By Leo Wolfson, political reporter
Recent legislation provided through the America Rescue Plan Act allows states to extend postpartum coverage offered through Medicaid to mothers for a 12-month period. The Wyoming Legislature is now considering this Medicaid expansion through a state plan amendment.
If approved, the legislation would allow new mothers to circumnavigate a complicated waiver provision that allows for this coverage if approved.
The Legislature’s Labor, Health and Social Services committee approved moving forward with a draft bill granting this coverage, with a 6-5 vote at its Aug. 11 meeting.
U.S. federal law requires states to provide pregnancy-related Medicaid coverage through 60 days postpartum. Medicaid is a program that provides medical services to the poor, disabled and those 65-years old and older. As of 2021, there were about 69,000 people in Wyoming enrolled in Medicaid.
In response to the pandemic, the 2020 Families First Coronavirus Response Act temporarily extended postpartum medical benefits to mothers for one year. At the end of the year, children remained eligible for Medicaid if their household incomes were at or below 154% of the federal poverty level, and mothers remained eligible for Medicaid if they were at or below the modified adjusted gross income, $873 per month for a family of three.
Since the beginning of the pandemic, Medicaid programs have been prevented from dropping any enrolled Medicaid members during the federal Public Health Emergency (PHE).
State Sen. Lynn Hutchings, R-Cheyenne, said she is in “total opposition to” the Medicaid expansion and finds it unauthorized by the Wyoming Constitution. She voted against the draft bill.
“We started something that was not in our Constitutional purview to start and now we’re trying to expand it, extend it,” Hutchings said.
The Families First Coronavirus Response Act authorizes a 6.2% increase in federal Medicaid matching funds to help states respond to the pandemic. The additional funds are being made available to states through the quarter in which the public health emergency period ends.
The U.S. Department of Health and Human Services (HHS) must renew the federal PHE related to COVID-19 every 90 days to maintain certain health care flexibilities and waivers. The latest HHS extension for the PHE is effective through Oct. 13. With COVID-19 cases dropping and vaccines widely available, some have speculated the PHE will end soon.
Normally, women are disenrolled from the state Medicaid plan 60 days after giving birth. New mothers are encouraged to make at least one doctor’s visit after the 60-day period and Rebekah Smith Hazelton, a staff member with the Wyoming Women’s Foundation told committee members during the Aug. 11 meeting a postpartum mental health screening should be made around 42 days after giving birth.
According to the bill text, the Medicaid extension would cost Wyoming an estimated $3.8 million on a biennial basis, which would be matched by $3.8 million in federal funds.
“Once you start a government program it never goes away,” Hutchings said. “That’s what I see here.”
Hutchings did vote for a motion that would have allowed the program to run for a single year, but this motion was voted down by the committee. The committee instead voted for a March 2027 deadline.
Stefan Johannsen, director of the Wyoming Department of Health (WDH), said during the meeting it is unknown whether the federal program would be extended past that 2027 deadline. He said if this coverage wasn’t provided at the federal level “we would obviously stop” offering it.
Franz Fuchs, a policy advisor with WDH, said the extension would be expected to cause a 1,250-person increase in the average Wyoming Department of Health monthly enrollment. Johanssen said the federally mandated program has already given WDH “a natural experiment” as to what this program would look like for Wyoming if extended, but Fuchs was not able to provide any statistically significant data as to how much the extended coverage would benefit women.
“We do have a very low sample size in Wyoming so detecting effects is difficult,” Johannsen said.
Johannsen said health care costs can be unpredictable and detrimental to a patients’ finances.
“Coverage extension, whether that’s through public sources or private sources, Medicaid, the insurance exchange … having that ability to cover health care costs is certainly a benefit to individuals on the financial side,” Johannsen said.
Johannsen said people would still have to meet qualifying requirements for participating in other programs separate from the Medicaid expansion.
Jan Stall, interim state Medicaid agent, said she doesn’t expect the Wyoming Pregnant By Choice program to be impacted by the extension. She said this program, which offers birth control and reproductive support services, serves about 20-30 women per year.
Tracy Brosius of Cheyenne Regional Medical Center said the pandemic has caused a noticeable uptick in young mothers seeking mental health services. Postpartum depression is a very common issue for new mothers. This issue is also being addressed in the Legislature’s Judiciary committee.
“That stress of being a new mom, in addition to all the rest of the stresses they experience,” she said.
There are a number of nonprofit pregnancy providers throughout the state, but Brosius said many of these don’t have licensed mental health providers on staff.
“Sometimes the help of the people that deal with that day in and day out is sufficient for a person that can come in daily if they need to or weekly,” said State Rep. Pepper Ottman, R-Riverton, who voted against the bill. “I’m thinking it would be nice for the communities to work together to whomever could provide it.”
Ottman said she is not aware of any large-scale postpartum issues affecting mothers in the 10 month-1 year time frame.
Johannsen said postpartum care for children between six months and 1-year old is valuable. He said the one-year timeframe was chosen by the federal government because it is seen as the most effective way of addressing maternal mortality.
“Having postpartum coverage in that timeframe does have significance in eliminating complications- death,” Johannsen said.
According to Worldpopulationreview.com, Wyoming has the 12th highest maternal mortality rate at 26.3 deaths per 100,000.
Under the temporary Medicaid expansion in 2020, 31 women made claims for serious medical conditions and 561 women made claims for mental health care in Wyoming. .
Brosius said every emergency visit to the hospital costs a patient $1,500 just to enter the doors of the facility.
“If they have health insurance through the Medicaid program that is an immediate benefit to them because they already have an established relationship with a care provider,” she said.
For those who don’t have Medicaid coverage, she said mental health counseling can jump from $3 per session to $35. This can mean a difference of hundreds of dollars per month.
Mary Lynne Shickich, policy consultant for the Wyoming Primary Care Association said adequate care provided for the first year of a baby’s life can have a lifetime impact.
“For a Medicaid mother, this 12 months of postpartum health care would be very valuable for the long term health care of a baby’s life,” she said.
Sheila Bush, executive director of the Wyoming Medical Society, said it’s far too difficult to quantify preventative care based on money spent.
Bush brought up the example of a mother shaking their baby while under extreme mental duress. Not only could this have long-term mental side effects for the baby, but if the mother is sent to prison for this action, it will cost the state money to keep her in custody.
Shickich said the first few years of a child’s life are heavily dependent on their mother’s health care coverage.
“I see it as going hand-in-hand, that relationship between the mother and the baby is essential for the baby’s life,” she said.
States have had the option to provide 12 months of continuous coverage to children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) since CHIP’s enactment in 1997, which Wyoming participates in.
Medicaid expansion bills have been brought before the Wyoming Legislature eight times in the past two years. Since the passage of Obamacare, there has been a national push to expand Medicaid services to low-income earners.
The Affordable Care Act provides subsidies for private health insurance to anyone who earns 138% or more of the federal poverty level, which in 2021 was $17,774 for an individual or $30,305 for a family of three. Anyone who earns more than the poverty level but less than 138% of the poverty level, falls into the “coverage gap,” a group of around 25,000 people who would benefit from Medicaid expansion in Wyoming.
A bill defeated during the 2021 Legislature would have allowed people making up to $36,500 to receive these services, which would substantially increase the amount of people in Wyoming eligible. A 2022 bill didn’t list an income allotment and simply pledged a commitment to Medicaid expansion.
In Wyoming, the federal government currently covers 50% of Medicaid costs with the state covering the remaining 50%. The federal government pays 90% of the cost for those covered under Medicaid expansion, but this is only guaranteed for two years.