Wyoming Healthcare Commission
Medicaid Subcommittee
May 14, 2007
Present:
Rod Barton, Committee chair and WHCC commissioner
Lorraine Saulino-Klein, commissioner
John Vandel, commissioner
Dr. Greg Gruman, WDH Medicaid director and subcommittee member
Judy Powers, WHCC staff
Wendy Curran, Governor’s Office
Cheryl McVay, Governor’s Office
Kristy Westfall, Wyoming Primary Care Association
Call to Order / Goals of Meeting:
The meeting was called to order at 10:45a.m. The primary goals of this meeting were to begin work on a Medicaid fact sheet for presentation to the Commission as a whole and eventually to legislators and to discuss the President’s Affordable Choices initiative. The meeting began with a decision to reverse the order of discussion on the agenda and to take up the second topic first.
Affordable Choices Initiative
The Affordable Choices initiative was brought to the attention of the committee by Wendy Curran, the Governor’s health policy advisor. Recently, federal HHS Secretary Leavitt has been traveling around the country on the President’s behalf discussing and gathering reactions to a proposed program aimed at extending health insurance coverage to a larger portion of the uninsured population. The program would ask states to develop innovative ways to provide insurance for uninsured Americans at or above 150% FPL with partial funding from sources such as redirected Medicaid DSH funds, grants, and federal income tax credits. The governors of a small number of states, including Wyoming, have been asked by Secretary Leavitt to give a detailed response to this proposal in terms of what aspects of it would and would not work for their states.
Wendy informed the subcommittee that, while Governor Freudenthal recognizes some problems in the proposal, he sees it as presenting an opportunity for discussion, creative thinking, and articulating our needs. He is asking the members of the WHCC(and others in the state) to think around the obvious barriers to insuring the uninsured by these approaches (or any others) and consider whether there is something innovative we could do.
The subcommittee had before it a series of comments on the proposal that Greg Gruman had provided to Wendy earlier. Lorraine Saulino-Klein commented that Greg’s observations, which pinpointed a number of the difficulties in using the proposal’s approach to solving problems with the uninsured in Wyoming, gave the committee good food for thought in this creative context. She saw coming up with a workable model as a good idea.
Greg indicated that there are already a great many different models being tried for insuring the uninsured. He talked about models used by California and Massachusetts that may or may not prove to be workable. He also mentioned some states that are establishing insurance pools, but said that pools might not work in our state. In general, the committee agreed that a workable model for Wyoming was likely to be different from one for most other places because of the state’s small population.
The question arose at this point as to whether the issue under discussion was really within the charge of the Medicaid subcommittee or would more appropriately be taken up by the Access and Affordability subcommittee. The initial answer to this question seemed to be that it could be the business of this committee if Medicaid funds were being used to solve the problem, though even then there would be some overlap in committee responsibilities.
Rod then reminded the committee of last month’s discussion which, as he recalled, made clear the fact that we have very little latitude to revamp the current Medicaid benefit structure. Greg confirmed the accuracy of that statement and said it pinpointed the precise flaw in the HHS proposal so far as Wyoming is concerned. Wyoming gets so little in DSH payments (one hospital/only $160,000 per year) that there are almost no funds to redirect. This kind of funding might work for states with large urban hospitals that are more Medicaid dependent but cannot work for us.
The discussion then turned to the fact that many of Wyoming’s uninsured are working at one or more jobs, just not jobs that provide insurance. John Vandel mentioned some of the difficulties businesses in small towns like Torrington have in providing insurance for employees, often because of the insurance rules they must work under. In many cases, we would need changes in insurance law to solve these problems.
At this point, once again, the committee turned to the question of whether this issue should be sent to the Access and Affordability subcommittee since, if Medicaid cannot be used to fund the new insurance coverage, the topic to be discussed is really insuring the uninsured, not Medicaid.. The committee nevertheless continued to pursue the more general topic of innovative models. Among models discussed were an idealistic model that would provide universal care up to 300% of the FPL, the “three-legged stool” model of the past with private insurance, employer, and state as partners, and current models that work reasonably well like SCHIP and Medicaid.
Wendy turned the committee’s attention to a very preliminary draft of a possible grant-based program that had been sketched out on a workshop agenda she had distributed. She asked for the committee members’ reactions to it. Rod commented that he thought the section that involved the structure of coverage would be the key issue for Wyoming. He described the coverage Medicaid currently provides as relatively rich in the sense that it provides 100% of coverage for mandatory populations. If, for example, Wyoming restructured the Medicaid population, it could cover more people (or allow people to buy in), but it would need to provide less. The coverage would go from everybody gets everything to everybody gets something. We could follow one of the options on the draft proposal, e.g., provide only catastrophic case or provide only preventive care—make insurance not for everything but for some things.
The outcome of the above brainstorming was that committee members found themselves returning to programs like SCHIP that can provide reasonable care for a reasonable monthly amount ($157/month) as a good model, but not one that could be funded from present Medicaid resources. At that point, committee members agreed that discussing these other options was the charge of the Access and Affordability Subcommittee, and Wendy and Cheryl McVay left the meeting to join the other committee.
Medicaid Fact Sheet:
Greg Gruman distributed a Medicaid fact sheet his office has prepared and a number of related materials intended to help the committee develop its own fact sheet. Among the materials were reports from several national analyses, one of which reported that Wyoming is 47th among the states in scope of services and 39th in eligibility, both of which indicate how little “fluff” there is in the current program. He reiterated from the previous meeting that the purpose of all these materials is to educate legislators and people in the state about the realities of the situation with Medicaid.
These comments brought the subcommittee back to its earlier realization that, if the committee has business left to complete, it is in this area. Issues remainin LTC and DD care/coverage in regard to the items that were not funded during the last legislative session. The most expensive part of the Medicaid population is still there—it is both growing and becoming more expensive. The committee’s remaining task may be to continue its efforts to help people understand what needs to be done, i.e., the legislators and citizens of the state must understand that cutting benefits is not an option because the benefits we offer are mandated benefits for a mandated population. We cannot change them, short of simply opting out of the federal program.
Topics for Next Meeting:
The committee will return to the task of creating its own Medicaid fact sheet for review by the full Commission, using the materials provided by Greg as a starting point for discussion. Its goal will be to create a brief informative handout that could be used to educate legislators and the public about Wyoming Medicaid. It will differ from the fact sheet created by the Medicaid office in that it will focus on the issues that make the committee’s directive from the LHSS (to save money by cutting benefits) unlikely to succeed. This fact sheet will supplement the efforts of the Medicaid Office, and the fact that it comes from whatlegislators may perceive as a less personally invested group may led it credence.
Adjournment:
The meeting adjourned at 12:10 p.m.
Respectfully submitted:
Judy Powers