(Fremont County, WY) – Over the past three years, more than 50 newborn babies in Fremont County have been diagnosed with impacts related to maternal alcohol or drug use, according to the Wyoming Hospital Association.
The statistics place Fremont County third on the list of Wyoming counties reporting “the greatest number of infants with substance exposure,” legislative researcher Donna Shippen said during a Joint Labor, Health and Social Services Committee meeting this month in Riverton.
Fremont County also shows the highest rate of Medicaid-funded births in the state, Shippen said, at almost 50 percent.
But in Wyoming, Shippen said, Medicaid doesn’t cover many levels of care for substance use disorder identified by the American Society of Addiction Medicine.
In fact, she said, Wyoming is one of only seven states whose Medicaid plan covers three or fewer of the nine levels of care for substance use disorder.
Most other state Medicaid plans cover six or more of the levels of care, Shippen said.
Medicaid ‘gap’
Wyoming Medicaid covers early intervention, outpatient, and intensive outpatient services for substance use disorder, Shippen said, but it does not cover residential or inpatient treatment.
To cover that “gap,” she said, the Wyoming Department of Health provides block grants to community mental health and substance abuse treatment providers to pay for residential treatment beds in the state.
In 2022, that funding provided for a total of 256 substance abuse treatment beds in four communities statewide, Shippen said.
Less than 10 percent of those beds are available to parenting women, however – and none of those are located in Fremont County.
The beds aren’t always open, either: Andi Summerville, executive director of the Wyoming Association of Mental Health and Substance Abuse Centers, said facilities in her organization “consistently have waiting lists.”
Ninety-four parenting women received residential substance use disorder treatment through community mental health centers in Wyoming last year, Summerville said – but 113 additional women could have benefited from the service.
“There is more demand than we can potentially serve,” Summerville said. “We just don’t have the beds for these women.”
She noted that the state has undertaken a behavioral health reform process that includes discussions about services for pregnant people suffering from addiction.
Criminalization
Those discussions should not involve criminal penalties for pregnant women with substance use disoder, said Louisa Mook, a pediatrician for Indian Health Services in Fort Washakie and SageWest Health Care at Lander.
“Criminalizing these mothers does not make babies any safer – it actually harms babies,” Mook told the legislative committee this month.
She was referring to a bill proposal from Wyoming Rep. Ember Oakley, R-Riverton, that would make it a felony to consume certain illegal substances while pregnant.
The bill would make more pregnant people with addiction issues “avoid important prenatal care due to fear,” Mook said.
“Criminalizing these pregnant women will not stop them from using drugs – but it will stop them from going to the doctor,” she said. “Any legislation that deters women from getting prenatal care will hurt babies the most.”
Postpartum coverage
During this month’s meeting, Shippen also shared information about an opportunity, under the American Rescue Plan Act, to extend postpartum Medicaid coverage for up to 12 months after delivery.
Currently, Wyoming Medicaid only covers postpartum care for two months, Shippen said.
After that, more than 70 percent of new mothers are disenrolled from Medicaid coverage due to income eligibility requirements, which change after the postpartum period ends.
Single women can make up to $1,650 per month and still qualify for Medicaid coverage, Shippen explained, but after a baby joins the family, the mother can only make up to $740 per month.
Wyoming Sen. Troy McKeown, R-Gillette, said he was “frustrated” to hear those numbers.
“It just seems like we’re working against ourselves on some of these programs,” he said. “If you do get a better job and you do something better, we take the help away.”
Shippen estimated that 1,250 families in Wyoming would benefit if the state extended its postpartum Medicaid coverage to 12 months.
The move would cost an extra $3.125 million, she said, with half of the funding coming from the federal government.