CHEYENNE — An estimated 19,000 people would be covered within two years if Medicaid were expanded in Wyoming, according to an analysis presented to lawmakers Thursday, just days before legislators will again consider expansion.
Wyoming stands almost alone among its neighbors in the West in not expanding Medicaid, which would extend the joint state and federal program to include those at 138 percent of the poverty line, which is roughly $26,000 a year for a family of four. The Legislature here has repeatedly rejected attempts to expand Medicaid, often killing bills before they see the light of day.
Still, the Joint Revenue Committee will consider a bill next week that would expand the program. That measure requires study by various departments and support from Gov. Mark Gordon.
Policy analyst Franz Fuchs, who works for the state Department of Health, told lawmakers Thursday that the department projects a $154 million cost to expand Medicaid in the first two years. However, under the provisions of the Affordable Care Act, the state would pay only $18 million of that. The remaining $136 million would be funded by the federal government.
The projected enrollment Fuchs presented had a wide range: 19,000 is expected, though the numbers within the first two years could be as low as 9,000 or as high as 32,000. The success of the program also depends on who enrolls. Fuchs told lawmakers that the department is expecting sicker Wyomingites to enroll first, which would make the program more expensive. However, the department is projecting a more diverse, healthier pool developing over time, stabilizing costs.
Of those who are projected to enroll, 56 percent are currently uninsured. Sixty-four percent are below the federal poverty line. Those numbers are important: The uninsured and impoverished are not immune to illness. Because they’re uninsured or cash-strapped, their care is often written off by hospitals as charity care or bad debt. That, in turn, can drive costs up for Wyomingites with insurance.
Notably, the bill in front of the Revenue Committee does not include a work requirement. In recent years, legislators have proposed such a rule — which would require Medicaid beneficiaries to work or be educated for several hours each week — with the underlying suggestion that it may make expansion more palatable.
Indeed, a Democratic lawmaker last session proposed a Medicaid expansion bill with a work requirement baked in. It seemed an olive branch to the rest of the Legislature. In any case, the bill was killed.
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It was estimated that roughly 3,000 people who currently receive Medicaid here would be affected by such a requirement. Wyoming has strict rules on who can qualify. Most are single and poor mothers, disabled people, the elderly or caregivers for a disabled person.
According to federal data compiled by the Kaiser Family Foundation, 63 percent of Medicaid beneficiaries nationally work full or part time. Of those who don’t, most are disabled, are caregivers or are enrolled in school.
On a broader note, this work may all be a moot point. A federal appeals court is expected to rule imminently on a lawsuit against the Affordable Care Act brought by Republican attorneys general. A lower court judge previously ruled the law unconstitutional. While a court ruling against the ACA would mean the end of Medicaid expansion, it would also likely be appealed to the Supreme Court. In other words, the future of the ACA remains very much unknown.
Meanwhile, while the Legislature again ponders Medicaid expansion, the policymakers at the Department of Health have submitted their plain to reduce air ambulance costs to the federal Centers for Medicare and Medicaid Services.
The plan is ambitious and unique. It would essentially treat air ambulances as a public utility and would expand Medicaid in a limited capacity to cover air ambulance costs for all Wyomingites. One air ambulance provider would be selected after a bidding process to be the state’s preferred Medicaid provider.
Naturally, the air ambulance industry has opposed the proposal. Representatives for the companies say that costs aren’t as high as advertised, that fixed costs tie their hands and that most patients don’t pay the bills they do receive.
Still, federal reports indicate there’s significant money being made in the industry nationally.
In any case, the plan must be approved by the federal government. Fuchs, the policy analyst for the Health Department, previously told the Star-Tribune that CMS has indicated they won’t approve it. If that happens, legislators — who have indicated they want to address air ambulance costs somehow — will have to go back to the drawing board.