A state legislative committee on Monday voted to proceed with a series of reforms designed to address escalating costs in Wyoming’s Medicaid program.
Lawmakers also want to study paying private organizations to manage care for the entire Medicaid population.
Under a managed care system, Medicaid recipients would receive services through third-party networks. In theory, managed care would save the state money, but it could also limit options for people who rely on Medicaid for coverage.
“Managed care is going to be a change of some magnitude for Wyoming that we haven’t used before,” said Sen. Charlie Scott, R-Casper. “It has considerable implications both for our providers ... and frankly, for some of our populations. But it has considerable ability to reduce the costs we are seeing in Medicaid.”
The reforms were included in a report that state health officials presented to the Joint Labor, Health and Social Services Committee during a day-long meeting in Casper. The recommendations resulted from a Wyoming Department of Health Study that examined the factors driving Medicaid costs and options for controlling them.
Medicaid, a joint state and federal program that provides coverage to the poor and medically needy, is expected to cost the state $560 million during the current, two-year budget cycle. More people than ever are using the program, and the cost of covering them has steadily increased over the past decade.
The committee supported several changes to the existing Medicaid program. Some will require approval from the full Legislature; others can now be implemented by the health department.
Incentives to encourage healthy behaviors in Medicaid recipients and good outcomes among health care providers
Increased fraud prevention
Decreasing unnecessary visits to the emergency room, which are costly and an ineffective primary care treatment option
Prenatal services to all pregnant women who deliver Medicaid-eligible babies
Tightening standards for nursing home eligibility, while expanding other, home-based options.
Those recommendations and others should maintain costs at current levels, according to the report. More significant changes, like managed care, could actually save the state money.
Under the existing system, people who use Medicaid must find providers who are willing to accept Medicaid recipients. With managed care, those people receive health care from a third-party contracted by the state.
States have increasingly turned to managed care to coordinate care among providers and cut costs. Wyoming is one of only three states without a comprehensive program, according to a survey conducted by the Kaiser Family Foundation.
The legislative committee wants to study whether to use managed care for Wyoming’s entire Medicaid population, or just for certain groups — like older adults or people with disabilities — that account for the most spending.
“It may be that we don’t have the population size to do anything,” Scott said. “We may not have the population size to do a full-blown effort. We don’t know at this point.”
The study must be approved by the full legislature next year.
The committee also asked the health department to develop a tool for evaluating a managed care system, should it be implemented. Both cost and the quality of care should be considered, said Sen. John Schiffer, R-Kaycee.
“If we are going to go down this route of very fundamental change in the way we are delivering medicine, we ought to require up front some way to evaluate this thing,” he said.