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Gov. Mead Still Waiting for Answers on Medicaid

By Keith Phucas on September 7, 2012

 Though Wyoming Gov. Mead has the option of refusing to set up a health insurance exchange as part of the Patient Protection and Affordable Care Act, he still wants answers from U.S. Health and Human Services (HHS) as to how to implement the onerous law before making a final decision.

Mead’s position is curious given the Republican governor opposes the Affordable Care Act and joined 26 other states in a lawsuit to fight the law.

Appearing at a press conference Thursday at the State Capitol, Mead mentioned the July letter he sent to HHS Secretary Kathleen Sebelius, and suggested the state would not make a decision until the federal agency provided details about how an exchange would actually operate and how it would be funded.

If Wyoming and other states do not establish exchanges, the federal government is supposed to create and run them. But despite having the option of ignoring this provision of the health care law, the governor mentioned the state would “miss some of the deadlines” while awaiting an official response from Sebelius.

“There’s questions to be answered, and we haven’t gotten answers to those questions, and so if and until we get answers to those questions, I don’t think it’s reasonable for the federal government to say we have to make very big decisions that can impact our state budget and impact the quality of our health delivery system in Wyoming,” the governor said.

The cost of Medicaid will continue to rise in Wyoming over the next decade, and the total could exceed $2 billion between 2014 and 2020, according to the “Wyoming Medicaid Expansion Analysis: Results summary,” which was released Sept. 5.

As of June 2011, about 70,000 people were enrolled in Wyoming Medicaid. Overall enrollment rose 15 percent between 2005 and 2011. For the 2013-2014 biennium, the state expects to spend about $560 million for Medicaid, according to a July estimate.

By 2014, the state must cover adults currently eligible for Medicaid, but who are not enrolled, as well as newly eligible children between the ages of 6 and 18 whose households meet poverty guidelines.

But the state has a choice whether or not to add an estimated 17,600 newly eligible adults to the program’s rolls in 2014 that would cost about $35 million or more during that seven-year period.

Mead is concerned about the prohibitive cost of Medicaid, so why doesn’t the governor take a stand and say he won’t expand the program?

The expanded adult population, who would only become eligible if the state chooses to expand Medicaid, would include uninsured adults who earn income below 138 percent of the federal poverty level (FPL); those who expect to lose or drop their insurance who meet the low-income guidelines; and adults who might “deliberately reduce their income in order to qualify for Medicaid,” according to the Medicaid Expansion report.

 The current FPL income for an adult individual is $11,170. The amount increases $3,960 for each additional household member.

If Medicaid eligibility were to increase to below 138 percent of the FPL, a family of four earning $31,789 would become eligible for Medicaid.

In 2014, Wyoming would be required to pay Medicaid costs for low-income adults now eligible for the program and children who will become eligible.

That year, children expected to be transferred to Medicaid would be those between 6 and 18 and currently enrolled in Kid Care CHIP with household incomes under 138 percent FPL; uninsured children eligible for Kid Care CHIP; those likely to lose or drop coverage in favor of Medicaid; and children of adults who reduce their incomes to become eligible for the program.

According to the Medicaid Expansion analysis, if Affordable Care Act-mandated Medicaid expansion were fully implemented in Wyoming, new enrollments would range from 16,800 to 44,500 people by 2016.

The low-end estimate for the cost of the program’s expansion between 2014 and 2020 range from $53 million to $68 million; the high-end cost estimate $245 million to $311 million, according to the report.

And if existing Medicaid enrollees are added to the anticipated expansion numbers, the program’s grand total could reach as high as $2.8 billion for that same period.

The nagging question is why the Mead administration continues to insist on guidance from HHS, when the state is not legally bound to set up insurance exchanges or expand Medicaid for the group of 17,000-plus adults?

Yet the governor seems content to bide his time.

“So I continue to wait for Secretary Sebelius, and hopefully she and her office (will) give us some answers,” the governor said.

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