Senate adds work requirement to Medicaid expansion plan

The Wyoming Senate advanced a plan for Medicaid expansion this morning, but not before adding an work requirement amendment that the bill’s sponsor called a “poison pill.”

Senators voted 18-11 Monday morning to pass Senate File 129-Medicaid SHARE Plan through first reading. The bill went forward with an amendment from Senate Majority Floor Leader Eli Bebout (R-Riverton) that would require recipients of Medicaid benefits to work at least 32 hours a week.

The Wyoming Department of Health estimates that about 59 percent of Wyoming’s uninsured are working. About two-thirds of those employed work 32 hours a week or more.

Bill sponsor Sen. Michael Von Flatern (R-Gillette) pointed to the experiences of other states that have failed to convince Center for Medicaid and Medicare Services to agree to a work requirement. “This will not fly with CMS,” Von Flatern said.

Bebout’s amendment passed on a voice vote. The Senate passed another amendment from Bebout to clarify language on how long the Medicaid expansion may go on. The original bill vaguely reads that the expansion would be “temporary,” while the amendment states it would be “time limited” according to provisions laid out in federal statute.

Another successful amendment sponsored by Sen. Stephan Pappas (R-Cheyenne) creates an account to gather state funds saved as a result of expanding Medicaid. Department of Health numbers project the state could save more than $14.3 million a year by transferring state-funded services to Medicaid.

Sen. Larry Hicks (R-Baggs) offered an unsuccessful amendment to delay submitting an application for Medicaid expansion to the federal government until July 2016. Von Flatern countered that this amendment would result in $54 million in lost federal funds for fiscal year 2016. Senators also tossed out Von Flatern’s amendment to create incentives for taking part in wellness programs, and penalties for inappropriate use of emergency rooms.

Senate Labor Committee members Sen. Bill Landen (R-Casper), and Sen. Charlie Scott (R-Casper) spoke against passing the bill out of first reading. They argued that the bill would only reduce uncompensated care in hospitals by about 7 percent. Von Flatern pointed to data showing other states have seen a 40 percent drop in unpaid care after expanding Medicaid.

Just before the first reading vote, Senate President Phil Nicholas (R-Laramie) spoke in favor of giving the bill three full readings in the Senate. He cautioned the Senate to consider what they would do if the federal share of the expanded Medicaid program drops below 90 percent.

“If you want to move toward this direction, you will anticipate (the state) picking up a greater share, and if you do, you will look to redistribute the care that the (Department of Health) provides so that more people are covered with the same dollars,” Nicholas said.

Currently the bill has a “trigger” provision for Wyoming to opt out if the federal share drops below 90 percent. The Center for Medicaid and Medicare Services has told states such as New Hampshire that states can drop out of the expanded Medicaid program without financial penalty from the federal government.

SF 129 faces two more rounds of debate in the Senate before moving to the House.