PASSE (Provider-Led Arkansas Shared Savings Entity) is how our state handles Medicaid funding for eligible individuals. Together with CES (Community and Employment Support), these programs directly affect the wages and work environment for our DSPs.
The Waiver Process:
Our providers’ clients are individuals who apply for medicaid assistance due to disability via CES. Once a client has applied and been approved, they are assigned to 1 of 4 PASSEs:
- Summit Community Care
- AR Total Care
- Empower Solutions
- CareSource
The client chooses a provider affiliated with their PASSE who provides the requested services and waiver hours. The following steps apply to this process:
- The provider must be contracted with the client’s assigned PASSE.
- The state (DHS Medicaid AR) gives money to each PASSE attached to the client’s application
- Providers provide the approved waiver services
- Providers then bill PASSE for the hours to get reimbursed

What is a DSP?
Direct Support Professionals (DSPs) are essential to the Intellectual/Developmental Disabilities Industry.
How does this process affect DSP wages?
Waiver hours for clients are based on need, and are determined by each PASSE through assessment. PASSEs have payment tier levels based on these hours, as well as the complexity of client needs. Examples include:
- One-on-one DSPs
- Shared DSPs
- Communal programs
- Adult and child services
Service Example:
One-to-one DSP: $23/hour per client.
Example Earnings
Breakdown of $23/Hour
Provider Earnings ($4.60)
Administration, payroll, insurance, etc.
DSP Payout ($18.40)
~20-35% used for discretionary provider costs
What are discretionary costs?
Each providers determines how much it costs to train and maintain their DSPs. Thus, DSP payout varies from provider to provider. Generally, 70-80% of the $18.4 above ($11.96-14.72) directly goes to DSPs.
This amount also varies as regulations and PASSE rules change – 20-35% may not be enough to sustain the provider’s current business model.
Other factors to consider:
- Lack of DSPs resulting in overtime (1.5x pay) adjustments for providers
- In 2024, 20 surveyed DDPA providers paid over $5.8M in overtime!
- Some providers have lost staff/DSPs to Human Development Centers (there are 5 in AR) and other PASSEs because of wage improvements.
- 4 PASSEs have switched programs to state-decided “managed care” systems
- Managed CarE: PASSE parent company is private insurance company, not a nonprofit
- Every PASSE has unique regulations and billing systems, resulting in higher administrative overhead
- Statewide rule changes often cost providers revenue, and may come without any additional financial assistance
- Example: all vans are now required to be retrofit with interior and exterior cameras that can record and contain alarms
- Medicaid renewal errors caused some clients to lose Medicaid, which led to failed reimbursements for providers
- Conflicting policies and reports from PASSEs and AR policymakers are affecting providers, as neither is currently planning to increase the budget for compensating providers at this time.
The most recent budget increase for individual rates from PASSEs was in 2018 – since then minimum wage increases and inflation have negatively affected DSP hiring and retention.