Highlight on Wyoming: Medicaid expansion attempts renewed

Despite three years of failed attempts to expand Medicaid in Wyoming, lawmakers are again being asked to consider expanding the program in their state, which is estimated to provide coverage to an additional 20,000 low-income adults and bring in $268.4 million in federal funds over the next two years. The expansion efforts are being spearheaded by an unlikely supporter, the state’s governor, Matthew Mead (R), who previously opposed any expansion, but who now continues to push lawmakers to accept the federal funding, especially in light of the state’s expected $100-200 million budget shortfall.

Governor’s attempts

Wyoming’s governor is not a supporter of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). In fact, the Governor sued the federal government over the ACA and even opposed earlier attempts to expand Medicaid in the state. However, that all changed two years ago, when the governor reversed course and began to favor the program’s expansion.

At the time, Governor Mead explained his change in attitude. “I agree it is not a good piece of legislation, but as I see where we are, I think we have to be realistic and say, ‘This is the current law of the land and we need to either go forward with this’ or if the legislature wants to come up with a different plan, I certainly would be open to that.” Mead added, “But I don’t think we can say to those people in Wyoming who are working who cannot get insurance that we’re not going to do anything.”

A 2014 poll found that while Wyoming residents overwhelmingly opposed the ACA, 56 percent favored expanding Medicaid in the state. Additionally, hospitals in the state have also urged the legislature to approve the expansion.

SHARE Plan

Governor Mead urged lawmakers to accept the state-specific Medicaid expansion plan that the Wyoming Department of Health and Human Services negotiated HHS. The plan, entitled Strategy for Health, Access, Responsibility and Employment (SHARE) plan classifies Medicaid enrollees in two groups and would require all participants to make co-payments. Those enrollees with higher incomes would participate in a demonstration project and would be required to pay monthly premiums ranging from $25 to $50. The program would also provide enrollees with employment assistance programs and vocational rehabilitation programs.

The SHARE program is estimated to reduce uncompensated care in state hospitals by $200 million and the Health Department estimates that it would add 800 jobs without incurring any additional state costs. However, last winter, the Wyoming legislature voted against expanding the program in the state.

Renewed attempts

Governor Mead is again pushing for expansion of the program in the state due to the state’s expected oil, gas, and coal revenue shortfall. This year, the Joint Appropriations Committee (JAC) will be the first to review Department of Health budget issues, which will include Medicaid expansion funds. This is a departure from previous years, when Medicaid expansion proposals were reviewed first by the Labor, Health, and Social Services Committee, which has strongly opposed the expansion.

Wyoming Department of Health Director Tom Forslund appeared before the JAC and stated that the governor intended on using the expansion funds to cover rising costs and to free up general fund money that the state is required to use on health programs for needy residents.

Forslund explained how the expansion funds could be used for low-income individuals. He said, “Right now, a person who needs a colorectal cancer screening, we would pay for it 100 percent with state general funds.” He added, “So what would happen if we do expansion? This individual can sign up for Medicaid, and then Medicaid would pay for that service to the provider.”

State share

Forslund also explained that the expansion would allow the Department of Health to lower its outpatient mental health spending by $10.9 million and substance abuse spending by $6.3 million, which would, in turn, allow it to “self fund” the state’s share of the expansion costs. Additionally, it is expected to produce sufficient savings to cover the Department’s $23.7 million in exception requests in the 2017-2018 budget, which includes a $11.4 million shortfall in the involuntary hospitalization plan, $3 million in readjusting nursing home provider service rates, and $954,000 for growth in preschool enrollment.