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Health officials release modified Wyoming Medicaid expansion proposal

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A modified plan for Medicaid expansion would provide care for nearly 18,000 uninsured Wyomingites, according to a report released Wednesday by state health officials.

The expansion would bring more than $100 million in federal funding to the state annually, according to the Wyoming Department of Health report. The plan modifies traditional Medicaid coverage by borrowing cost-sharing measures from common private insurance plans.

Participants in the state's Medicaid plan would pay co-payments, and those with larger incomes would pay monthly premiums between $25 and $50.

The state’s proposal also provides employment assistance, including access to job search services and vocational rehabilitation programs.

The Health Department’s latest proposal attempts to meet the needs of Wyoming Republicans who are skeptical of the federal government’s ability to ensure funding for expanding Medicaid. It also provides components like employment service counseling to quell Republican concerns.

“It would promote participants to take an active role in their own health,” said Tom Forslund, director of the Wyoming Department of Health. “Participants will have a financial responsibility to be part of this plan.”

Health Department officials are confident in the proposal’s chances for approval after informal discussions with the Center for Medicare and Medicaid Services.

Governor Matt Mead voiced his support for the plan in a Wednesday release.

I believe it is the most favorable plan for Wyoming and it addresses the needs of those who fall in the gap," he said. "If the Legislature chooses not to authorize Medicaid expansion – I would ask and expect them to have an alternative for the 17,000 people who do not have coverage in Wyoming." 

Legislators voiced concern about the plan’s workforce services component. In the past, federal Medicaid officials have rejected work requirements for Medicaid programs. Wyoming officials say the proposed employment services are not a requirement but a benefit.

“Just like any other benefit, it comes with the enrollment onto the program,” Forslund said. “They will be able to access various levels of assistance. If they don’t need these services, they won’t be required to make use of them."

Sen. Jim Anderson, R-Casper, said many states have struggled to pass workforce service portions of their expansion proposals.

Wyoming officials are confident the distinction between a benefit and requirement will pass a formal approval process with federal Medicaid officials.

The expansion plan would provide support for Wyoming hospitals, which provide more than $200 million in uncompensated care annually and create more than 800 jobs with no added cost to the state, according to the report.

Wyoming Medical Center in Casper provided $56 million in uncompensated care in the 2014 fiscal year, 12.2 percent of the hospital’s gross revenue.

In a statement released after Wednesday's announcement, hospital officials said the expansion will help hospitals across the state recoup a significant percentage of those costs.

Legislators say the proposal is a start in passage of Medicaid expansion this year.

“Certainly this doesn’t mean anything is going to pass,” said Sen. Chris Rothfuss, D-Laramie. “I think we have a lot of work to do to demonstrate the benefits to the state of Wyoming.”

Sen. Charlie Scott, R-Casper, a co-chariman of the Joint Labor, Health and Social Services committee said the committee will consider a bill of its own that would use federal Medicaid expansion money to create health-savings accounts as an alternative to the proposal.

In February, the Senate defeated an attempt to pass Medicaid expansion, on a 21-9 vote.

Legislators did allow for negotiations between state Health Department officials and the Centers for Medicare and Medicaid Services. Since the session ended, the two sides worked to draft a waiver that would provide Medicaid services to more than 17,600 uninsured Wyomingites.

The concession on the part of Republicans in the Legislature came in the form of a budget amendment that allowed the Health Department to negotiate with federal Medicaid officials on a waiver.

The footnote required a Nov. 1 report on the progress of the talks. The footnote also gave lawmakers the final approval of any negotiated plan from Medicaid officials.

Gov. Matt Mead announced in an early November news conference that federal health officials had eased their stance on what he called a plan tailored to Wyoming's needs.

State health officials said at the time that the plan met the unique needs of the state. Wyoming health advocates are optimistic the plan will provide enough incentives for both parties to pass a Medicaid expansion in the state.

The Health Department's report will be delivered to legislators at the Dec. 15-16 meeting of the Joint Interim Labor, Health and Social Services Committee in Cheyenne.

Staff writer Laura Hancock contributed to this report.

Reach general assignment reporter Trevor Graff at 307-266-0639 or Trevor.Graff@trib.com. Follow him on Twitter @TrevGraff.

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