Budget amendment allows state to make 2015 Medicaid expansion plan

By Ron Feemster
— February 27, 2014

A budget amendment passed in conference committee today allows Wyoming to negotiate with the Centers for Medicaid and Medicare Services to design a Medicaid expansion proposal that could cover nearly 18,000 of Wyoming’s poorest residents.

But not until sometime next year at the earliest.

Unlike the bills debated on the floor of the House and Senate this session, the amendment does nothing now for Wyoming people who have no insurance and are too poor — under 100 percent of the federal poverty level — to qualify for subsidized health insurance under the Affordable Care Act.

“I’m concerned about the long-term effect on the people of Wyoming,” said Sen. Eli Bebout (R-Riverton), who co-chaired the conference committee. “We’re not rushing into this. We’re going to do it the right way for all of us. People who rush into big decisions often regret it.”

Supporters of the uninsured see the matter differently. While they appreciate the fact that Wyoming is moving forward at all on Medicaid expansion, they see the year delay as a giant lost opportunity.

“The Rothfuss bill would have covered people right now,” said Rep. Mary Throne (D-Cheyenne) who sat on the conference committee that passed the amendment. “I’m sorry that we are not doing that. But this bill builds momentum.”

Throne was referring to Senate File 118, a compromise bill sponsored by Sen. Chris Rothfuss (D-Laramie). It came closest of all bills proposed this session to covering people who lack insurance today. It won introduction in the Senate but was defeated 21-9 after debate. A budget amendment based on Rothfuss’s bill was also defeated in the Senate.

The session saw all three of the bills worked by the Joint Interim Labor Health Committee fail to win the two-thirds majority necessary for introduction to the House or Senate. Several budget amendments failed as well.

House Budget Amendment 34, which resembles the failed Rothfuss amendment except that it provides no coverage for poor people this year, was the last act of the House before passing their version of the budget bill.

The compromise amendment, which says the governor “may” negotiate with the federal government to develop a Medicaid proposal, was nearly the last act of a conference committee that must balance the state’s $3.3 billion budget for the 2015-2016 biennium.

Throne takes the optimistic view shared by many legislators and lobbyists who did not expect the Legislature to pass even this watered-down approach to Medicaid expansion.

“This is a start,” said Dan Perdue, executive director of the Wyoming Hospital Association and chairman of the Wyoming Coalition for Medicaid Solutions. “This ensures we will go into the 2015 session with some plan to insure very low-income working adults without children through Medicaid. Currently they have no options for health insurance.”

The people in greatest need of coverage earn less than 100 percent of the federal poverty limit, $11,670 for the typical single childless adult targeted by Medicaid expansion. Those who earn up to 138 percent of FPL are eligible for Medicaid in states that expand it, but may also buy subsidized insurance on the Affordable Care Act insurance exchange.

“We hope the governor and his agencies will move quickly to begin negotiations with CMS,” said Chesie Lee, executive director of the Wyoming Association of Churches. “These people are hurting and need insurance so they can take care of themselves.”

The budget amendment lifts a ban on state agencies negotiating with the federal government in any way that could implement the Affordable Care Act. In fact, the amendment requires the Department of Health to submit terms of the proposed Medicaid expansion proposal by Nov. 1 to two joint interim legislative committees: Appropriations and Labor Health.

No action can be taken on a Medicaid expansion proposal without the approval of the Legislature, according to the amendment.

The proposal may contain a variety of mechanisms for covering the poor, including premium assistance for people who buy insurance on the exchange, “cost sharing” including premiums and deductibles, and straight Medicaid expansion.

The most contentious debate in the budget conference committee, which may be a harbinger of what awaits an eventual bill next year in the Legislature, was the exact way in which the bill must be budget neutral for Wyoming. The language discussed and passed by the committee, which may yet be refined by the Legislative Service Office, specifies that that the cost of administering the expanded program must be paid for by “demonstrated cost savings from implementing the Medicaid expansion program.”

Most of the time in conference committee was spent discussing the details of budget neutrality. Meanwhile, because the state Legislature chose to wait to expand Medicaid, the state must also wait to access the federal money that funds the program.

“This is a compromise,” notes Dan Neal, executive director of the Equality State Policy Center. “We wanted to see the state take advantage of the millions of dollars available to improve the quality of life for Wyoming people this year. That won’t happen, but at least we have a chance in 2015.”

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