Wyoming and the ACA’s Medicaid expansion

Lawmakers continue to oppose expansion, despite public support

Where in your state to call or visit for Medicaid.How to apply

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

Who is eligible in your state to get Medicaid?Who is eligible

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.

  • By
  • healthinsurance.org contributor
  • September 29, 2016

Efforts to expand Medicaid, but no progress yes

Although the vast majority – 70 percent – of Wyoming residents are opposed to the Affordable Care Act (ACA) in general, by the end of 2014, 56 percent of the state’s residents support the idea of expanding Medicaid to cover more of the Wyoming’s low-income population. In in 2016, after the legislature passed a budget that didn’t include Medicaid expansion, only 41 percent of survey respondents approved of the budget. But when the budget in the survey was altered to include Medicaid expansion, 52 percent of respondents approved of it.

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, as Governor Matt Mead has 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 2015.

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.

The outcome of the 2016 election will have an impact on the possibility of Medicaid expansion in Wyoming in 2017, since some lawmakers who are opposed to expansion are running for re-election against candidates who favor expansion. In-person absentee voting began in Wyoming on September 23, 2016.

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.

Previous expansion discussions

The legislature in Wyoming voted in 2014 to block Medicaid expansion, but they directed Governor Matt Mead and the state Health Department to continue negotiations with the federal government.  In November 2014, Governor Mead announced in a press conference that federal officials appeared to be “more open” to his proposals for a state-specific Medicaid expansion plan than they were in the past.

Later in November, 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 is between 100 percent and 138 percent of poverty level, and there would also be 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 was not a requirement for participation (which would have been a hard sell in terms of winning federal approval), 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.

Lawmakers considered expansion in early 2015…

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 are currently in the coverage gap in Wyoming (ie, no access to Medicaid or premium subsidies in the exchange).

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 has 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 has 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.

… but ultimately rejected it

On January 29, 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.

Who is currently eligible?

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 percent of poverty (about $11,080 annually for a family of three).
  • Pregnant women and children age 0 – 5 with household incomes up to 154 percent of poverty.
  • Children 6 – 18 are eligible for Medicaid with household incomes up to 133 percent of poverty.
  • All children are eligible for separate CHIP with household incomes up to 200 percent 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 percent of poverty.

How do I enroll?

2013 – 2016: overall enrollment declines 6%

Medicaid enrollment runs year-round, but tends to spike during open enrollment because of outreach efforts on the part of enrollment assisters. 2,216 people enrolled in Wyoming Medicaid from October 2013 through April 2014, through HealthCare.gov. Another 847 people enrolled in Medicaid through Healthcare.gov 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 program actually decreased by 3,900 people – a 6 percent decline. Wyoming and Nebraska are the only states where total Medicaid/CHIP enrollment decreased during that time period.

If Medicaid is not expanded in Wyoming, there are 11,000 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.