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Wyoming and the ACA’s Medicaid expansion

Joint Revenue Interim Committee sponsors legislation to expand Medicaid in 2022; legislation has failed in seven previous sessions

Still no Medicaid eligibility expansion in Wyoming

Wyoming is among only a dozen states where Medicaid still has not been expanded, and the state continues to refuse federal funding that would allow it to expand coverage to about 34,000 low-income residents (this had been pegged at about 19,000 people as of 2019, but the COVID pandemic has increased the number of people with low incomes).

An estimated 7,000 of those individuals are in the coverage gap (i.e., they essentially have no access to coverage), despite federal rules that would allow them to have coverage if Wyoming were to accept federal funding to expand Medicaid. The federal Build Back Better legislation called for a temporary fix for the coverage gap in states like Wyoming that have refused to expand Medicaid, but that legislation has stalled in the Senate as of early 2022, and the coverage gap continues to exist in Wyoming.

The majority of Wyoming residents support Medicaid expansion, and Democratic state lawmakers, along with former Governor, Matt Mead, (a Republican), have spent years pushing for Medicaid expansion. But Republican lawmakers, who hold an overwhelming majority in both legislative chambers, have steadfastly refused to expand Medicaid eligibility in Wyoming.

There were hopes that might change in 2020 and again in 2021, but that did not come to pass. But as described below, Medicaid expansion legislation is again under consideration in Wyoming in 2022, for the eighth time in the last decade.

As of June 2021, 68,493 people are enrolled in Medicaid/CHIP programs in Wyoming, which was 1% higher than enrollment had been in 2013. As of 2019, Medicaid enrollment in Wyoming had been 20% lower than the 2013 level, but enrollment in Medicaid has increased nationwide during the COVID pandemic, even in states that have not expanded Medicaid eligibility under the ACA.

In every state, the Families First Coronavirus Response Act (enacted in 2020) is providing additional federal Medicaid funding, but on the condition that states cannot disenroll people from Medicaid during the COVID public health emergency period. Nationwide, Medicaid/CHIP enrollment is up 45% since 2013. As of September 2020, Wyoming was the only state where Medicaid enrollment was still below what it had been in 2013, but that was no longer the case by mid-2021.

Joint Revenue Interim Committee again pushes for Medicaid expansion in the 2022 session

As described below, Wyoming lawmakers have debated Medicaid expansion numerous times since the ACA was enacted. The most recent legislation, HB20, was introduced in early January 2022, and is sponsored by the Joint Revenue Interim Committee. It calls for Wyoming to expand Medicaid, with the caveat that expansion would only continue as long as the federal government continues to pay at least 90% of the cost (this is a common provision that other states have incorporated into their Medicaid expansion legislation).

This is the eighth time that legislation to expand Medicaid has been considered in Wyoming’s legislature, and the Joint Revenue Committee has been supportive of Medicaid expansion in recent years. But in all of the previous sessions, Medicaid expansion has not garnered enough support from lawmakers to pass.

The American Rescue Plan, enacted in 2021, provides additional federal funding for states that newly expand Medicaid. But as of early 2022, only Oklahoma and Missouri had expanded Medicaid and received the extra funding, and both of them did so as a result of ballot measures that voters passed in 2020 (in other words, Medicaid expansion was already slated to take effect in those states in 2021; despite the additional federal funding, it still an uphill battle to get Medicaid expansion in place in Missouri).

Wyoming’s current federal matching rate (FMAP) is 56.2% (this includes an additional 6.2 percentage points that the federal government is providing to states for the duration of the COVID pandemic emergency period, as long as the state doesn’t disenroll people from Medicaid). If a state expands Medicaid, the federal government will pay 90% of the cost of covering the newly eligible population, but the rest of the state’s Medicaid funding continues to use the existing FMAP in terms of the state/federal split. Under the American Rescue Plan, however, Wyoming (and any other non-expansion state that newly expands Medicaid) would get an additional 5% added to its FMAP for two years.

Wyoming’s normal FMAP is 50%, but the extra funding related to the COVID emergency period and the American Rescue Plan would bring the state’s FMAP up to 61.2%. This extra funding would be temporary (through the end of the COVID pandemic emergency period and for two years, respectively). After that, without additional legislative action, the state’s regular FMAP would return to 50%, although the federal government would continue to pay 90% of the cost of covering the Medicaid expansion population.

Although Medicaid expansion advocates are hopeful that HB20 will finally result in Medicaid expansion in Wyoming, the state’s legislature has a long history of rejecting it.

Senate committee approved Medicaid expansion in 2021, but it did not advance after that

Senate File 154, was introduced in Wyoming’s Senate in March 2021. On March 8, the Senate Labor, Health, & Social Services Committee voted 3-2 to advance the bill (you can watch the committee discussion here). But the legislation did not advance after that.

S.F.154 called for Medicaid expansion in Wyoming to end if the state’s regular FMAP were to drop below 55%. Medicaid expansion advocates noted that the state could work with the federal government to try to maintain an FMAP of at least 55%, but also pointed out that even if Medicaid expansion were to be implemented for just two years in Wyoming, the additional federal funding would make the decision a profitable one for the state, bringing in more in federal revenue than the state spends on its own share of the cost.

Legislative committee advanced Medicaid expansion legislation in advance of 2020 session, but legislature killed it

In November 2019, lawmakers on Wyoming’s Joint Interim Revenue Committee voted in favor of a Medicaid expansion bill that was to be sent to the full legislature once it convened in February 2020. The vote was 8-5 in support of the measure, raising hopes that it might garner enough support in the full legislature to pass in 2020 (since the state’s budget would have been involved, the bill needed two-thirds support in its originating chamber in order to advance).

A group of medical students from the University of Wyoming testified in front of the committee in favor of Medicaid expansion, noting that when patients are unable to afford their care it affects their doctors as well, leading to high rates of burnout and potentially driving doctors out of the state. The Wyoming Hospital Association also testified, explaining how the state’s uncompensated care costs would be mitigated by Medicaid expansion.

Some GOP committee members who had previously opposed Wyoming Medicaid expansion voted in favor of the measure in late 2019, but some remained steadfast in their opposition, including one who noted that he believes the federal government’s 90% funding rate for Medicaid expansion will not last (there is no evidence to support this, as federal Medicaid expansion funding has never dropped below 90% in any state).

Ultimately, the bill died in committee on the first day of the 2020 legislative session. However, as the Covid-19 pandemic struck, Wyoming lawmakers voted to have the Joint Revenue Committee again consider Medicaid expansion, with the possibility that it could be part of a special session in June. That did not come to pass, however, and the committee recommended that Medicaid expansion be reconsidered again during the regular 2021 legislative session (S.F.154, described above, was the 2021 version of Medicaid expansion legislation in the state; it did not advance during the 2021 session).

So although the issue of Medicaid expansion became more urgent than ever as a result of the widespread job and coverage losses caused by the pandemic, Wyoming opted to postpone the Medicaid expansion debate. This left rural hospitals without enough funding and thousands of low-income residents without any realistic access to health coverage. As of early 2022, nearly two years into the pandemic, that’s still the situation in Wyoming.

Lawmakers considered Medicaid expansion with a work requirement in 2019, but it didn’t pass

In 2019, lawmakers in Wyoming considered SF 146, which called for a study of the effects of Medicaid expansion if Wyoming were to expand coverage as of 2021. The measure passed with strong support in the Senate, but narrowly failed in the House.

Lawmakers also considered HB 244, which would have directed the state to work with HHS to expand Medicaid, albeit with a work requirement. But that bill failed in February in the House, by a vote of 23 to 36.

Medicaid work requirements were favored by the Trump administration, and several states received federal approval to implement them. But the Biden administration revoked federal approval for all Medicaid work requirements in 2021, and has made it clear to states that no additional work requirement proposals will be approved by the administration.

Wyoming has not accepted federal Medicaid expansion

  • 68,493 – Number of Wyomingites covered by Medicaid/CHIP as of June 2021
  • 34,000 – Number of additional Wyoming residents who would be covered if the state accepted expansion
  • 7,000 – Number of people who have NO realistic access to health insurance without Medicaid expansion
  • $274 million – Federal money Wyoming is leaving on the table in 2022 by not expanding Medicaid

Wyoming Senate passed a bill in 2018 to impose work requirements, but it died in the House

Federal poverty level calculator

 Instead of working towards Medicaid expansion in 2018, Senate Republicans passed S.F.97 in February 2018, by a vote of 25 to 5, in an effort to impose work requirements on the state’s existing Medicaid population. The measure moved to the House, where an identical bill (H.B.148) failed on introduction in the House in mid-February, by a vote of 34-24 (it needed a two-thirds majority to advance). Ultimately, S.F.97 failed in the House, where the Labor, Health, & Social Services Committee killed it with a 4-4 tie vote, not allowing it to advance.

If S.F.97 had been enacted, the state would have submitted a waiver proposal to the federal government, seeking permission to impose a work requirement for the existing Medicaid program. There would have been a variety of exemptions, but for people not exempt, there would have been a requirement to either work, volunteer, attend school, or participate in a job training program for at least 20 hours per week. If they failed to do so, they would have lost eligibility for Medicaid for 12 months. Amendments to soften the requirement by making the ineligibility period shorter than 12 months did not pass in the Senate.

Since Medicaid has not been expanded in Wyoming, the state only provides Medicaid to low-income elderly residents who need long-term care, low-income disabled residents (those two populations account for about 60% of the state’s Medicaid spending), low-income children and pregnant women, and very low-income parents who are caring for a dependent child. In Wyoming, those parents are only eligible if their household income doesn’t exceed 56% of the federal poverty level (51% plus a built-in 5% income disregard). For a family of three, that’s about $1,074 in monthly income in 2022.

In general, the Medicaid work requirement would only have applied to that last category, of very low-income parents. Low-income parents whose child is over the age of six would have been subject to the work requirement. The state estimated that about 2,500 to 3,500 people would have been subject to the work requirement—the Wyoming Department of Health confirmed that the rest of the state’s Medicaid population (roughly 57,000 more people) would either have been exempt from the work requirement or are already working.

But those 2,500 to 3,500 very low-income parents would have had to start working (or volunteering or participating in a job-training program) at least 20 hours per week in order to keep their Medicaid coverage if S.F.97 had been enacted and the federal government had approved a waiver proposal. But that did not come to pass, as the legislation did not advance in the Wyoming House.

Prior efforts to expand Medicaid, but no progress

Although Wyoming’s lawmakers have been reluctant to expand Medicaid thus far, a downturn in oil and gas revenues and the resulting shortfall in Wyoming’s budget may eventually make them reconsider; former Governor Matt Mead estimated that expanding Medicaid would bring $268 million in federal dollars into Wyoming.

Governor Mead was initially opposed to Medicaid expansion when he took office in 2011, but by 2013, he had begun exploring options for expansion of coverage, and by the end of 2014, he was a proponent of expanding Wyoming’s Medicaid program using a Section 1115 waiver to implement a state-specific version of expansion.

In the fall of 2015, Governor Mead’s administration was working to obtain estimates from CMS regarding federal spending for Medicaid expansion in Wyoming, and Mead provided two versions of his 2016 budget to lawmakers. One version included Medicaid expansion, and the other didn’t, so that lawmakers could see the financial ramifications of continuing to reject Medicaid expansion. But lawmakers continued to reject Medicaid expansion.

In 2016, Governor Mead tried again, including Medicaid expansion in his budget proposal. The Joint Appropriations Committee removed it, but Medicaid expansion supporters attempted to put it back in via a budget amendment. That effort failed, however, with only 10 senators voting in favor and 20 voting against it. Opposition in the House was even stronger, so Medicaid expansion proponents in the House didn’t attempt a budget amendment of their own.

Hospitals in the state have thrown their weight behind the efforts to expand Medicaid, noting that their budgets are already tight, and that they face considerable uncompensated care losses unless the state accepts federal funding to expand Medicaid. In just three months in 2015, Wyoming hospitals had already used up more than half of a small fund set aside by the state to offset uncompensated care losses.

In 2017, Mead noted that he regretted the fact that the state hadn’t expanded Medicaid, and pointed out that Wyoming was missing out on $100 million per year in federal funding by rejecting Medicaid expansion. But Medicaid expansion still has not gained traction in the Wyoming legislature as of 2019, due to strong Republican opposition. Even when a work requirement was added to the expansion legislation (2019’s HB 244), the measure failed to pass.

Early expansion discussions

In November 2014, Governor Mead’s administration released the details of their SHARE (Strategy for Health, Access, Responsibility and Employment) proposal for modified Medicaid expansion.

The governor’s proposal included having newly-eligible enrollees pay a small premium ($20 to $50 per month for most households) if their income was between 100% and 138% of poverty level, and there would also have been small copays for most newly-eligible enrollees. Mead’s proposal also included access to vocational rehabilitation and job search services to encourage unemployed enrollees to enter the job market. Officials noted that the job training and placement portion of the program would not have been a requirement for participation (which would have been a hard sell in terms of winning federal approval under the Obama Administration, which flatly rejected work requirements and similar provisions), but rather a benefit for enrollees.

Governor Mead’s proposal had not yet been officially approved by HHS, but Mead and his administration were reasonably certain that HHS would ultimately approve their plan for Medicaid expansion, as it had been thoroughly vetted by the federal government and approved as budget neutral for the state.

But it also had to be approved by Wyoming lawmakers, which didn’t happen. Mead noted that if the legislature didn’t approve his plan, he “would ask and expect them to have an alternative for the 17,000 people” who have no realistic access to coverage in Wyoming due to the state’s failure to expand Medicaid.

In December 2014, the Joint Interim Labor, Health, and Social Services Committee approved a different Medicaid expansion bill, created by the committee’s chairman, Charles Scott, a Republican from Casper.  This alternative passed the committee by a 10 – 4 vote, but it hadn’t been vetted by the feds, and nobody knew how it would perform from the perspective of the state’s budget. The committee also voted on the SHARE proposal, but it didn’t pass (7-7).

Scott’s alternative proposal — loosely modeled on Indiana’s plan — called for having the Medicaid expansion population put funds into health savings accounts (HSAs), supplemented by additional government funds (since this proposal had not been approved by the federal government, it remained unclear whether the state would have to fund the HSAs rather than relying on federal Medicaid funds). Scott had long advocated for HSAs as a measure of healthcare reform, but they’re rarely useful for people who are living in poverty.

Initially, after the committee vote, it appeared that Wyoming lawmakers would use Scott’s plan as the focus of their Medicaid expansion discussions during the 2015 legislative session. A concern was that the plan has not been approved or even reviewed by HHS, and similar proposals had been rejected by HHS. But then in late January, Indiana announced that their Medicaid expansion waiver had been approved by HHS, creating hope that perhaps Scott’s plan could also get approval.

In January 2015 the Senate Labor and Health Committee approved a Medicaid expansion bill (SF 129) that was essentially a combination of the SHARE proposal and Scott’s HSA proposal. The committee voted 4-1 to approve the bill and send it to the Senate floor. But on February 6, the Senate rejected the bill on a 19 – 11 vote.

A House committee had been scheduled to consider another Medicaid expansion proposal on the same day, but the committee abandoned their efforts after seeing the results of the SF 129 vote in the Senate. As a result, Medicaid expansion was off the table for the 2015 legislative session in Wyoming. And efforts to expand coverage in subsequent sessions have also failed, even when a work requirement provision was added to the legislation.

Wyoming Medicaid can seek recovery of birth costs from unmarried fathers

Wyoming enacted legislation in 2018 (HB 86) that allows the state to seek to recover a portion of the cost of Medicaid-funded births in certain situations. As of July 2018, when a baby is born to a mother who is on Medicaid and not married to the baby’s father, the state can work to determine paternity and then bill the father for a portion of the cost of the birth.

The amount billed depends on the father’s income. Fathers with income below 200% of the poverty level do not have to pay the state for the cost of their baby’s birth. But fathers with income above that level have to pay a percentage of the cost, ranging from 10% to 50%, depending on how high the father’s income is.

The legislation doesn’t apply to fathers who are married to the mother of the child, since Medicaid eligibility is based on household income. In other words, those fathers’ incomes are already taken into consideration when determining whether the mother is eligible for Medicaid to cover her pregnancy costs. But when the mother and father have separate tax households, the mother can qualify for Medicaid without the father’s income being taken into consideration. So the intent of the legislation is to ensure that fathers with financial means are accountable, at least to some extent, for the cost of their baby’s birth.

Legislation like this is controversial, however, and consumer advocates worry that it is a counterproductive approach in terms of the overall health of the mother and baby.

Who is eligible for Medicaid in Wyoming?

Eligibility is unchanged for now, and remains as it was in 2013.  Non-disabled, non-pregnant adults without dependent children are not eligible, regardless of income.  The following legally-present Wyoming residents are eligible for Medicaid:

  • Parents with dependent children, if their household income is up to 56% of poverty (about $12,897 annually for a family of three).
  • Pregnant women and children age 0 – 5 with household incomes up to 159% of poverty.
  • Children 6 – 18 are eligible for Medicaid with household incomes up to 138% of poverty.
  • All children are eligible for separate CHIP with household incomes up to 205% of poverty.
  • The Pregnant by Choice program provides no-cost family planning services to women who enroll within 60 days postpartum and have household incomes that do not exceed 159% of poverty.

How does Medicaid provide assistance to Medicare beneficiaries in Wyoming?

Many people with Medicare receive help through Medicaid with Medicare premium costs, prescription drug expenses, and expenses that Medicare doesn’t cover — such as long-term care.

Our guide to financial resources for Medicare enrollees in Wyoming provides an overview of those programs, including Medicare Savings Programs, nursing home coverage, and income guidelines for assistance.

How do I enroll in Medicaid in Wyoming?

Residents have several avenues to apply for Medicaid in Wyoming:

  • You can enroll online through — or call 1-800-318-2596 for phone assistance at (Use this option only if you’re under 65 and don’t have Medicare.)
  • You can enroll online through the State Department of Health application website.
  • You can print an application in English or Spanish and mail it to the Wyoming Department of Health (address here).

Once you have coverage, you can use the Wyoming Medicaid client portal, or contact their customer service department at 1-800-251-1269.

Wyoming Medicaid enrollment numbers

Medicaid enrollment runs year-round, but tends to spike during open enrollment because of outreach efforts on the part of enrollment assisters. About 2,200 people enrolled in Wyoming Medicaid from October 2013 through April 2014, through Another 847 people enrolled in Medicaid through during the second open enrollment period. All of them were already eligible under the existing rules, but had not enrolled prior to October 2013.

People cycle in and out of Medicaid eligibility though, and from the fall of 2013 to July 2016, the net total enrollment in Wyoming’s Medicaid/CHIP program actually decreased by 3,900 people — a 6% decline. By November 2019, enrollment was 20% lower than it had been six years earlier. There were nine other states where enrollment had declined, but only by 1 to 9% (nationwide, Medicaid/CHIP enrollment was 26% higher at the end of 2019 than it had been six years earlier). Medicaid enrollment has grown amid the COVID pandemic, however, and even Wyoming had more Medicaid enrollees as of mid-2021 than they’d had as of 2013 (but just barely, with an overall increase of just 1%. Nationwide, Medicaid/CHIP enrollment was 45% higher in mid-2021 than it had been in 2013.

If Medicaid is not expanded in Wyoming, there are several thousand people who will remain in the coverage gap and have no realistic access to health insurance.  They do not qualify for Medicaid, and they are not eligible for subsidies in the exchange because their incomes are too low. In addition, rural hospitals in Wyoming are increasingly under a budget crunch, as they still face uncompensated care costs for people who are uninsured, but for whom federal Medicaid funds would be available to reimburse the hospitals if Medicaid were to be expanded.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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Apply for Medicaid in Wyoming

You can enroll through or the state Department of Health website.

Eligibility: Pregnant women and children are eligible with household incomes up to 154% of poverty (children are eligible for CHIP with household incomes up to 200% of poverty).  Parents with dependent children are eligible with household incomes up to 56% of poverty.

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