‘Let us help ourselves’: Lawmakers advance bill allowing increased federal Medicaid funding for psychiatric residential treatment facilities

Wyoming’s Labor, Health and Social Services Committee approved a bill draft this month that would let private medical providers seek more federal Medicaid money to support psychiatric residential treatment facilities in the state.

The proposal received “ay” votes from both of the Fremont County lawmakers on the committee: Wyoming Reps. Andi LeBeau, D-Ethete, and Pepper Ottman, R-Riverton.

“This really sounds good,” Ottman said during discussion on the bill. “I mean, just for everybody to look at the problem and to say, ‘OK these are things that we can work together and do.’”

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The legislation would authorize the Wyoming Department of Health to collect fees from private medical providers in the state, then use that money to generate federal matching funds from the Centers for Medicare and Medicaid Services to benefit Wyoming’s two psychiatric residential treatment facilities for adolescents: the Wyoming Behavioral Institute in Casper and St. Joseph’s Children’s Home in Torrington.

“It’s a no-general-fund way to increase cost coverage,” WDH director Stefan Johansson said, noting that similar programs already exist in Wyoming to support nursing homes and “a variety of other providers.”

Out of all of those programs, “this might be one of the most important ones,” Wyoming Hospital Association president Eric Boley said.

“The mental and behavioral health crisis in our country and in our state is terrible,” Boley said. “It’s one of the worst we’ve ever seen.”

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Part of the problem is that facilities like WBI and St. Joseph’s don’t have enough staff to accept all of the patients who could benefit from their services, Boley said.

“Staffing … continues to be a bit of a challenge,” St. Joseph’s finance director Ronda Meyer said. “We’re licensed for 62 beds, but right now we can only serve anywhere between 36 and 40 (patients), and that’s because of staffing concerns.”

Boley said the staff are leaving primarily “because they can get higher wages elsewhere.”

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“We can’t offer those (higher wages),” he said, pointing to the gap between medical costs and Medicaid reimbursements. “There’s not enough money (when) you’re getting paid less than your costs.”

The majority of patients at WBI and St. Joseph’s are on Medicaid.

The state could increase its own Medicaid reimbursement rate, Boley noted, “but that seems to be something that we aren’t willing to do.”

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“So we’ve come with our own solution, and that’s to assess ourselves,” he said. “We’ve got the private hospitals on board – they want to be part of this … because it’s so important.”

Staffing shortages at psychiatric residential care facilities have caused “some serious situations in our state,” Boley explained, “clogging up our emergency rooms” and requiring patients to be held “in places where they’re not receiving the type of treatment that they really need.”

He recalled one patient who was housed in a hospital emergency room for 70 days while waiting for a bed at a residential treatment facility.

In Fremont County, Ottman said she knew of another patient who spent 45 days in the emergency room while awaiting placement elsewhere.

“It’s because there’s no place for them to go,” Boley said.

Johansson estimated that the new program supporting psychiatric residential treatment facilities could generate an extra $3.85 million in federal funds for Wyoming.

That funding will do “a lot (to) help,” Boley said.

“This is such a vital tool to help (these facilities) be solvent and maybe be able to stem some of the bleeding and to bring in some additional staff,” he said. “I would just ask (you to) let us help ourselves – or if you’re not willing to do that, we’d ask you to increase the general fund that’s allocated towards reimbursing these providers.”

The Labor committee voted 11-2 to support the bill.

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