Wyoming lawmakers are still ironing out details of legislation that would overhaul the state’s Medicaid program.
The legislation, now before the Senate Labor, Health and Social Services Committee, would implement a number of reforms to Medicaid. State health officials and advocacy groups say the bill could decrease costs, while making new services available to those already enrolled in the program.
Health officials spent Monday detailing how the reform package could address the increasing cost of Medicaid, which provides health coverage to about 77,000 poor and medically needy people in Wyoming.
About 60 percent of Medicaid dollars are spent on older adults and people with disabilities. The bill seeks to address those costs by restructuring a key program for the developmentally disabled and by making changes to long-term care services. Other provisions would address mental health treatment and prenatal screenings.
The committee will have one more meeting before it votes on whether to send the bill to the Senate floor.
The bill would overhaul a state program that funds services for more than 2,200 people with developmental disabilities and brain injuries. Wyoming’s waiver program pays for a range of programs, from job training for developmentally disabled adults to assistance for parents with special needs children.
The state spends roughly $120 million a year on the waiver system, and some applicants have to wait years before receiving services. The changes included in the legislation are designed to cut waiting times for services, without adding to the overall cost of the program, said Chris Newman, senior administrator for the Wyoming Health Department’s Behavioral Health Division.
“The goal is to make sure people get the basic services they need to remain in the community, while still getting at least some services for people who have been waiting for up to five years,” Newman said.
Right now, the waivers pay for both support services and 24-hour care for people with more significant needs. But the cost of the intensive services isn’t sustainable, Newman said.
The bill would address this by creating two separate waivers. Most people would receive waivers that cover support services, like job assistance programs. A smaller group would be eligible for more comprehensive, and expensive, services.
Some people on the waiver program would receive less funding, Newman said.
“We have to tighten up on the budget and make sure that people are getting critical services based on their needs,” she said.
But as the state looks to address its waiver costs, it’s important to ensure that people who use the program receive the support they need, said Chris Boston, executive director of NOWCAP Services, a Wyoming nonprofit that oversees a variety of programs for people with disabilities.
Boston supports a redesign of the waiver program. But during that process, state officials should consider the views of groups that provide services, as well as the recipients, he said.
“We don’t want to put potentially vulnerable people at great risk,” he said.
The reform package devotes considerable attention to how the state funds long-term care for Medicaid recipients.
Currently, the state has a cap that puts Medicaid patients on a waiting list for at-home care. There are usually 10 to 20 people on the list, said Teri Green, state Medicaid agent. In many cases, the state will place Medicaid participants on the waiting list into a nursing home, incurring high costs for the state. Green wants to ensure participants at nursing homes really need to be there.
The new bill creates opportunities to eliminate caps so more Medicaid participants can stay in their homes, said Tom Forslund, director of the Wyoming Health Department.
“We have a low-cost program that we have capped, and we have a high cost-program that we haven’t capped,” he said.
The bill would also allow the health department to update its tool for determining nursing home eligibility, and could provide state officials with more flexibility in setting reimbursement rates for Medicaid patients at nursing homes, said Steve Bahmer, executive director of the LeadingAge Wyoming, which represents 29 nonprofit long-term care and assisted living providers.
State officials can already consider the severity of patient needs at a nursing facility. The bill would allow them to also consider regional economic factors and the percentage of patients at the facility that are served by Medicaid.
Prenatal care is not available to mothers who are going to deliver children who will be immediately eligible for Medicaid, Green said.
“Oftentimes that leads to a more extensive delivery and more negative outcomes for the birth of the child,” she said. “Those can be very costly cases for the Medicaid program.”
The state would receive a return on its investment if it covered prenatal services for all women that would deliver Medicaid eligible babies, Green said.
The state would implement a program that screens pre-natal women for substance abuse and mental health disorders.
“The issue we are trying to attack is that we have pregnant women on the program who have substance abuse issues and mental health issues,” Green said.
Wyoming would not use federal money to cover the costs, said Sen. Charles Scott, R-Casper.
“What this does is change the number of births that would be on Medicaid,” Scott said. “There are some people who give birth on Medicaid who are not eligible for prenatal care, which sounds kind of irrational. And this is an attempt to change that.”
Whether the state Medicaid department can cover every eligible mother is still unknown. The state’s Medicaid program is still compiling data on that subject, Green said.
All behavioral health programs come out of the state’s budget. Health officials believe that they can work with the federal government in a cost-matching program that would help reduce costs for the state. The federal Medicaid program would pay half; the state would fund the other.
The cost-matching would allow the state to reduce its budget by $13.8 million in fiscal years 2015 and 2016, Newman said.
It also wouldn’t increase the number of recipients, according to Green.
“What this is saying is that there are people out there who we’re paying 100 percent out of the general fund for, and should we try to leverage federal funds for that,” she said.
State hospitals and community mental health centers would be eligible to work in the partnership.
Medicaid recipients with serious and persistent mental illness or serious psychological distress would qualify, Newman said. Today, the state cares for anyone who seeks treatment in community health centers.
Those who don’t meet the threshold will not be covered if the bill passes, she said.