What was widely interpreted — and decried — as a $58-million budget cut to tribal health services was actually an accounting maneuver, the chairman of Wyoming’s budgeting committee said Tuesday.
“The funding was never ever in jeopardy,” Rep. John Bear assured lawmakers and health care advocates gathered at Central Wyoming College in Riverton for the Select Committee on Tribal Relations meeting.
Bear’s announcement over Zoom was met with surprise and relief, even by fellow lawmakers who believed their colleagues had indeed cut the funds. It also came minutes after a crowd of protesters stood near the building entrance on the college campus to demand that legislators reverse what many believed was a cruel and unnecessary cut.
The reduction would have curtailed federal spending authority for the Indian Health Service, preventing tribal facilities from receiving higher reimbursement rates required by the federal government.
Medicaid reimbursements are a crucial part of funding that has helped Wind River Family and Community Health Care grow into the largest employer in Fremont County, CEO Rick Brannan told the committee.
Wind River Cares, as it’s commonly called, operates clinics and health services across reservation communities and beyond. Brannan expressed immense relief that the funding will not be stripped.
“I am so grateful, because without the funding, our people would die,” Brannan said.
Budget vote backlash
The perceived cut took place during a budget meeting of the Joint Appropriations Committee on Jan. 13. The JAC, as it’s commonly known, was in the middle of weeks of hearings on the governor’s draft budget. That morning, Sheridan Republican Rep. Ken Pendergraft announced he would propose several cuts as the committee walked through the Wyoming Health Department’s budget. The state has become “addicted” to government intervention, the Wyoming Freedom Caucus-aligned legislator said.
When the topic of federal spending authority for the Indian Health Service came up, Pendergraft proposed a $58 million reduction.
The Indian Health Service is a federal program responsible for providing health care services to Native Americans. The funds were earmarked to cover All-Inclusive Rate increases for tribal medical facilities. Those increases are federally mandated.
JAC member Rep. Trey Sherwood, D-Laramie, interjected to note that the funds in question were 100% federal and Wyoming Medicaid is legally required to adopt the new rates.
“This is an ask for a [spending] increase,” Pendergraft responded. “And as I’ve stated before, I believe that … the first thing that needs to be done is to stop the acceleration.”
Other lawmakers on the committee pushed back. Sen. Mike Gierau, D-Jackson, called Pendergraft’s proposal “draconian.”
“What you’re doing is, while trying to slow down the train, you’re throwing our tribal members under it,” Gierau said.
But Bear defended Pendergraft.
“I think my colleagues that are pushing for more spending make an impassioned argument about services, but also somebody needs to look out for the taxpayer,” Bear said. “And I think those people who are voting against expanding Medicaid further are looking out for the taxpayer.”
The committee passed the amendment 9-3.
In the wake of that vote, outcry has mounted over what critics see as a harmful decision that will result in denied care to vulnerable patients. Those views were on display Tuesday at CWC as protesters shouted slogans like “honor the treaties.”
Under separate treaties between the U.S. government and Wind River Reservation tribes, the federal government is obligated to provide health care.
Tribes can opt to administer their own health care services, as both the Eastern Shoshone and the Northern Arapaho tribes have done with their so-called “638” clinics. Even under that arrangement, however, the Indian Health Service and federal government must still uphold treaty obligations by financially supporting the facilities.
Rapid reset
The Tribal Relations committee invited Rep. Bear to speak to the issue during its meeting. Bear started by stating that the program, which has been fully funded since 1995, will continue to be funded.
The cut was not a cut at all, he said, but a new accounting strategy. Because reimbursement rates have been varying wildly in recent years, the JAC removed the expenditure so that it could avoid having to adjust based on the most current rate, he said. It turns out that the $58 million was overestimated, Bear continued, because based on the newly announced rates, the actual amount is $41 million.
“Never was the full funding from the federal government based on these adjustments ever at risk,” Bear said. “I just want to make that really clear.”
The Joint Appropriations Committee will likely take action before the budget session begins Feb. 9 to approve that $41 million spending authority, he said.
His message prompted celebration.
“I am thrilled beyond measure at the good chairman’s comments,” said Gierau, who also joined via Zoom. “The bottom line is, I’m just immensely gratified after a 9-3 vote against it … that this full funding is going to occur.”
“I think we should stop and kind of savor this moment,” said Tribal Relations Co-chair Sen. Cale Case, R-Lander. “I can’t even begin to say what a good day this is.”