MEDICAID EXPANSION: The state has the option under federal health reform law to extend Medicaid coverage to adults under 65 without children and with very low incomes (up to 138% of the federal poverty line). In the last General Session, the Legislature rejected calls to expand Medicaid, claiming that the federal government cannot be trusted to honor funding commitments in the Affordable Care Act. (Aside: Similar arguments are not made when it comes to taking federal dollars for highways and transportation, education, and other state programs that rely on federal aid.)

The Joint Committee heard from the Department of Health, which recently published a report titled “The Wyoming Approach for Medicaid Expansion” laying out five potential plans to expand Medicaid.The committee did not discuss the department’s options. It instead discussed a raw draft of a limited expansion proposal that the state of Arkansas has proposed to the U.S. Department of Health and Human Services. The Arkansas plan includes the use of health savings accounts and requires co-pays for services from people who don’t have much money.

“Everybody ought to have some skin in the game,” said Sen. Charles Scott, SD30, R-Casper. Scott has ardently opposed Medicaid expansion. Though Scott suggested he would oppose even an Arkansas-style expansion, other committee members expressed interest.

The general support for the Arkansas plan troubled Rep. Mary Throne, HD11, D-Cheyenne. “We’re too excited about this Arkansas plan because it pleases us ideologically,” she said. It seemed to be a suggestion that the committee would prefer to score rhetorical points rather than produce more effective policies.

The committee ultimately directed the LSO to draft a bill based on the Arkansas proposal. The committee also asked LSO to draft a bill based on the Department of Health’s preferred option approach labeled “Medicaid Fit.”

Meanwhile, Northern Arapaho Tribal Liaison Gary Collins and Tribal Health Department Director Allison Sage asked the committee to take steps to allow the Wind River tribes to seek Medicaid expansion on the reservation through a waiver request to HHS. (The Casper Star-Tribune offers the perspective of Gov. Matt Mead and others here.)

UNEMPLOYMENT INSURANCE/WORKER MISCONDUCT: The committee addressed unemployment insurance legislation that was passed during the recent session but vetoed by the governor. The new legislation seeks to define worker misconduct. Under Wyoming law, a worker fired for misconduct can be denied unemployment insurance benefits.

A version of the bill passed by the House in the 2013 session was not opposed by advocates for workers. The Senate adopted amendments that significantly changed the bill. They made it virtually certain that employees discharged for inadvertent errors – such as failure to lock a door – could be denied unemployment insurance benefits.

Proponents have said the bill mirrors a 1986 state Supreme Court decision that has guided state hearing officers in deciding contested unemployment insurance cases. At the Aug. 26 committee meeting, they proposed amendments stating that a worker must intentionally violate policy or take action contrary to the employer’s interests in order to be found guilty of misconduct. Rep. Throne raised a new concern, however, when she noted the bill does not include a court directive that “(i)nefficency or failure in good performance as a result of inability or incapacity” likewise shall not be considered misconduct by a worker.

The committee will consider a new draft of the bill at its meeting in November.

WORKER SAFETY: The committee heard a report from the Department of Workforce Services on the Safety Improvement Program. Under the program, businesses can get matching grants of up to $10,000 to start or improve company safety programs or to buy safety-related equipment.

More than 45 companies have submitted applications; however, legislators questioned some of the grants, noting that they had gone to large companies with significant resources. (Laramie County School District No.2 is one of the grantees.) The Legislature needs a conversation to consider whether companies that have had a fatality in the last five years or that have been fined for serious violations should be eligible for the grants. Rep. Throne said the grants could be perceived as an “offset’’ to the state fines. It’s not clear when and if that conversation will be had by legislators.