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VA Mental Health

A construction worker walks along the roof of the Cheyenne Veterans Affairs Medical Center’s Mental Health Facility Monday afternoon, April 6, 2015 in Cheyenne. Buffalo, Casper and Sheridan are the three cities being considered for a VA skilled nursing facility in Wyoming. 

CHEYENNE — Wyoming now has a clear picture of the potential costs, locations and necessary steps to bring a subsidized long-term treatment facility for veterans to the state.

The Wyoming Veterans’ Commission, Wyoming Department of Health and the State Construction Department were commissioned by the Legislature in 2018 to study how to secure a VA skilled nursing facility for the state. The second phase of the study was finished this month and presented Wednesday to the State Building Commission.

Wyoming must now decide where to put the potential facility, and if it’s willing to spend more than $7 million to make it a reality.

Skilled nursing facilities provide long-term care to veterans and are partially subsidized by the VA. While the state has the Veterans’ Home of Wyoming in Buffalo, the proposed skilled nursing facility would focus specifically on providing long-term care to veterans, especially those who would otherwise not be able to afford treatment in a hospital setting.

Currently, Wyoming is the only state without a VA skilled nursing facility.

The study found that Sheridan, Buffalo and Casper were the three locations that make the most sense to house such a facility. If the state’s application is approved by the VA, Wyoming would receive a grant to cover 65 percent of the cost to build a facility. That money wouldn’t cover the cost of the land, which was a major factor in deciding where to build a facility.

To build in Buffalo, the state estimates its portion of the project would cost $7 million, while the cost would be $7.7 million in Casper and $7.6 million in Sheridan.

Cheyenne was in the running during the first phase of the study, but land wasn’t available for development, said Franz Fuchs, policy analyst with the Wyoming Department of Health. Another issue with Cheyenne was the large percentage of veterans who might travel from other states for care.

“The location consideration was one of the most sensitive issues we wanted to look at,” Fuchs said. “The top three criteria were the proximity to (veterans) family, the low cost of care and the close proximity to VA care.”

The study figured that if the state took out a loan or bonded its share of the cost for building the facility, it could expect to see an annual cost of around $550,000, depending on which site was picked, said Steve Kravitsky, director of the Wyoming Veterans’ Commission and a retired U.S. Air Force colonel.

Each location had positives and negatives, including cost of construction, ease of access and if an adequate workforce of medical professionals existed close by, Fuchs said. In the end, the decision as to where to place it will be up to the state Legislature.

Gov. Matt Mead said during the Wednesday meeting it was important that input on the location be taken from across the state. But he didn’t want a fight over where to place the facility to keep Wyoming from getting the much-needed resource for its veterans.

“I think the important thing is we’re the only state that doesn’t have this. And you have to think about that as a state. Do we want to have that distinction of not having a facility that every other state has to serve our veterans? I don’t want the selection to get a point where we’re not going to have it because we can’t agree,” Mead said. “I do think the workforce is a big issue. I do think you have to have it in a place with an adequate workforce.”

One of the biggest benefits to veterans in Wyoming of a skilled nursing facility is it allows veterans who qualify to receive a $107.16 per diem from the VA. That assistance is only available if the veteran stays at one of those facilities, Kravitsky said

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“Over a year, that’s almost $40,000. That’s a huge cost savings to a private-pay veteran,” Kravitsky said.

As of now, a potential facility would house between 45 and 85 beds to start, with the potential to expand. Kravitsky said the VA limits the number of subsidized beds for veterans in treatment facilities in a state, with Wyoming capped at 454 beds.

Fuchs said the amount of money the state would need to add to its budget to pay for operations at the facility could be zero. The facility would receive both the per diem payout from the VA and Medicaid funding for veterans who qualify helping to fund it. There could also be cost savings to Wyoming by treating veterans in the facility, as opposed to the state hospital, which would be a more expensive option for long-term treatment.

But Fuchs said it was hard to predict if that zero cost would end up being the case at this phase of the study.

“In reality, it’s a complex question to answer on whether or not there would be a net cost to the state,” Fuchs said.

The next step in the process would be for the Joint Transportation, Highways and Military Affairs Committee to pick a final site and support funding for the final phase of a study. The Legislature would also need to pass a bill that funded Wyoming’s 35 percent match for the project.

Kravitsky said the earliest the VA would be able to release grant funds, if Wyoming’s application is approved, would be 2021, and it could be as late as 2023. The deadline for the application is April 15, but Kravitsky said it needed to be finished and submitted around February to ensure there were no errors or additional information needed by the VA.

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