A major concern in the state budget is the growing cost of Medicaid. Medicaid is matching federal and state funded health coverage for lower income people, children, those with disabilities and elderly nursing home residents. State officials say that Medicaid costs take up a large chunk of the state budget and recently have been growing between 30 and 40 percent a year. Wyoming Public Radio’s Bob Beck reports that has pushed legislators to undertake a major study to find ways to reduce costs.
BOB BECK: Those familiar with Medicaid say that there are two big drivers in costs. One is funding for nursing homes and the other is providing services to those with developmental disabilities. During a legislative hearing Department of Health Director Tom Forslund says the focus of the study will be looking at what they can do with high cost areas…but he admits it won’t be easy.
TOM FORSLUND: And each of these are going to have various options for your consideration. And some might be very politically acceptable and some might be politically unacceptable.
BECK: But the big thing is that nobody believes cuts can be made overnight.
Sitting in the lobby outside of the Wyoming Senate, longtime Health Committee Chairman Charles Scott of Casper says many have failed to study Medicaid adequately because they failed to understand the implications of what a cut could mean. Scott says they want to do things differently this time
CHARLES SCOTT: So what are trying to do is take a little longer look. You gotta understand the complications of the regulations, what you can do and what you can’t. And then you gotta think out, ok if we do this how are both individuals that are on Medicaid and providers going to react to this change. We are changing the system, what are the incentives in the new system and how are people gonna react to it.
BECK: Scott says there are a lot of possible ideas. For instance they might find a way to reduce the list of those awaiting Development Disability services while saving money…
SCOTT: There’s an allegation that our various waivers for adult and child DD, contain a number of items that are really gold plating and that we could take the same amount of money and get a lot more people covered. If that’s true, we out to do it.
BECK: Scott says they could develop incentives to keep people out of emergency rooms, reduce the number of C-sections the state is currently paying for and even setting up a menu of options people can sign up for as opposed to giving everyone the whole array of benefits they currently get.
House Health Chair Elaine Harvey says instituting co-pays for those who can afford it is another option she’d like to consider. Harvey is also interested in new ideas in how they handle the elderly.
ELAINE HARVEY: If it costs 6-thousand a month for someone to be in a nursing home. Or could we pay an agency or a series of people two thousand dollars a month to keep people in their own home for six, eight, 12, 18 months longer… I mean look at the savings.
BECK: Harvey says increasing costs is a big reason for retooling Medicaid in the state, but there is another issue. In the Affordable Care Act, states are being mandated to offer more services…
HARVEY: And although the federal government will pay or say they will pay a 100-percent for two years and then drop that down to 90-percent, it still adds a significant amount of people to our rolls.
BECK: But while the Governor and the majority of the legislature want to reform Medicaid, some are concerned. Steve Bahmer represents a number of health care concerns through his personal consulting group. Bahmer is nervous that the state is only looking at cuts that would be hard on providers...
STEVE BAHMER: If you run a nursing home today it’s pretty likely that 65-percent of your business is Medicaid business and it’s also likely that you are losing 30 to 50-dollars a day for every Medicaid resident of your nursing home. That’s a challenge. So we can’t take a look at the structure and the cost of the program without also understanding what is the impact of inadequate reimbursement of nursing homes.
BECK: Bahmer echoes Senator Scott’s concern that they look at the total ramifications of every change they make. The fear is that some providers may no longer take some Medicaid patients, which could actually drive up costs. Many others in the health care lobby have decided not to comment until they see what lawmakers come up with. But Representative Bernadine Craft shares a common concern. The Democrat says while they do need to find savings… She opposes the state going too far.
BERNARDINE CRAFT: I hate to see our services cut. While I understand being frugal and I understand being prepared and conservative with our budget, I don’t want to do that at the expense of our citizens.
BECK: The one major hurdle for the legislature is that they are trying to finish up the study quickly and have a report by the end of the year. The Department of Health is planning to provide some recommendations to those looking at the issue by June.
For Wyoming Public Radio, I’m Bob Beck.