Medicaid expansion may be dead in Wyoming, but there’s a chance it could return to life next year in a new form.
Gov. Matt Mead has asked state health officials to explore options for an alternative Medicaid program that might be better suited for Wyoming. That could include a system that mirrors private insurance, with incentives that push patients toward preventive care and away from costly emergency room visits, said state Health Department Director Tom Forslund.
Copayments and deductibles could also be built into the alternative program.
Lawmakers voted last month to reject optional parts of Medicaid expansion, which is a key component of the federal Affordable Care Act. The decision is expected to cost Wyoming $79 million over six years.
The state won’t feel the full budgetary effect of that decision until next year, when mandatory parts of the expansion go into effect. Roughly 10,600 people may be added to Wyoming’s program, according to state estimates.
Health officials want to be prepared with alternatives in case lawmakers, faced with a sizable Medicaid bill, reconsider the optional expansion, which could turn a $79 million loss into $47 million in savings, according to a Health Department study.
“We want to present options without having to scramble,” Forslund said.
States must expand Medicaid, a government health program that covers the poor and medically needy, as part of federal health care reform. But a 2012 U.S. Supreme Court ruling gave states the power to opt out of certain parts of the plan.
Optional expansion would add about 17,600 poor adults to the state’s Medicaid rolls. Wyoming currently does not offer income-based coverage to childless adults and only covers parents with incomes well below federal poverty guidelines.
Extending coverage to those groups would allow the state to spend less on other health programs, resulting in the projected $47 million savings. However, those savings did little to persuade Republican lawmakers, who worry the federal government won’t honor its promises to cover the cost of at least 90 percent of the expansion.
Some lawmakers also complained that the traditional Medicaid program was inefficient and encouraged unnecessary care.
Wyoming lacks another program to significantly reduce its uninsured population or address the roughly $200 million a year in uncompensated care that hospitals perform for people without coverage. That seemingly leaves the state with the choice of expanded Medicaid or the status quo.
Enter the U.S. Department of Health and Human Services, which has offered a third choice: Build a more flexible Medicaid program for the expansion population.
“You could put people on the traditional Medicaid plan, or the state could have an alternative plan that is quite a bit different,” Forslund said.
Mead opposed optional expansion and has criticized federal officials for failing to provide the state with adequate information on the effects of the Affordable Care Act. But the governor has also said Wyoming should explore a Medicaid package with more flexibility. He’d like to get the Legislature’s input on alternatives, said Mead spokesman Renny MacKay.
The Health Department plans to present Mead with alternatives this summer.
A second chance?
Some lawmakers say they’d reconsider Medicaid expansion if state officials and the federal government can agree on a plan that works for Wyoming. Sen. Bill Landen, R-Casper, voted against optional expansion when it was debated earlier this month, but said he’d be open to discussing alternatives that cover more of the uninsured.
Like many lawmakers, Landen questions whether the federal government will meet its financial commitments. But regardless of what happens, Wyoming’s health care problems aren’t going away, he said.
“We have a lot of folks who are uninsured,” he said. “And that is not good for our hospital system, not good for our providers, and most importantly, it’s not good for our citizens.”
If federal officials are willing to be more flexible with Medicaid, lawmakers should revisit their decision, said Sen. Charlie Scott, who was among the most vocal critics of optional expansion. But he said state leaders might want to wait until the 2015 legislative session — after expansion has been in effect for more than a year — before making a decision.
“We may have our hands full the next few years dealing with the consequences of [the Affordable Care Act.]” he said. “We just don’t know.”