Wyoming’s SHARE Plan: Politics and Policy Driving Creation of Governor’s Proposal to use Federal Medicaid Expansion Funding

Wyoming Governor Matt Mead is no fan of the Affordable Care Act. He led the state into joining the multistate suit against the ACA and isn’t shy about sharing his opinion. Despite this, practical considerations around cost and the continuing number of uninsured Wyomingites have led him to carefully construct a state-specific proposal for using the new federal Medicaid expansion dollars that will be presented to the legislature. Governor Mead put his state of mind on the release of the plan this way last week:

 “What I will tell the Legislature is: We have fought this [the ACA],” Mead said. “I agree it is not a good piece of legislation, but as I see where we are, I think we have to be realistic and say, ‘This is the current law of the land and we need to either go forward with this’ or if the Legislature wants to come up with a different plan, I certainly would be open to that. “But I don’t think we can say to those people in Wyoming who are working who cannot get insurance that we’re not going to do anything.”

 So what does his plan look like and how was it developed? Overall it’s a fairly pragmatic approach to tailoring a state-specific plan for Wyoming to use the federal funding. The Wyoming Department of Health used a data-driven analysis to look at the experience of expansion in other states, the current state of Wyoming’s Medicaid program and private health insurance market, and the particular needs and strengths of the state’s health providers. The eventual plan developed is called SHARE, an acronym for “Wyoming’s Strategy for Health, Access, Responsibility and Employment.”

I’ll leave it to my colleague and waiver watcher Joan Alker’s piece to show how this plan compares to other state’s recent Medicaid expansion proposals that have required waivers and how negotiations with the federal government over the plan would fare. In addition to these important mechanics of the plan, I think three key points of Wyoming’s proposal development are important to keep in mind as an indicator of how a conservative state is moving forward to use the federal funding:

1.  Wyoming will build on its existing Medicaid delivery system to expand coverage because provider participation is robust and the state believes – after extensive research on costs – that a premium assistance approach would be too expensive. In addition, because of substantial reform-driven savings and federal participation, Wyoming’s SHARE proposal will be budget neutral to the state according to the Wyoming Department of Health.

2.  The plan uses a commercial benefits package with some copays and premiums for those over poverty. Wellness incentives and referrals to job training will also be part of the package. (More on this from Joan in her blog.)

3.  Wyoming will drop out if federal funding drops: Mirroring some other state laws, Wyoming’s SHARE plan will contain an automatic trigger eliminating expansion if the share of federal funding for the program ever drops below 90%.

As with other states now moving forward with discussions of how to best use federal Medicaid expansion dollars, Wyoming’s experience in proposing a state-specific plan is unique and reflects state circumstances, but builds on themes that are popping up around the country. Governor Matt Mead enjoys the advantage of having been instructed last year by the legislature to research and assemble proposals for using the federal Medicaid money and has constructed a detailed plan that takes the traditional Medicaid system in Wyoming and melds it with evolutionary reforms. The unique demographics and geography of the state also clearly played a role in plan development. For example, the state proposal notes the relatively high premiums in its health marketplace plans, in part due to these factors.

And with Utah moving forward today along with rumbles in Idaho, the Mountain West clearly continues to be the region to watch for people interested in Medicaid expansion issues.