- Associated Press - Monday, February 2, 2015

CHEYENNE, Wyo. (AP) - The Wyoming Senate on Monday gave initial approval to a bill to expand the federal Medicaid program, but only after amending it to require that new participants must work up to 32 hours a week if they can.

The bill’s supporters, however, say the work requirement would kill Medicaid expansion in the state because federal regulators wouldn’t approve it.

The bill would need two more votes of approval before heading to the Wyoming House. Whatever its ultimate fate this session, Monday’s approval in the Senate signals a new high-water mark for Medicaid expansion in the Wyoming Legislature, which has shot down expansion proposals in the past two sessions.

Gov. Matt Mead, a Republican, has called on lawmakers in this session to approve a Medicaid expansion bill. Wyoming is one of an increasing number of Republican states that are moving toward getting on board with Medicaid expansion, a fundamental element of the federal Affordable Care Act.

In his State of the State address last month, Mead said he doesn’t believe Wyoming can afford to ignore about $120 million in available federal funds to expand the program. Accepting the federal expansion would help hospitals in the state, which currently absorb millions in uncompensated care they provide to low-income people every year, he said.

The Senate deliberations on Monday were a continuation of deliberations that started Friday on the Medicaid expansion bill sponsored by Sen. Michael Von Flatern, R-Gillette. The expansion would extend coverage to 17,600 low-income adults in the state.

Sen. Eli Bebout, R-Riverton, sponsored the work amendment. “We want to have a requirement that these people shall, if able, work,” he said.

Bebout said they would be required to work up to 32 hours a week if they’re able to and if there are jobs available. “I think it’s very important to put this provision in, because most people that are on this, if they’re able to and they can, they should in fact work,” he said.

Von Flatern said the federal Centers for Medicare and Medicaid Services would shoot down the work requirement out of hand. “This is a poison pill in itself,” he said.

Wyoming is seeking to negotiate its own Medicaid expansion agreement with Centers for Medicare and Medicaid Services. Von Flatern said it’s not clear in the amendment who would determine whether participants are disabled and by what definition.

Bebout countered that he didn’t believe the amendment would necessarily result in federal rejection. He said the federal government is becoming more flexible about what waivers it approves in working out state-specific expansion plans.

Von Flatern’s bill, modeled after an expansion plan developed by the Wyoming Department of Health, calls for Medicaid participants between 100 to 138 percent of federal poverty guidelines to pay copayments and premiums. Those below 100 percent would be making copayments, but they could be as low as just a few dollars.

The federal government has committed to paying 100 percent of the cost of expansion through 2016 and then taper off funding to 90 percent, leaving the state to cover 10 percent.

Sen. Bruce Burns, R-Sheridan, on Monday voiced concern about the federal government’s long-term commitment to funding the program.

“Frankly, if I had faith that the federal government was going to keep this up ad infinitum, I’d probably support this bill. But let’s take a look at what’s facing the federal government here: you’ve got an enormous debt and deficit,” he said.

Burns said future lawmakers will face tremendous political pressure to fund an increasing share of the program if the federal government ever cuts funding below 90 percent.

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