Medicaid work requirement in Wyoming unlikely, but would affect few

Jan. 21--CHEYENNE -- A new waiver program through the federal government now allows states to issue work requirements for some Medicaid recipients. Kentucky became the first state to be approved for the waiver, and 10 more states are awaiting federal permission.

The new requirements would order some Medicaid recipients to have a job, enroll in school, become a volunteer or participate in other community service activities. While the legislation is most popular in the states that expanded Medicaid programs under former President Barack Obama's Affordable Care Act, there is speculation Wyoming could try to take advantage of the new waivers in the upcoming legislative session.

Wyoming's Medicaid program is jointly funded insurance split between the federal and state government that primarily covers children, elderly, blind and disabled individuals in the state. Wyoming shares roughly 50 percent of the cost of the program with the federal government.

In 2016, combined federal and state spending for Medicaid in Wyoming totaled about $581 million, according to Ballotpedia.

Wyoming does not currently have expanded Medicaid, which would most likely have to be one of the first steps if legislators want the work requirement to affect more than a small number of the state's recipients.

"I would be hard-pressed to believe that our state would change the way they are administering the Medicaid program," Eric Boley, president of the Wyoming Hospital Association, said. "I think, if expansion was reconsidered, the work requirement would be a major exception for our state Legislature. I think Wyoming could benefit tremendously if we were to expand Medicaid."

Measures to expand the Medicaid program in Wyoming have been rejected in four consecutive legislative sessions. Gov. Matt Mead's office once estimated expansion would bring $268 million to the state, but the Legislature refused to support an extension of the Affordable Care Act, which they believed was an unsustainable ambition of the federal government.

"I think the conversation needs to continue, because the Affordable Care Act has not gone away and I think our state has really missed the boat," Boley said. "I don't know if there is much chance of revitalizing Medicaid in our state."

In an expanded program, able-bodied adults who meet income guidelines would receive assistance in addition to working an agreed-upon number of hours each month, or providing other community services.

"I think if the waivers had been available two or three years ago when we were trying to expand Medicaid, the opponents for expansion would not have had the argument to use as a reason for voting against it," Boley said.

In Wyoming, children make up 70.3 percent of Medicaid recipients, according to Wyoming Department of Health spokeswoman Kim Deti.

"In our state, there would be a small percentage of current Medicaid recipients who would be potentially eligible for a work requirement, but the devil would definitely be in the details," Deti said.

Deti said the state wouldn't necessarily need to expand its Medicaid program to enforce work requirements. One of the few Medicaid recipient categories that may be affected is Parent/Caretaker Relative, people who provide home and day-to-day care of a Medicaid recipient under the age of 18 and meet income requirements.

The change would require direction from policymakers before applying for a work requirement waiver.

"Some of the people in this category probably work, so one of the things we do not have numbers on is of people in that group, how many already work?" Deti said.

This is entirely speculation until a proposal is issued in the upcoming legislative session, Deti said. No one has yet to propose any legislation in the state, but Boley said it is possible that a Medicaid expansion proposal may be considered.

"We do not have estimates or details, and some of it would depend on the details of a proposed bill," Deti said.

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