State Health Dept. seeks funds for long-term care, mental health

CHEYENNE — The Wyoming Department of Health is seeking $121 million in additional state funding on top of its $2.1 billion budget request for the 2025-26 biennium, but officials are willing to settle for the governor’s recommendation of $101 million.

Despite the $20 million difference, Director Stefan Johansson said the Health Department worked closely with Gordon on his $101 million recommendation. The director clarified the differences in request were not due to different opinions on spending.

“We worked with the governor and his staff quite a bit to strike that balance,” Johansson told the Wyoming Tribune Eagle on Monday, after the department’s budget hearing. “Obviously, our request was slightly higher than his.”

Johansson explained that some of the costs came down since the department submitted its budget request in August, and that the department supported a lot of the changes Gordon recommended.

“There’s just some hard choices the governor has to make when trying to balance the general fund budget,” Johansson said. “All those differences between my budget requests and the governor’s recommendations, there’s no surprises here. We’ve worked hand in hand to strike that right balance on it.”

A majority of the exemption requests heard by members of the Legislature’s Joint Appropriations Committee on Monday was the department’s attempt to “establish a baseline flat budget,” Johansson told the WTE.

When Wyoming faced serious revenue shortfalls in 2021, the Department of Health was forced to cut an excess of $100 million in programs and services. However, some were saved at the direction of the Legislature through an allocation of one-time funding.

Most of the exemption requests in this year’s request were to fix one-time funding issues created by the Legislature in the last biennium budget session.

Four categories of requests

The $121 million total in exemption requests was divided into four categories: stayed cuts, mandatory requests, maintaining funding and additional requests.

About $43.7 million of the department’s exemption requests were categorized as “stayed cuts” or one-time funding for programs that would have previously been cut in 2020, but stayed through either funding by the department or through the American Rescue Plan Act (ARPA).

“Mandatory requests,” for which the department requested a total of $46.9 million, were exemption requests statutorily required of the department either at the state or federal level. The “maintaining funding” category, which totaled $23.3 million of the department’s exemption requests, is a similar situation to stayed cuts.

Programs under the “maintaining funding” category were one-time funded by the Legislature in the previous budget session but are not directly related to actual cut proposals.

“So again, the vast majority of the $121 million is just to correct or fix one-time funding issues,” Johansson said. “They’re not for new services or for new programs — it’s really to keep the budget flat.”

A majority of these one-time funded programs include mental health services, substance abuse programs and home-based services for Wyoming’s older residents. Most of these services are provided through Medicaid, receiving a match in federal funds.

The remaining $7.4 million was for additional requests, the fourth and smallest category, which included some internal department funding, such as tuition reimbursement for health care workers.

Furthermore, the department anticipates reversions of $20-30 million by the end of this fiscal year, which Johansson said could be put toward funding of some of these programs. The reversion is a “best guess” by the department, with about seven months left in this biennium.

Taking care of an aging population

Tuition reimbursement was a line item under the department’s “additional request” category. The state is seeing a “historical” vacancy rate in certified nursing assistants (CNAs) and registered nurses (RNs), Johansson said.

One of the most effective tools in attracting and retaining nurses is allowing CNAs to attend college while working at a hospital. Johansson said CNAs are hired as full-time employees, scheduled 40 hours a week. The CNAs would work 20 hours at a health care facility and dedicate the other 20 hours to taking class.

After the CNAs obtain their nursing degree, they are then contracted for three to five years with the Department of Health.

“That balance of time that we essentially gave them will have to be repaid back,” Johansson said.

Wyoming is quickly becoming one of the states in the country with the oldest population. Services such as long-term care facilities are in high need of CNAs and RNs to support seniors who depend on them.

One-time funded services included in the department’s request include Wyoming Home Services, Medicaid home-based services and Medicaid nursing homes.

Costs of Medicare are anticipated to increase due to Wyoming’s aging population, Johansson said, tied in with rising costs of medical inflation. As people get older and qualify for long-term care services, dual enrollment for both Medicare and Medicaid have increased.

“Those causes of an aging population and increasing federal policy, as it relates to premiums cost sharing, results in these increasing costs,” Johansson said.

The director told the WTE there’s a chance of seeing increased medical costs in the future.

“Medical inflation is no joke in the health and human service industry,” Johansson said. “Things like prescription drug cost covering people between Medicare and Medicaid, those are costs we’ve historically seen increases.”

Flattening suicide rates

Wyoming’s 988 suicide hotline has shown effective results in “flattening” the state’s rate of suicide, Johansson told lawmakers. This service was one of three line items in the department’s “maintaining funding” category.

The Children’s Mental Health Waiver, which helps fund mental health services for children with high needs, was nearly cut. However, after a “lengthy” conversation with the governor, this program was added to the list of one-time funding under the “stayed cuts” category.

“I think there’s a big opportunity with the amount of high-needs behavioral health children that we see in the Department of Health, the Department of Family Services and the Department of Education,” Johnasson said. “Without a reasonable alternative ready to go and in place for this program, I do not believe now is the right time to do a full-scale elimination.”

There’s still a lot of room for performance improvement, the director admitted. At the same time, he said he has “seen successes with our care management agency as a provider for affordable contracts with this program.”

“I don’t think the performance of this program is absolutely where it needs to be, which is the case in a lot of Department of Health programs,” he said. “but, in my view, now’s not the right time to eliminate this program, given the problem we have with our high-needs kids.”

Without the allocated funding in the exemption request, Johansson said this program would be eliminated in July.

Larsen brought up that one of the reasons the program was nearly cut in 2021 was because of its “isolation,” where only certain communities scored contracts with mental health providers through the waiver. The lawmakers asked Johansson on Monday if it was possible to spread the program to underserved communities.

The director responded the department would look into counties and/or regions where there have been success rates, and take into account where enrollment with the waiver has been successful.

“I don’t disagree with you at all,” Johansson said. “Looking at the performance of the program, we’re happy to provide that to the committee where we see potential for improvement or growth.”