Lawmakers backtracked this week on what many – including some lawmakers – believed was a proposed $58 million cut to federal Medicaid reimbursement funding for tribally-run medical facilities.
At a Select Committee on Tribal Relations meeting in Riverton on Jan. 27, Rep. John Bear (R-Gillette) called the confusion an “accounting issue” and emphasized that the funding was “never, ever in jeopardy.” Bear co-chairs the Joint Appropriations Committee (JAC) that voted to strike the funding from the draft budget bill earlier this month.
Bear’s announcement came right after the Tribal Relations Committee meeting’s lunch break. During the break, a group of about two dozen peaceful protestors gathered outside the meeting location at the Central Wyoming College Intertribal Community Center to voice their frustration with the situation.
Some of the signs read “Restore Federal $ For Indian Health,” “IHS Funds Belong with the Tribes,” “Be Honorable” and “58 Million Cut, Shame!”
Providing health care to tribal members is part of the promises made by the federal government in treaties to both the Eastern Shoshone and Northern Arapaho tribes on the Wind River Reservation.
The federal Medicaid funding in question would ensure that tribal facilities receive the higher reimbursement rates from the Indian Health Service, as required by the federal government.
The program has been fully funded since 1995.
But Bear said those rates have fluctuated significantly in the past years, and that the Wyoming Department of Health has an alternative way to make sure spending is reimbursed retroactively, rather than proactively.
“Without that authority, they simply do a B-11 and notify the Legislature that they're going to spend the money, and then they get the reimbursement after the activity is taken care of for the tribal member,” he said.
B-11 is a process through which, in specific scenarios, the governor has the ability to modify budgets without the approval of the Legislature.
Bear added that, given current reimbursement rates, the necessary funding is more in the ballpark of $41 million rather than $58 million.
Sen. Cale Case (R-Lander) asked Bear and Salazar to provide the committee with a copy of the Department of Health’s memorandum about the new estimate.
Bear added that getting the funding locked down by approving the Department of Health’s request is now how the committee will move forward.
“The JAC is likely to take action before we get into session to ensure that we accept that new estimate and that we go ahead and give that spending authority to the chief executive to the department,” said Bear.
The JAC is scheduled to meet again on Feb. 5 in the afternoon. Its agenda does not specifically mention the IHS funds.
Bear had not mentioned any of those technical details when the funding was first discussed earlier in the month.
Tribal reactions
Rick Brannan is the CEO of Wind River Family and Community Healthcare, which is more commonly known as Wind River Cares. It operates clinics in Riverton, Arapahoe and Ethete and opened a new dialysis center in Riverton in 2024.
He testified in the Tuesday meeting and said that Medicaid funding is essential to their operations.
“It is very hard for me to try not to show my emotions because I'm about ready to cry, because Medicaid means everything to our patients,” he said. “Without it, we couldn't provide the healthcare at the levels we are.”
Lee Spoonhunter is a member of the Northern Arapaho Tribe and represents the Rocky Mountain Region on the National Indian Health Board.
“Today is a good day… I am, like Rick here, happy and a little emotional that the healthcare money was put back into the budget or is going to be put back into the budget,” he said. “It's very critical.”
Rep. Ivan Posey (D-Fort Washakie) is the co-Chair of the Select Committee on Tribal Relations and an enrolled member of the Eastern Shoshone Tribe. He said he was “pleased” with the update, especially given the fact that Indian Health Service has been underfunded over the years.
“ We appreciate all the work and help that's gone into this decision,” said Posey.
Lawmaker reactions
Sen. Mike Gierau (D-Jackson) voted against the initial motion to cut the funding from the draft budget and said he was “immensely gratified” by the change of course.
“I'm just thrilled that this subject is now off the table and that this full funding is going to occur, is going to pass through and is going to be there,” he said.
Sen. Tim Salazar (R-Riverton) sits on the Select Committee on Tribal Relations and also co-chairs the JAC. He echoed Bear’s sentiment that the ball is rolling on securing the funding before the upcoming budget session.
“I'm very confident that the state Senate will fully support whatever the Department of Health's number is. I also believe that that will be put into the biennium budget actually before the session,” said Salazar.
How we got here
Freedom Caucus Rep. Ken Pendergraft (R-Sheridan) initially brought up the motion to cut the Medicaid funding at a JAC meeting on Jan. 13, with the goal of eliminating any additions to the government’s budget.
But the motion was met with opposition from lawmakers like Rep. Trey Sherwood (D-Laramie), who pointed out that the funding was all federal money, part of an already federally-approved update to Medicaid reimbursement rates.
“This is 100% federal funds, and Wyoming Medicaid is legally required to automatically adopt these new federal calculated rates,” she said.
Sen. Ogden Driskill (R-Devils Tower) also pushed back on the proposed cut.
“What you're actually doing is denying service to people of Wyoming. And these are tribal members, by the way,” he said. “This is 100% federal. It's all funded. They're trying to take care of probably our most disadvantaged population we have in the entire state.”
But JAC co-Chair Rep. Bear argued that not approving the $58 million in question was a way of looking out for state taxpayers.
“Any time you increase spending in government of any type, you are putting a burden on the taxpayer,” he said.
Others cautioned that denying the IHS funds would end up burdening Wyoming’s Medicaid program. Wyoming’s share of Medicaid spending is 45%, with the federal government pitching in the remaining 55%.
Rep. Lloyd Larsen (R-Lander) told WPR, “To deny it, I think potentially runs the risk of the state having to make up the difference, because we don't have the federal dollars to pay for it, and the healthcare provider still has the right to charge at the higher rate.”
The 12-person committee ended up approving the motion to make the cut with a 9-3 vote.
