CASPER, Wyo. — Wyoming lawmakers will begin discussions next month on a reform package designed to address escalating costs in the state’s Medicaid program.
The legislation would encourage healthier lifestyles among Medicaid recipients and reduce unnecessary emergency room visits. It would also create incentives for health care providers to meet certain outcomes for patients.
The Joint Labor, Health and Social Services Committee agreed Friday to sponsor the legislation. The bill is based on a lengthy Health Department study of ways to improve Medicaid.
“Our objective is to bring the Medicaid budget under control without taking a whack out of (health care) provider reimbursement, which can cause all sorts of trouble,” said Sen. Charles Scott, the Natrona County Republican who co-chairs the committee. “And I think it will succeed at that.”
State officials already expect to spend more than a half-billion dollars on Medicaid during the current two-year budget cycle. Roughly 77,000 poor and medically needy people in Wyoming used the program during the last fiscal year.
About 60 percent of Medicaid spending goes to older adults or people with disabilities. The reform package includes a number of measures to address those costs, including tighter standards for nursing home eligibility. Another would replace, when possible, high-cost residential care for the developmentally disabled with community-based services.
The bill would also direct the Health Department to explore hiring private organizations to manage care for some or all of the state’s Medicaid population. Generally, such organizations contract with health care providers to form networks for treating patients.
Officials want to study whether managed care could save the state money while providing the same or better care than exists now. Wyoming is one of only three states in the country that doesn’t use some form of managed care in its Medicaid program.
The legislation would not actually bring managed care to Wyoming. Instead, it would give officials a green light to explore options for such a system and to seek input from providers, Scott said.
“If you don’t have reasonable support from them, they don’t participate and it doesn’t happen,” he said. “It’s just as simple as that.”
Lawmakers will have a lot of convincing to do. Members of the Wyoming Medical Society, which represents about half of the state’s doctors, oppose bringing managed care to the state, said Sheila Bush, the group’s executive director.
In fact, many physicians come to Wyoming because it lacks a managed-care system. They believe it isn’t the best way to address patient needs, Bush said.
“We have a small enough population, and we have smart people here in the state who can come up with more innovative solutions to address these problems than hiring an outside firm and sending that money outside the state,” she said.
The Health Department can begin some reform measures before the legislative session begins, said agency spokeswoman Kim Deti. Adding to the state’s existing fraud prevention effort is one example.
Significant changes, though, won’t take place without approval from lawmakers.
“Major shifts, we would want the Legislature’s buy-in,” she said.