The CMS earlier this month rejected a Wyoming Medicaid waiver proposal that aimed to lower air ambulance costs for all residents of the state.
Wyoming essentially proposed making air ambulances into a public utility by using a Medicaid waiver to make all residents eligible for Medicaid coverage of air ambulances, regardless of their income level. The Wyoming Department of Health submitted the waiver to the CMS on Oct. 28, 2019 and it was denied on Jan. 3.
"We do appreciate the timely decision from CMS on our waiver application related to air ambulance service. Working with our policymakers here at the state, we will look at the options of what we might do next," said Kim Deti, a spokesperson for the Wyoming Department of Health.
Federal law limits states' power to regulate air ambulance billing, and the CMS said Medicaid waivers should not be used to circumvent federal law.
"Using the Medicaid administrative structure to provide services to other individuals in the state as a mechanism to avoid the application of federal aviation law is a clear departure from the core, historical mission of the Medicaid program to provide health coverage to the Medicaid eligible population," CMS Acting Deputy Administrator and Director Calder Lynch wrote.
Lynch also said the CMS refused to approve the waiver because the state did not indicate that the program would be budget-neutral for the federal government.
Providers would have bid to be the exclusive air ambulance service in a geographic area, and the companies would have been paid a flat amount instead of per transport. Patient payments would have been related to income, and insurers would have contributed to the program.
Wyoming Medical Center and Cheyenne Regional Medical Center sent the CMS a letter urging the regulatory agency to reject the waiver, the Casper Star-Tribune reported.
The Save Our Air Medical Resources campaign supported the CMS rejection of Wyoming's waiver.
"If accepted, the waiver would pose a direct risk to all Wyoming patients, including current Medicaid beneficiaries, because of the diminished access to emergency critical care health services that it would have caused," SOAR spokesperson Carter Johnson said.
A recent Government Accountability Office report found that nearly 70% of air ambulance transports in the United States were out-of-network in 2017, and that air ambulance companies charged privately insured patients a median of about $36,400 for a helicopter transport and $40,600 for a fixed-wing transport.
A bicameral, bipartisan package of legislation banning balance billing included air ambulances failed to pass Congress at the end of 2019, but the issue could be addressed again ahead of a May funding deadline for several Medicare and Medicaid programs.