Wyoming Department of Health Director Tom Forslund did not mince words to lawmakers Tuesday.
“I just can’t handle it this time around,” he said of the $32 million deficit facing the department, which has cut roughly $100 million already. “This’ll be the first time in my career of public management that I haven’t been able to deliver a budget in a time period under what was authorized. We’re going to blow through it. ... I need help from the Legislature.”
Such was the tone of the health department’s presentation to the Joint Appropriations Committee. It had been cut and cut, and the stark reality, Forslund said, was that there wasn’t $32 million floating around that could absorb the deficit.
The shortfall is largely accounted for by a wave of older Wyomingites moving into long-term care facilities, a wave that will only swell as baby boomers age and require more care. In a document detailing the department’s budgetary needs, at least $28 million of the shortfall was directly related to Wyoming’s aging population.
While $32 million seems significant now, the costs will only climb from here, Forslund said. Long-term care costs about $130 million a year now and could more than double to $312 million by 2030.
Forslund — and Gov. Matt Mead — had sounded the alarm about the situation before. Forslund appeared in front of lawmakers in October and warned them of what was needed now and what would be needed in the future.
He told lawmakers Tuesday that there were five subfactors — which tentacle back to the larger issue of Americans simply aging — that are going to contribute to this growth.
One is that the older population is “increasingly burdened with chronic disease” and that those people are living longer. Second is that there’s a “decreasing ratio” of working-age adults to retirees, meaning that there are fewer people to pay into the programs that pay for their elders. Third, long-term care is costly. Wyoming spends the fourth most money in the country on the aged and the ninth most on caring for those with disabilities, Forslund said.
Fourth is that fewer people are prepared to pay for their own long-term care, meaning they end up on state Medicaid rolls. And finally, the long-term care insurance market is “small and weakening,” Forslund said.
Past cuts have left the department with fewer options to move money around and absorb the $32 million shortfall elsewhere.
“Our ability to flex out is greatly diminished,” the director told lawmakers. “I just don’t have the ability to handle the type of unanticipated costs or unusual things that come up as we have been. Because of this Medicaid overrun, we are trying to absorb a portion of them by moving money around. But we can’t absorb all of this overage.”
While the government can’t stop people from aging and it can’t stop them from moving into state nursing homes, it can work to keep them home longer — a cheaper and, officials say, patient-preferable option.
“The longer we can keep them out of the nursing home and in their home, the less expensive it is for the state and generally more rewarding it is for the individual,” Forslund told lawmakers. “We hope, as part of our strategy, is to increase these home and community based services significantly to try to better control nursing home costs.”
Asked if that would really be cheaper, Forslund said nursing home costs were “157 percent higher” than those receiving care in their home.
There’s the $32 million that the department is short for the remainder of this two-year budget cycle, which ends June 30. For the next cycle, Forslund requested an additional $49 million from lawmakers — roughly $25 million of which is for the aging population.
Contributing to both the $32 million current deficit and the $49 million supplemental request was Mead pivoting away from a legislative decision. Lawmakers had previously stripped funding from Medicaid programs for certain individuals with disabilities and with cervical and breast cancer. The thinking was that these individuals could get insurance from the health care exchanges.
But Mead apparently balked at the move, Forslund said, because he thought it was too important to cut. Though the funding — $1.5 million of it — was gone, the governor told the health department to find the money and keep the programs alive.
Overall, Forslund said that he hoped he was giving lawmakers his worst-case scenario.
“I need help is what I’m telling you,” he said.
“So do we,” said committee vice-chairman Rep. Bob Nicholas, a Cheyenne Republican.
“I think we’re in this together,” Forslund replied.