Medicaid Expansion Back On The Table In 2023
Medicaid expansion has become a perennial issue in Wyoming. But advocates are hoping that this year is the last legislative session theyll have to push for a bill that expands Medicaid.
Currently, there are at least 19,000 people in Wyoming who make too much money to qualify for traditional Medicaid but don’t make enough to afford their own insurance or to qualify for the tax credits that make insurance more affordable. These residents fall into what is known as the “Medicaid gap” and often go uninsured a state of affairs that can tax healthcare systems and put personal and financial strain on the individuals and their families.
Wyoming is the only state in the Mountain West that has yet to expand Medicaid.
Jan Cartwright, a volunteer with the organization Healthy Wyoming, rallied with her allies in front of the state capitol on the first day of the session. She said everyone deserves healthcare.
“There are still tens of thousands of people who cannot get insurance either because their jobs don’t offer it or because they can’t afford it,” she said.
A similar Medicaid expansion bill failed last year during the budget session. But it’s easier to pass bills during a general session, like this year, so expansion advocates like Cartwright are hopeful.
She’s also hoping expansion still has majority support following the 2022 election.
“The thing that we’re up against this year is that there are so many new legislators,” Cartwright said.
Wyoming Medicaid State Plan
he State Plan is a contract between a State and the Federal government, enabling the delivery of health care. It ensures that a State abides by Federal rules and gets FFP. The State Plan sets out groups to be covered, services provided and limitations, reimbursement methodologies, and administrative requirements.
To view the process on getting a State Plan Amendment approved click on the flow chart link.
Public Notices for Pending State Plan Amendments
Public Notices for Pending Waiver Amendments
Section 1135 Waiver Flexibilities
Department of Health & Human ServicesCenters for Medicare & Medicaid Services7500 Security Boulevard, Mail Stop S2-26-12Baltimore, Maryland 21244-1850
6101 Yellowstone Road, Suite 210Cheyenne, Wyoming 82002
Re: Section 1135 Flexibilities Requested in March 24, 2020 Communication
Dear Ms. Green:
Your communication to CMS on March 24, 2020, detailed a number of federal Medicaid and Medicare requirements that pose issues or challenges for the health care delivery system in all counties in Wyoming and requested a waiver or modification of those requirements. Attached, please find a response to your requests for waivers or modifications, pursuant to section 1135 of the Social Security Act, to address the challenges posed by COVID-19. This approval addresses those requests related to Medicaid.
To streamline the section 1135 waiver request and approval process, CMS has issued a number of blanket waivers for many Medicare provisions, which primarily affect requirements for individual facilities, such as hospitals, long term care facilities, home health agencies, and so on. Waiver or modification of these provisions does not require individualized approval, and, therefore, these authorities are not addressed in this letter. Please refer to the current blanket waiver issued by CMS.
Sincerely,
APPROVAL OF FEDERAL SECTION 1135 WAIVER REQUESTS
CMS Response: March 27, 2020
Suspend Pre-Admission Screening and Annual Resident Review Level I and Level II Assessments for 30 days
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What You Need To Know
The vaccines are FREE and available to EVERYONE.
- If you have insurance, your insurance can be billed for administration fees but no fees will be billed to you.
- If you do not have insurance, you will be able to get the vaccine and no fees will be billed to you.
- Everyone old enough to receive an authorized vaccine is eligible, regardless of immigration or insurance status .
The vaccines are SAFE.
- CDC has safety information and guidance to answer questions and help you prepare for vaccination.
The vaccines WORK!
- Learn more about COVID-19 vaccination benefits and facts.
- COVID-19 vaccines are effective, especially at preventing severe illness.
Maternal Mortality Review Committee Membership
The Utah-Wyoming Joint Maternal Mortality Review Committee is currently seeking new members to serve on the committee. Current members represent diverse backgrounds, professions, and lived experience. These members include medical practitioners, social workers, public health nurses, toxicologists, mental health providers, community leaders, etc.
The Utah-Wyoming Joint MMRC reviews de-identified case case summaries of deaths occurring during pregnancy or within the year of pregnancy, and all information about an identified case is gathered from death and birth certificates, medical records, autopsy reports, and other pertinent sources of information.
The goal of the MMRC reviews are to identify trends and risk factors for pregnancy related-death in Utah and Wyoming, identify preventable risk factors, and develop recommendations or strategies for prevention or intervention.
Currently, the Utah-Wyoming Joint MMRC is need of the following type of experts/expertise and/or lived experience:
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Advocacy and/or Lived Experience: Substance Use
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Advocacy and/or Lived Experience: Housing Insecurity/Poverty
With these open positions in mind, if you are interested in being a member of the Utah-Wyoming Joint Maternal Mortality Review Committee, please fill out the application below and email it to [email protected] .
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Applying For Wyoming Medicaid During The Pandemic
- Wyoming Department of Health
As the coronavirus disease 2019 pandemic continues to affect state residents in many ways, the Wyoming Department of Health is describing the best ways to apply for Wyoming Medicaid and who may be eligible.
We realize that COVID-19 has touched many residents lives, including those who may have suddenly and unexpectedly found themselves in a very different financial situation, said Teri Green, Healthcare Financing Division senior administrator. We want to help them know how they can apply for Medicaid in Wyoming and who the program covers.
Wyoming Medicaid is a joint federal and state government program that pays for medical care for some low-income and medically needy individuals and families.
In person applications are not being accepted at this time. Individuals and families can apply for Medicaid or Kid Care CHIP by:
- Sending applications by email to or fax to 1-855-329-5205. Applications and documentation can be scanned or a picture taken of the document to email.
- Applying online at .
To qualify for Medicaid, an individual must qualify financially as well as meeting the criteria for a specific coverage group. For many eligibility categories, the federal poverty level is a key factor. The FPL for a family of four is currently $26,200 income levels are adjusted up or down according to family size. Learn more about FPL amounts at .
Wyoming Medicaid And Benefit Managementsystem And Services
Wyoming Medicaid helps pay for healthcare services for children, pregnant women, families with children, and individuals who are aged, blind, or disabled who qualify based on citizenship, residency, family income, and sometimes resources and healthcare needs.
Division of Healthcare Financing serves as the State Agency that oversees the Wyoming Medicaid program for the Wyoming Department of Health .
CNSI serves as the Fiscal Agent overseeing specifically the Benefit Management System and Services portion of Wyoming Medicaid.
BMS is one of the critical modules of the new Wyoming Integrated Next Generation System . WINGS involves both system and service-based components as well as modules that together will replace the current Wyoming Medicaid Management Information System .
Both DHCF/WDH and CNSI each have specific responsibilities associated with their roles within Wyoming Medicaid. These roles and responsibilities are as follows:
State Agency Responsibilities
DHCF administers the Wyoming Medicaid program for WDH. They are responsible for financial management, developing policy, establishing benefit limitations, payment methodologies and fees, and performing utilization review.
Fiscal Agent Responsibilities
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Enroll As A Wyoming Medicaid Provider
Steps to Enroll
In Wyoming, the Medicaid Program is administered by the Wyoming Department of Health, Division of Healthcare Financing, Office of Medicaid. We are pleased to report that the majority of Wyoming physicians participate in Medicaid and we encourage you to enroll. The State has contracted with HTG Technology Group to operate the provider enrollment system.
Steps to enroll:
Steps to Bill for Claims
Steps to Bill for Claims
Steps to Bill Claims:
How Does Medicaid Provide Assistance To Medicare Beneficiaries In Wyoming
Many people with Medicare receive help through Medicaid with Medicare premium costs, prescription drug expenses, and expenses that Medicare doesnt cover such as long-term care.
Our guide to financial resources for Medicare enrollees in Wyoming provides an overview of those programs, including Medicare Savings Programs, nursing home coverage, and income guidelines for assistance.
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Wyoming Medicaid Enrollment Numbers
Medicaid enrollment runs year-round, but tends to spike during open enrollment because of outreach efforts on the part of enrollment assisters. About 2,200 people enrolled in Wyoming Medicaid from October 2013 through April 2014, through HealthCare.gov. Another 847 people enrolled in Medicaid through Healthcare.gov during the second open enrollment period. All of them were already eligible under the existing rules, but had not enrolled prior to October 2013.
People cycle in and out of Medicaid eligibility though, and from the fall of 2013 to July 2016, the net total enrollment in Wyomings Medicaid/CHIP program actually decreased by 3,900 people a 6% decline. By November 2019, enrollment was 20% lower than it had been six years earlier. There were nine other states where enrollment had declined, but only by 1 to 9% . Medicaid enrollment has grown amid the COVID pandemic, however, and even Wyoming had more Medicaid enrollees as of mid-2021 than theyd had as of 2013 (but just barely, with an overall increase of just 1%. Nationwide, Medicaid/CHIP enrollment was 45% higher in mid-2021 than it had been in 2013.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
How Do I Enroll In Medicaid In Wyoming
Residents have several avenues to apply for Medicaid in Wyoming:
- You can enroll online through HealthCare.gov or call 1-800-318-2596 for phone assistance at HealthCare.gov.
- You can enroll online through the State Department of Health application website.
- You can print an application in English or Spanish and mail it to the Wyoming Department of Health .
Once you have coverage, you can use the Wyoming Medicaid client portal, or contact their customer service department at 1-800-251-1269.
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Who Is Eligible For Medicaid In Wyoming
Eligibility is unchanged for now, and remains as it was in 2013. Non-disabled, non-pregnant adults without dependent children are not eligible, regardless of income. The following legally-present Wyoming residents are eligible for Medicaid:
- Parents with dependent children, if their household income is up to 56% of poverty .
- Pregnant women and children age 0 5 with household incomes up to 159% of poverty.
- Children 6 18 are eligible for Medicaid with household incomes up to 138% of poverty.
- All children are eligible for separate CHIP with household incomes up to 205% of poverty.
- The Pregnant by Choice program provides no-cost family planning services to women who enroll within 60 days postpartum and have household incomes that do not exceed 159% of poverty.
What Is A 1095
- Form 1095-B is a tax document that includes information about the health coverage provided for one or more months during the year to you, your spouse and individuals you can claim as dependents.
- This form relates only to coverage provided by state Medicaid and CHIP agencies.
- The healthcare law requires health coverage providers, including state Medicaid and CHIP agencies, to provide these documents to the IRS and covered individuals.
- Receipt of this form does not create a federal tax return filing requirement with the IRS. Please check IRS.gov and the Form 1040 instructions to determine if you have a federal income tax return filing requirement.
- Keep Form 1095-B with your records. You do not need to attach the form to your income tax return.
- For more information about Form 1095-B, and other health care tax documents, please visit IRS.gov/aca.
Please note: Effective April 1st, 2021, Wyoming Medicaid will no longer require 40 qualifying work quarters for Lawful Permanent Residents.
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Wyoming Medicaid Health Management
What is WYhealth?
WYhealth Health Management is a benefit you have through Wyoming Medicaid. The program focuses on wellness for the Wyoming Medicaid population as well as those with complex medical conditions.
The WYhealth Care Management Program can help if you need some extra support to meet your health goals, understand your health condition, and get help with other needs you may have like food or transportation. We have nurses who would love to connect with you! Once you agree to participate, a nurse will contact you and work with you each month on your health goals.
A healthy reminder if you havent seen your doctor for routine and preventive care checkups in a while, please schedule a visit today! If you dont have a primary care physician or need help finding a doctor, please use our Find a Doctor search tool.
What does WYhealth Care Management look like?
Each individual is assigned a Nurse Care Manager. To begin, your Nurse Care Manager will perform a clinical health assessment, which asks you questions about your health and other needs.
Ongoing, your Nurse Care Manager will call you monthly to discuss your chronic condition, medication, establish health goals with you and document them in a plan of care. Each month, you will work through your plan of care goals until they are all completed and youre happy with the progress youve made!
Ready to connect with a Nurse Care Manager?
Care Management Referrals?
24/7 Nurse Line
Wyoming Health Insurance Consumer Help
Wyoming does not operate a Consumer Assistance Program under the Affordable Care Act. The consumer protections and benefits of the law still apply to you, however.
The agencies listed below can help you take advantage of some of these protections and benefits. They can answer your questions about different types of coverage.
If you need health insurance, be sure to check out HealthCare.govs Plan Finder. It will help you find and compare health care coverage options in your area.
If you have questions about insurance you bought for yourself and/or your family or you have insurance provided by an employer who does business only in Wyoming, contact:
Wyoming Insurance Department
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Nursing home care is extremely expensive. Consequently, many people in nursing homes end up becoming eligible for Medicaid, even if they didnt start out that way.
Medicaid a jointly-funded state and federal health insurance program is the single largest payer for long-term care in Wyoming, according to the health department. Because of that, declines in Medicaid cost coverage can hit providers pretty significantly. Its especially a concern with increases in Wyomings aging population.
Unlike some neighboring states, Wyoming has avoided widespread nursing home closures so far.
But it hasnt been completely immune, Wyoming Department of Health Director Stefan Johansson explained Monday to the Joint Appropriations Committee.
One facility in Wyoming the Bonnie Bluejacket nursing home in Basin closed this past fall. Two more are on distressed rates, temporary contracted rates that the health department pays to struggling nursing facilities. Yet another has also requested to be on a distressed rate.
Long term care facilities across the country took a survey, which reveals that 87% of them are experiencing short staffing.
I think part of that, certainly not the full equation, but part of that does relate to Medicaid reimbursement rates, Johansson said.
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Frequently Asked Medicaid Questions
Q: What is the difference between Medicare and Medicaid?
A: The federal government administers Medicare. Medicare is not based on financial need, but is generally linked to receiving Social Security benefits based on being age 65 or older, or have a disability. Each state administers their own Medicaid programs. Medicaid is based mainly on financial need.
Q: What services are covered?
A: Covered services vary by program. Call 855-294-2127 and choose option 1, and option 1. You can also go to this website for the Medicaid Handbook: or sign up for the myHealthPortal: .
Q: Where do I apply for Wyoming Medicaid?
A: You may apply for Medicaid by calling the Customer Service Center at , online at www.wesystem.wyo.gov, or you may fill out an application in English or Spanish and mail it to:
WDH Customer Service Center 3001 E. Pershing Blvd., Suite 125 Cheyenne, WY 82001
Q: How long does it take to process an application?
A: Applications have 45 days to approve or deny an application. This is extended to 60 days if more information is needed from you and 90 days if the application is pending a disability determination. You will receive a letter in the mail letting you know if you qualify.
Q: How will I be notified of my eligibility determination?
A: The eligibility determination notice will be sent in the mail.
Q: If I have other insurance, would I still be eligible for Medicaid?
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