings stay within the waiver budget, potentially funding more hours of care.

Getting Started

Participant-directed services are available to any CCW enrollee — your parent can choose this model at enrollment or switch from agency-based care at any time during their waiver period.

The Wyoming Home Care Guide includes a complete participant-directed care setup checklist covering employer responsibilities, caregiver screening requirements, FMS coordination, and EVV compliance — everything you need to run your parent's care team confidently.

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