Wyoming leaders mull Medicaid expansion options

2013-09-05T08:30:00Z Wyoming leaders mull Medicaid expansion optionsBy JOSHUA WOLFSON Casper Star-Tribune The Billings Gazette
September 05, 2013 8:30 am  • 

CASPER, Wyo. — An alternative form of Medicaid that’s more like private insurance would be Wyoming’s best option if lawmakers decide to expand the program, Gov. Matt Mead said Wednesday.

Mead told reporters at a news conference that he agreed with the conclusion of a Wyoming Department of Health report that selected “Medicaid Fit” as the best substitute for the expansion rejected by the Legislature in February. But he didn’t stake out a position on whether the state should actually grow Medicaid.

“The decision I have not made yet is whether I want to push that expansion or not,” he said.

Two influential lawmakers, meanwhile, indicated Wyoming should pursue other options for covering poor residents. One has already drafted a bill based on a model developed in Arkansas.

Mead directed the health department to study options for extending Medicaid benefits to more people after lawmakers defeated the expansion included in the federal health care reform law known as Obamacare. The study found Medicaid Fit would provide health coverage to roughly 17,000 poor, childless adults, albeit with fewer benefits than the existing program.

Health officials predict the model would save the state more than $47 million by allowing it to spend less on other safety-net programs.

Mead, like many lawmakers, has expressed worry about what might happen if the federal government fails to meet its obligations to fund most of the expansion. Under that scenario, legislators would have to decide whether to cover the difference or take away an entitlement from people who’ve begun relying on it for care.

“I have heard some people couch it in these terms: If we don’t accept it we basically are paying money not to insure 17,000 people,” Mead said. “But that statement assumes it will all go as planned by the federal government.”

“I have my doubts about that. We already see major portions being delayed,” he added.

Arkansas option

Lawmakers are exploring other options for extending coverage to more of the state’s uninsured. Rep. Elaine Harvey, R-Lovell, chairs a legislative committee that studies health issues. She’s drafted a bill that’s based on an approach conceived in Arkansas.

That model would use Medicaid funding to buy private insurance for poor children and adults through the health insurance marketplace now being developed by the federal government. The aged, blind and disabled would continue to use the existing Medicaid population. Other groups, and the new expansion population, would receive care through the Arkansas-style plan.

The health department looked at similar approaches, but concluded the Medicaid Fit model would work better for Wyoming. Harvey, however, says the Arkansas plan offers several benefits. By using private insurance, it would offer doctors better reimbursement rates than Medicaid. It would also mean people who use it wouldn’t have to switch insurance with each change to their income.

Harvey said she’s not sure how palatable the model would be among legislators skeptical of anything related to the federal health law. She’s no fan of the law either, but advocates for a pragmatic approach that helps citizens avoid paying penalties for not having coverage.

“This is the law,” she said. “How are we going to make it fit in Wyoming?”

Sen. Charlie Scott, who also chairs the health committee, said he’s intrigued by the Arkansas approach, but would prefer if it doesn’t involve the federal insurance marketplace, which he suspects will drive up costs.

The Natrona County Republican is no fan of the Medicaid Fit option endorsed by the health department. He views it as too similar to the original expansion proposal that’s already been defeated by the Legislature. That model relies on a Medicaid program that he says encourages excessive use of health care services.

Regardless, Wyoming leaders do need to take steps to address the thousands of people who can’t afford insurance and don’t have jobs that offer coverage, he said.

“There is still a problem there and sooner or later we’ll need to deal with it,” he said.

Draft legislation

Medicaid Fit has found at least some support in the Legislature. Rep. Mary Throne, D-Cheyenne, also sits on the health committee. She’s asked the Legislative Service Office to draft a Medicaid Fit bill that the committee could review when it meets this fall.

Throne supported Medicaid expansion in its original form, but said she’s willing to consider the health department’s recommended approach. The important thing is quickly getting health care to those who need it.

State leaders should consider options beyond the Arkansas plan, she said.

“We don’t have any evidence it would work in Wyoming,” she said. “I think people are playing politics with health care.”

Star-Tribune staff writer Joan Barron contributed to this report.

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