Report: Medicaid alternative could save Wyoming money

2013-08-26T19:49:00Z 2013-08-26T23:56:06Z Report: Medicaid alternative could save Wyoming moneyBy JOSHUA WOLFSON Casper Star-Tribune The Billings Gazette
August 26, 2013 7:49 pm  • 

CASPER, Wyo. — Wyoming could reduce its uninsured population and save millions by developing an alternative form of Medicaid that’s more akin to private insurance, according to a state report released Monday.

Such a model represents Wyoming’s best substitute to the Medicaid expansion rejected by lawmakers in February, the report concludes. It would cover roughly 17,000 uninsured adults, but with fewer benefits than the existing Medicaid program.

The recommendation comes from a state Department of Health team that spent months analyzing alternatives to expanding Medicaid in accordance with the federal health care reform law. The team offered five options, with “Medicaid Fit” — described as a middle ground between private insurance and the traditional program — as its top recommendation.

“We thought that would be a good fit for Wyoming and would be something we could implement rather quickly, compared to some of the other ones,” health department Director Tom Forslund said.

Medicaid Fit would serve uninsured people who missed out on coverage when lawmakers voted down expansion during the past legislative session. That group consists of poor, childless adults.

Wyoming Medicaid would continue to serve other groups.

The alternative Medicaid model would share some of the same characteristics as private insurance. It would require recipients to contribute to the cost of their care through deductibles and co-payments. That could make the idea more palatable to conservatives in the Legislature who are skeptical of expanding government involvement in health care.

State health officials predicted the rejected Medicaid expansion could have saved Wyoming $47 million over seven years. The alternative approach could net the state even more money, Forslund said.

Savings are possible because the federal government would fund most of the alternative expansion, allowing the state to spend less on other safety-net programs. Medicaid Fit would meet minimum federal standards, but with benefits more limited than those offered by the state’s existing Medicaid program.

“Because this is a lighter version, there would be more savings,” Forslund said.

The department hasn’t calculated exactly how much money Medicaid Fit would save.

Gov. Matt Mead directed the health department study after expansion’s defeat in the Legislature. The health department team concluded Medicaid Fit was the best option, but offered four others to consider:

• Wyoming purchases health coverage for poor, childless adults through a federal health insurance exchange.

-- The state contracts with a private insurance company to provide coverage.

-- Officials extend the regular Medicaid package to more people.

-- The state develops a unique plan.

The report noted several advantages of the Medicaid Fit model. It would take advantage of reforms already underway in the existing Medicaid system. Wyoming would also maintain some control over the design of benefits.

Lawmakers who have opposed expansion worry the federal government won’t meet its funding promises, leaving Wyoming in the unenviable position of either footing a greater portion of the bill or taking away coverage from people.

Expansion backers tried to alleviate those concerns by including a trigger that would allow Wyoming to opt out of the program should the federal government fail to fulfill its obligations. A similar trigger would be added if state leaders choose to pursue a Medicaid alternative, Forslund said.

Mead and legislators must now decide whether expansion deserves a second look. They would then need to settle on one of the five options.

The governor hasn’t taken a position on any of the options discussed in the report, said spokesman Renny MacKay. Nor does he have a stance on expanding Medicaid in the future.

“He appreciates that this is out there so everybody can review it as he works with the Legislature on a decision on whether or not to expand,” MacKay said.

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