Monday, November 09, 2009

Instead of imagining "Medicaid cheats," Wyoming legislators should ensure mental health coverage

More on the Wyoming Medicaid situation by Wyoming Tribune-Eagle reporter Bill McCarthy:

Bob Peck, Wyoming Department of Health chief financial officer, met with the Wyoming Legislature's Joint Appropriations Interim Committee last week.

Without federal money from the American Recovery and Reinvestment Act of 2009, he said, the state's general fund would face about a $66 million deficit for Medicaid spending.

Medicaid is the health program for low-income people that is funded by the states, as well as the federal government. It is managed by the states.

"I want everybody to understand the stimulus funds are a temporary relief from the general fund obligation," Peck said.

The "biggest drivers," he said, are increased enrollment and use of the program.

Expenditures jumped from $466.7 million in fiscal year 2008 to $512.1 million in fiscal year 2009. Enrollment fluctuates month to month, he said, but this year it is up about 6,000 or 7,000 people. Not all enrollees access services, but the number of
people using services also is on the rise. Since fiscal year 2007, he said, enrollment is up 2.3 percent, but the number of people receiving services jumped 9.8 percent.

"We do think there are things that we can do to control costs," Peck said, but the state may potentially face future deficits.

But Appropriations Committee co-Chairman Sen. Phil Nicholas, R-Laramie, said there are some balances that have to be weighed. If the state lowers payments to providers, for example, a family practice doctor might decide not to see Medicaid recipients. Those patients could then end up in the emergency room instead. Peck said his department is trying to be analytical about cost savings and to gather more data on the trends in the claims data to find cost-effective ways of delivering care.

Committee member Sen. Ray Peterson, R-Cowley, said he sees people who seem
to be living quite well, yet their children are using Medicaid. Peterson said he would like to see the requirements tightened.

"We're aware there's abuse out there," Peck said, but often the state is prevented by federal regulation from acting. For example, Peck said at times single mothers live with boyfriends who make plenty of money, but the mother's children are not legally his dependents. The children's income status is reliant on the mother's income solely.

Remember the "welfare cheats" of the Reagan era? Newspapers and airwaves were filled with stories of men and women (mostly black) driving their Cadillacs up to the local grocery and using food stamps to buy steaks and desserts and other high-end edibles. There were stories about food stamps being traded like money, even used to buy drugs.

Did it happen? Probably. Did it happen often? Who knows. The stories caught on like wildfire and before long, every black person on food stamps and school-lunch programs and unemployment was a "welfare cheat" and not to be trusted with our hard-earned taxpayer dollars. Various remedies were attempted, but the Clinton administration brought us workfare programs. Most states (including Wyoming) had success with getting people off the welfare rolls. Single moms in Cheyenne found themselves working two or three jobs to make ends meet off welfare. Kids were often left to fend for themselves. Not a rarity among any working person in Wyoming. During most of our time in this state, my wife and I have worked at least two jobs each. There was a span of two years when my wife worked three jobs. There's a joke that goes something like this: Q: "What do you call a Wyomingite with two jobs?" A: "Underemployed." I have a tendency to mangle jokes, but you get the point.

I hope we're not getting to a point where we have a plague of "Medicaid cheats." Are there people who game the system? Yes. Is there an instance of a Cheyenne resident driving a Hummer to the Health Dept. to sign up for Medicaid? Maybe. But more than likely these are apocryphal stories that we just might want to believe if they are repeated often enough.

Is that what Sen. Nicholas and Sen. Peterson and Dept. of Health CFO Bob Peck have in mind? Wyoming is a conservative state, to be sure, but most its people are fair-minded. But we live in combative times. Media and the Internet Tubes are filled with all kids of opinions and rants and even lies. People says lots of things when they're under stress.

If the presiding phrase becomes "Medicaid cheats," we can look forward to lots of yelling and screaming on all sides of the issue. And families around the state will be left without much-needed medical and mental health care. It's hard enough to come by already, but shrinking budgets and narrow minds can turn it into tragedy.

The Wyoming Dept. of Health, especially the Mental Health Division, is staffed with caring, helpful people. The department's Children's Mental Health Waiver, complete with its strategy for family "wraparound care," is visionary. Because this is a Medicaid-funded program, it's also being stressed during hard times. It's undergone some changes since our daughter was enrolled in the program from March 2008 through Sept. 2009. Let's hope the misguided words of a few conservative politicians don't sink it.

If you've been a part of Medicaid or are concerned about this issue, call or write to your state representative or senator. Find contact info at Do it before they get to Cheyenne for the next legislative session.

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