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Lawmaker: State will resist optional Medicaid expansion under the ACA

Jan 13, 2014 - By Katie Roenigk, Staff Writer

Meanwhile, a federally mandated increase in Medicaid can be covered comfortably by existing state revenues.

With revenues of about $3.7 billion projected for 2015-2016, state lawmakers say Wyoming should have no problem paying for the Medicaid expansion mandated for this year by the Affordable Care Act.

Gov. Matt Mead has recommended combining $28.49 million from the state's general fund with $36 million from the federal government to pay for the mandatory expansion, which was approved by lawmakers last year.

"We have no choice," Joint Appropriations Committee co-chair and state Sen. Eli Bebout (R-Riverton) said. "We're fortunate to have revenues."

The expansion offers Medicaid to people who weren't previously eligible for health insurance coverage through the program.

"(We) call them 'out of the woodwork' -- they're there, they were always there, but now we have to cover them," Bebout said. "We're obligated to take care of those people."

Last year, he said changes to Medicaid through the ACA cost Wyoming $11 million dollars in "one-time funding."

Optional expansion

Bebout will support funding for the mandated Medicaid coverage, but he and his colleagues in the legislature are against moving forward with an optional expansion of the program.

"That's the one where we buy into the ACA provisions and rely on the federal government to pay all this money to us," Bebout said. "I think over a four-year period it costs like $900 million."

The Associated Press reports lawmakers voted last year to reject $50 million in federal money for the optional expansion that would extend coverage to about 17,600 low income adults.

The federal government has pledged to pay 90 percent of the cost of expanding the coverage for the first few years, according to published reports.

Some people want to buy into the optional expansion because of the federal money involved, but Bebout said he doesn't trust lawmakers in Washington, D.C., who in 2012 capped Wyoming's Abandoned Mine Land payments at $15 million a year -- a fraction of the $150 million annual payment the state used to receive.

Bebout also pointed to the Environmental Protection Agency's ruling last month that a 1905 Congressional Act opening tribal lands to homesteading did not diminish the Wind River Indian Reservation boundary north of the Wind River. Under that interpretation, Riverton would be considered part of the WRIR.

"How can you rely on the federal government?" Bebout asked. "In the dead of night they cost us $757 million, then you have the EPA's outrageous, unconscionable decision about the Riverton city boundaries. ... All these things add up, and you're going to trust the federal government? Not me."

Mead agrees that Wyoming should refrain from joining the optional expansion effort, which he calls "poor in design and poor in implementation."

"I cannot, now, in good conscience, recommend the state sign on to (the plan)," he wrote in his budget proposal.

He wants to continue monitoring what, "if any," progress is made by the federal government to improve the ACA before Wyoming joins the optional Medicaid expansion. According to Bebout, the ACA is "sort of imploding" -- mandates have been extended and other rules have been modified, and he thinks upcoming elections could bring new leaders to Washington, D.C., who may implement further changes to the act.

"Who knows what will happen with that?" Bebout said.

He commended Wyoming legislators who previously decided not to set up a state health insurance exchange through the ACA.

Other states have organized their own ACA implementation strategies, but Bebout said Wyoming left the logistics up to the federal government, saving about $10 million per biennium.

"That was a good move by the legislature," Bebout said. "It's a federal program. Let them have the headaches."

Mead acknowledged that there are citizens in the state who do not have access to health care, however. To address the problem, he recommended $4.5 million be added to the general fund for the 2015-2016 biennium to pay for services from aging and disability resource centers to medical homes and immunization clinics. The Legislature's budget session convenes Feb. 10.