Medicaid expansion—limited benefits.





This bill contains an appropriation of $156,700,000 from the FEDERAL FUNDS to the Department of Health.  This appropriation is effective immediately.



Agency #:  048     Agency Name:  Department of Health

Unit:  New - Optional Medicaid Expansion Adults


EXPENDITURE BY SERIES AND YEAR       FY 2014         FY 2015         FY 2016

0600  Grant & Aid Payments                          $49,210,000     $105,260,000

0900  Contractual Services Costs                     $1,180,000       $1,050,000


Total Expenditure Per Year:                         $50,390,000     $106,310,000

Grand Total Expenditure:          $156,700,000

Total Appropriated to Agency:     $156,700,000

Total Appropriated by Fund

FEDERAL FUNDS            :        $156,700,000



For Medicaid client benefits for approximately 17,600 individuals with incomes between 0% and 133% of the Federal Poverty Level (FPL) that would become newly eligible for the program.



The bill proposes the "Medicaid Fit" program whereby the Wyoming Department of Health (WDH) assumes costs for program services will be 95% the cost of traditional Medicaid services.  The program will be tailored to offer all required ACA-compliant services and as required the services of the Medicaid traditional program.  Some services paid for under Medicaid Fit are expected to provide state General Fund cost reductions.  All figures are adjusted to reflect a January 1, 2015 start date, the middle of (six months into) FY 2015.  The appropriation in the bill does not match previous cost estimates.  The appropriation will cover all benefit costs through FY 2015 and FY 2016, but will not be enough to cover the federal share of program administrative cost (short $1.47 million in FY 2016).  Administrative costs are estimated to be 4% of benefit costs and the federal share of administrative costs are estimated to be 59.375% based on federal matching percentages for various elements of program administrative costs).



FY 2015

FY 2016

FY 2017





Anticipated Expenditure Increase (Decrease):




FEDERAL FUNDS           




GENERAL FUND            





Source of Expenditure Increase (Decrease):

The bill proposes to cover the cost of Medicaid services to newly eligible clients under the optional Medicaid Fit program.



The state-contracted consultant report on state's best case scenario for Medicaid expansion estimates the program will cover about 17,600 individuals.  Some clients that are eligible for the program, but have other health insurance options (i.e. – employer-based coverage, etc.) would have to be covered by state funds (about $9.34 million in benefit and program administration expenses through FY 2017).  However, in total, the state expects to see an overall decrease in state General Fund services (about $57.36 million through FY 2017).  Programs which may show reduced state General Fund expenses include four optional Medicaid programs, state mental health and substance abuse services programs, Wyoming State Hospital, Renal Dialysis program, Colorectal Cancer Screening program, HIV/AIDS medication program, and the Tobacco Cessation program.


Note:  Calendar year (CY) 2017 is the first year when the optional Medicaid program enhanced federal matching percent is reduced to 95% for program benefit costs.




This bill has administrative impact that appears to increase (or decrease) duties or responsibilities of one or more state agencies and may impact agency spending or staffing requirements. As introduced, the bill does not modify any state agency budget or current personnel authorizations.

The following state agencies will be asked to provide their estimate of the administrative fiscal impact prior to the first committee meeting held to consider the bill:


Wyoming Department of Health




















Prepared by:    Michael Swank, LSO                         Phone:     777-7881

(Information prepared by Jesse Springer, Wyoming Department of Health, 777-8048)