Ottman votes against postpartum Medicaid extension; committee approves bill proposal 6-5

A state legislative committee has approved a bill that would extend postpartum Medicaid coverage in Wyoming to cover a 12-month period – up from two months.

Wyoming Rep. Pepper Ottman, R-Riverton, voted against the bill along with four other members of the legislative Labor, Health and Social Services Committee.

But six committee members voted “yes,” meaning the bill will move forward to the next legislative session.

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ARPA

The federal American Rescue Plan Act gave states the ability to extend postpartum Medicaid coverage for 12 months without a waiver through March 2027, Wyoming Department of Health director Stefan Johansson said.

His agency estimates that the change would cost Wyoming $3.8 million biennially due to a 1,250-person monthly uptick in Medicaid enrollments.

“That’s basically how much the pregnant women eligibility group would increase on a monthly basis,” WDH policy analyst Franz Fuchs said.

Fuchs could not offer any “significant findings” demonstrating the health benefits that might result from extended postpartum Medicaid coverage, but Johansson said maternal mortality statistics already show that postpartum coverage during the first 12 months after birth has “significance in eliminating complications (and) death.”

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It’s good for the infant too, according to the Wyoming Primary Care Association.

“The first several years of a baby’s life is very much dependent on its mother or major caregiver,” WPCA policy consultant Mary Lynne Shickich said. “So that child’s health and welfare is really dependent on the mother having coverage as well, and being available to the child. … I see it as going hand in hand.”

Healthcare costs

Johansson noted that extended Medicaid coverage would benefit new parents financially as well – especially those “at the lower income spectrum.”

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For example, HealthWorks CEO Tracy Brosius said the Medicaid copay for a mental health counseling visit is about $4, compared to around $35 for patients on the “sliding fee scale.”

That’s a “significant jump” in costs, she said, “especially when you have recurring appointments” that can add up to “a couple hundred dollars a month” for mental health care alone.

If a new parent can’t access that preventive mental health care because of an inability to pay, the situation can escalate and become even more expensive for the state, Wyoming Medical Society executive director Sheila Bush said.

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She asked the committee to imagine a new parent who “gets to a peak of stress and maybe shakes a baby – which we know is a problem.”

The infant might have long-term health problems as a result, Bush said, and the parent might go to jail – and “the state pays for all of it.”

“Whatever cost is associated with this extension of coverage … is easily covered and overshadowed by the cost of just one situation like that,” she said.

Mental health

There has been a “dramatic uptick” in the number of postpartum patients struggling with mental health issues during the COVID-19 pandemic, Brosius said, and Wyoming Counseling Association legislative advocate Lindsay Simineo agreed.

“We do see a lot of the mental health issues and postpartum issues after the eight-week period, (and) we have seen an uptick in that,” she said. “By extending (postpartum Medicaid coverage) to 12 months we are opening the chance for postpartum women to engage in those mental health services and engage in that continuity of care which is vital for those moms to be able to provide those stable environments for their new babies.”

Ottman wondered whether local “pregnancy help centers” might be able to offer more affordable support options to new parents experiencing stress and anxiety.

“Sometimes the help of people that deal with that day in and day out is sufficient for a person,” she said. “I’m just thinking it would be nice for the communities to work together. … We could get more educated on available services in communities rather than just through Medicaid.”

But Wyoming Rep. Sue Wilson, R-Cheyenne, replied that “the ability of the pregnancy centers to help would depend on the severity of the person’s problem.”

“If you can be counseled by a person like me or you … that’s one thing,” Wilson said. “If, on the other hand, you need psychiatric medication, that’s obviously beyond our scope.”

Postpartum patients can experience other medical complications as well, Wyoming Sen. Fred Baldwin, R-Kemmerer, said, explaining that, “sometimes we discover things through pregnancy – a disease process that the woman didn’t know she had to start with, (like) diabetes.”

“So in addition to the new child, now they have … new medicines, new things they have to learn on top of a pregnancy,” Baldwin said. “It compounds (the situation). Things get more complicated.”

Ariel Bernath, the Wyoming engagement manager with the American Cancer Society Cancer Action Network, said “cancer risks are actually heightened from their baseline … in the period after giving birth.”

“An additional 12-month period of affordable, accessible health coverage allows for more time to diagnose and treat health issues including cancer that may have been identified in the course of a routine pregnancy and postpartum care,” she said.

Preventing cancer is “much less expensive” than treating it, Bernath continued, adding that “the most cost-effective solution to improving the lives of all Wyomingites … is to fully expand Medicaid up to 138 percent of the federal poverty level.”

The Affordable Care Act of 2010 gave states the option to expand Medicaid in that way, but Wyoming has not taken advantage of the opportunity.

Instead, people looking to enroll in Medicaid in Wyoming “must fall into certain categories based on age or physical health status,” the WDH said in a January report.

“Having a low income does not currently qualify you for Medicaid in Wyoming,” the report states.

The “rules-based eligibility system,” which was implemented in 2014, “significantly tightened up eligibiltiy decisions,” the WDH said, resulting in a “steady decline in enrollment from 2015 to 2020.”

h/t Wyoming Department of Health

If Wyoming did fully expand Medicaid, the WDH estimated that 19,000 additional people would enroll in the program during the first biennium.

About 60 percent of those people would have previously fallen into the “insurance coverage gap,” the WDH said; about 55 percent would have been previously uninsured, and about 56 percent would have been employed.

The newly-enrolled members would see “a slight decrease in mortality for uninsured individuals between 45 and 64, increased healthcare utilization, improved mental health, and increased financial stability,” the WDH said.

The move would cost $22 million in state funds and $177 million in federal funds, the report states, but there is also a $54 million ARPA “incentive” for the move, meaning Wyoming would actually save $32 million in the first two years of expansion.

That excess money could be used to cover the cost of expansion for a second biennium, the WDH said.

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