The Wyoming Department of Health presented multiple exception requests to the Joint Appropriations Committee on Dec. 8 spanning Medicaid eligibility staffing, technology upgrades, enrollment increases and provider reimbursement initiatives.

Long‑term care eligibility staffing: Director Stephan Johansen and state Medicaid agent Jesse Springer asked the committee to convert or add two positions in the long‑term care eligibility unit to address growing caseloads. Springer told the committee that caseworkers have averages exceeding 600 cases each and in some cases approach 700, which has driven processing times above federal timeliness standards (about 45 days). The department said adding two staffers — funded largely by a 75% federal match — would reduce backlog and timeliness errors; Johansen characterized the state share as modest, noting an estimate of roughly $63,000 general fund with about $190,000 federal funds for the positions.

Medicaid system enhancements and technology: The department requested $736,000 general fund for eligibility system enhancements (90% federal match) to improve member notices, long‑term care functionality and compliance with new federal eligibility requirements, and to reduce reliance on consultant contracts.

CHIP and enrollment requests: The Department projected a CHIP enrollment rise and asked for $4.7M general fund (generating approximately $8.8M federal match) for the biennium to cover anticipated children’s coverage increases. Johansen noted children (Medicaid + CHIP) represent roughly two‑thirds of total Medicaid enrollment.

Supplemental payment authority and Medicare Part D clawback: Johansen explained growth in supplemental payment programs (provider assessments matched by the federal government) and requested federal and other funds authority (no state general fund) to account for growth in hospital, physician and ground ambulance supplemental payments. Separately, he identified the Medicare Part D clawback as a mandatory invoice the state must cover through the federal match mechanism and labeled it a top priority that the state cannot avoid.

Provider incentives and children's home health: The department proposed increasing inpatient critical access hospital rates to 100% of allowable cost for hospitals that maintain OB and labor‑and‑delivery services as an incentive to preserve rural maternity care, and requested restoration of home‑health reimbursements for a small number of very high‑needs children (previously around 46% of cost) toward 70% cost coverage to avoid costly out‑of‑state hospital stays.

Community Choices and DD waiver funding: For the Community Choices waiver (home‑and‑community based long‑term care) the department requested increased general and federal fund authority tied to enrollment growth (unit described as 50/50 match historically), and for the DD waiver system the department proposed a three‑pronged package: modest provider rate recontinuation (ARPA replacement), extraordinary care funding for emergency cases, and targeted wait‑list funding. The combined DD waiver package totals about $31M across funding sources ($15.5M general fund) for the biennium and would address only a portion of the projected 450–500 person wait list.

Committee action and context: Legislators asked for more detailed breakdowns, comparisons to other states, and clarifications on vacancy offsets; staff said they had already reallocated some vacancies and used contract labor where direct hires were unavailable. No formal votes were taken; committee members requested additional data and options to refine priorities during upcoming markup.