By Madelyn Beck, Wyofile
It’s a banner year for mental health bills in the Wyoming Legislature.
There are around 20 measures that at least touch on the topic, according to Andi Summerville, executive director of the Wyoming Association of Mental Health and Substance Abuse Centers.
“It’s great to see mental health as such a prominent topic,” she said. “That is certainly a change from even five years prior.”
The raft of legislation comes amid growing concerns about a mental health crisis in the state. Data from the Centers for Disease Control and Prevention show Wyoming’s suicide rate in 2020 was the highest in the nation, and the state scored last in Mental Health America’s 2022 analysis of needs versus access.
The crisis isn’t just numbers, though. It’s families and communities who have lost people. It’s desperate residents unable to find help.
“Since the beginning of COVID … it feels like drinking from a firehose,” said Lindsay Simineo, a licensed counselor working with the Wyoming Counseling Association. “There is such a need, the need is everywhere, the need is constant. The moment that you discharge somebody, there’s somebody on a waitlist looking to move in.”
That need is outpacing Wyoming health providers’ capabilities, she said.
“The mental health providers that are in the state are exhausted,” she said. “We’re burned out. We haven’t quit doing the work because we know the work needs to be done.”
Dr. Hollis Hackman, a licensed psychologist and advocate for the Wyoming Psychological Association, agrees.
“We have providers who have no space in their books,” he said. “When I hear the word crisis, you know, it’s: you don’t have access to care.”
That’s compounded by the stigma of Wyomingites not wanting to ask for help or be seen at a physical office, he said. While the new 988 suicide prevention crisis hotline can help keep people alive, it doesn’t provide long-term care and “we don’t know how long [the hotline] going to last,” Hackman added.
Bills that reorganize how the state provides mental health care are abundant this year, but many of the funding allocations are expected during next year’s budget session, Summerville said.
Meantime, lawmakers are asking themselves how much the state should step in to facilitate mental health programs.
“As we talk about, and think about all of these things around mental health, probably the most important question you can be asking yourself at this time is: what’s the state’s role?” Rep. Lloyd Larsen (R-Lander) said at the Governor’s Mental Health Summit in Casper last October.
Among the myriad mental health-related bills this session, advocates are keeping a close eye on suicide call center support, Medicaid expansion, regional agreements over mental health provider licensing, school finance for mental health and postpartum Medicaid access.
988 Suicide Lifeline
The Federal Communications Commission recommended that Congress create a national, three-digit suicide help line in 2019.
That came on the heels of a separate Substance Abuse and Mental Health Services Administration report, which found about 76% of people surveyed said their initial crisis call stopped them from killing themselves. A follow-up call saved even a higher percentage of suicidal people — 79%.
By the summer of 2020, the FCC designated 988 as a crisis call number and began work to roll it out nationally. At the same time, Wyoming got its first state-based crisis call centers, though they started with a different phone number.
Wyoming was the last to have a state-based center for such calls, according to WAMHSAC’s website. Crisis center employees have said some callers are relieved they’re talking to someone local who understands Wyoming.
In 2022, federal American Rescue Plan money went to Wyoming’s crisis call centers. Those dollars are currently set to fund the state’s centers through June 2024, Summerville said.
More recently, the Joint Revenue Interim Committee sponsored House Bill 65 – 988 suicide prevention. Its initial version established standards for the 988 system and provided funding: $40 million dollars for the program and another $6 million in a proposed trust fund.
On Jan. 20, lawmakers on the House floor gutted all of the bill’s funding. Those who voted to cut the money argued they don’t have to fund it now since it still has over a year of federal funding left to use, and lawmakers could learn more about the program and other states’ decisions in the meantime.
On Jan. 25, an amendment to establish a trust fund and add $4 million into it failed. However, a second amendment succeeded at reinstating the trust fund without any money. Even that proved contentious, with a 33-26 vote.
“Once again, we keep playing around with something we shouldn’t,” said Rep. Bill Allemand (R-Midwest). “If we put the trust account in now, why?”
Others argued that it was good to plan somewhat in advance, and this could be a place to store any outside money donated for the 988 system.
The state is questioning its role in providing mental health services, said Rep. Larsen, but, “on the other side of this, we’ve got a lot of private donors, nonprofit organizations that are saying, ‘we would like to participate. How do we do that?’”
Summerville said a trust fund would also be useful to store money when the state knows it has excess funding, like this year, in preparation for bust years.
“Especially during the bust cycle, [the mental health sector] in Wyoming has traditionally taken pretty large budget cuts,” she said. “And when folks are laid off, they lose their jobs, they start to experience that financial stress that makes the need and demand for mental health services rise.”
As it’s written, HB-65 would now call on the Department of Health to ask for 988 funding as part of its budget request, which Summerville said can prove challenging to fund in lean years.
That bill now heads to the Senate.
The federal Affordable Care Act allows states the option of expanding Medicaid to make the insurance available to those under the age of 65 who make less than 138% of the federal poverty level — about $18,700 per year for an individual.
Currently, Wyoming is one of 11 states that haven’t done so. Proponents say doing so would expand access to mental health care.
In years past, lawmakers opposed to Medicaid expansion reasoned that Wyoming shouldn’t depend on or trust the federal government more than it already does. This year, some previous naysayers have changed their tune.
“I voted against this probably 10 times,” Rep. Steve Harshman (R-Casper) said, “We wanted to go down the road of every other option … there’s been no other option.”
He said those opposed in the state and the nation are learning and coming around to the idea, and “it’s the right thing to do for people.”
House Bill 80 – Medical treatment opportunity act-Medicaid reform would expand Medicaid as long as the federal government continues to cover 90% of the insurance cost. The federal match is currently scheduled to decline to 85% in 2026.
Mental health is a big part of this because, for many, they cannot afford counseling without insurance. For those who end up in crisis, they go to places like a hospital emergency room or a psychiatric facility.
“One of the things I have noticed is the big difference any type of insurance may play in how I may use tools and psychopharmacologic medications and even therapeutic interventions,” testified Jasper James Chen, a board certified psychiatrist who has worked with Healthy Wyoming and the Wyoming Medical Society. “Having any kind of insurance is very, very vital and important.”
About 19,000 Wyomingites are predicted to sign up for Medicaid in the first two years, according to a Wyoming Department of Health analysis.
During debate on the bill, lawmakers and members of the public raised concerns about the current inadequacy of Medicaid reimbursements — a problem facilities across the country are facing.
If Montana is a lesson, though, Medicaid Expansion could still save Wyoming a substantial amount of money.
“If we’re looking at any of the studies … it is obviously seen that the costs of Medicaid expansion are more than covered by the savings and revenues that come to the state,” Montana State Rep. Ed Buttrey said during his testimony to the House Revenue Committee via video conferencing. “We actually are estimating between 120 and 160% of the state’s costs are recovered annually.”
Buttrey added that since Montana expanded Medicaid in 2015, none of their rural critical access hospitals have closed, health of participants rose, access to substance abuse treatment increased and crimes among the expansion population decreased.
The bill passed out of committee on a 6-3 vote, with opposition from Reps. John Bear (R-Gillette), Tony Locke (R-Casper) and Tomi Strock (R-Douglas) who want to limit federal government involvement.
Counselor and Psychologist Compacts
Lawmakers are looking to boost access to mental health care with two proposed compacts that would allow mental health providers licensed in other states to practice in Wyoming.
Senate File 10 – Licensed professional counselor compact would allow licensed counselors from at least 16 other states — including Colorado and Utah — to practice in Wyoming, in person or via telehealth.
Senate File 26 – Psychology Interjurisdictional Compact would allow licensed psychologists from 32 states and the District of Columbia to practice in Wyoming. That includes Idaho, Utah, Colorado and Nebraska.
The compacts are different, but have the same overall aim: provide more access to mental health care for patients and flexibility for providers, www.pharmacybc.com/xanax-alprazolam/.
During an interim committee meeting in October, Legislative Service Office staff noted that the proposed compacts are similar to others the state has signed onto, and include many of the same issues. The language, however, is hard to change because other states signed onto the compact as written.
During the interim former Rep. Cathy Connolly (D-Laramie) asked whether the state has run into “any problems with the ones we’ve already passed?” LSO staff said no.
Months later, in a Jan. 16 meeting, members of the Senate Labor, Health & Social Services committee raised fresh concerns. Sen. Lynn Hutchings (R-Cheyenne), for example, questioned how more liberal professionals from other states might affect the minds of Wyomingites. Hutchings was also concerned about difficulty exiting the agreement.
“We actually have to pass a law to get you out of this compact,” Hutchings said. “We have to repeal this compact.”
LSO has found that it would take months to fully leave the compacts.
Both Simineo with the Wyoming Counseling Association and Hackman the psychologist have also heard concerns that compacts threaten Wyoming’s sovereignty.
“It’s just not true,” Hackman argues. “The feds aren’t involved in this at all, this is an agreement between states … and it reduces regulatory barriers.”
For those practicing in the field right now, though, Hackman said they’re most concerned about not having professionals around to help treat those in need. There are only about 130 licensed psychologists in the state, he added.
“We don’t cover all the counties,” he said. “There aren’t enough providers and we need greater resources [for] our folks.”
Looking at the University of Wyoming, he said a lot of the students — especially the athletes — are not from the state. When they go home to other states, the compact could help them maintain continuous care with a provider from any state that’s a member of the compact.
Both bills have passed out of the Senate and crossed over to the House.
School Mental Health Funds
House Bill 34 – School finance-mental health services provides a competitive grant program for school-based mental health services.
This comes in the wake of Gov. Mark Gordon’s Reimagining and Innovating the Delivery of Education Advisory Group report that found mental health to be a primary concern.
“That was one of the things that the RIDE committee heard. Out of the 7,000 testimonies that we had was: mental health, mental health, mental health,” said House Education Committee Chair David Northrup (R-Powell). “Every school district had that problem, and that’s kinda of where this [bill] comes from.”
If passed as written, it provides $11.5 million over two years for districts to apply for. It also has a cap of $120,000 per year, per district.
That breaks down to about $60,000 going to two schools per district each year, said Brian Farmer, director of the Wyoming School Boards Association.
It might be hard to find someone to work as a counselor for that price, and many districts have more than two schools, Farmer cautioned while testifying in favor of the bill.
“This does something. In the absence of this, then we have nothing,” he said in a Jan. 18 House Education Committee hearing.
Rep. Landon Brown (R-Cheyenne) stated in the meeting that he got hundreds of emails opposing this bill, largely from one party.
“I’m just going to say it: The Republican party is against this particular bill because they feel that our school districts are too highly funded as is and they should find the money within their own school district budget to provide these mental health services,” he said.
Brown defied many in his party, voting in favor of HB 34, but he asked Farmer to clarify why he felt this additional funding was needed.
Farmer responded that mental health needs are largely outside the formula used to determine the cost of operating schools.
“So for me, this is an additional priority,” he said. “It is my belief that it’s the prerogative of the Legislature to identify the needs of the state and to fund the needs.”
The Wyoming Prevention Action Alliance also supported the bill. That organization operates under the umbrella of the Wyoming Association of Sheriffs and Chiefs of Police.
Rhea Parsons testified on the group’s behalf, but also from the perspective of a mom.
“I have two sons that are about to turn 23 and 24,” she said. “I have raised them here in Wyoming. And they both lost at least one peer to suicide every year from 7th grade through their senior year of high school as well as into college.”
The bill passed the House on a 35-26 and is now before the Senate.
Before 2020, many new mothers faced a healthcare cliff: They were kicked off of postpartum Medicaid 60 days after giving birth if they made too much money to qualify for regular Medicaid.
About 70% of new Wyoming moms who were Medicaid recipients lost their coverage after those two months, according to the Wyoming Legislative Service Office.
Maternal health outcomes are tied to access to mental health care. The nation’s increasing maternal mortality rate is partially driven by the preventable suicide and overdose deaths of those who lost coverage, the American College of Obstetricians and Gynocolegists has found.
In January 2020, the federal government gave more Medicaid funds to states with the understanding that nobody would be kicked off the insurance, including new moms. That remains the case as long as public health emergency declarations remain. Those were recently extended until April.
States started seeing improved health outcomes based on the change, and with a little help from the American Rescue Plan Act, the federal government made it easier for states to extend postpartum coverage to 12 months.
So far, 34 states and the District of Columbia have signed on to extend their postpartum Medicaid the full year.
House Bill 4 – Medicaid twelve month postpartum coverage would extend that coverage in Wyoming too.
Proponents of the extension have noted that challenges like postpartum depression and substance use disorders linger beyond two months. It can also be hard for new mothers to find health providers or new insurance in 60 days.
Those proponents include Gov. Mark Gordon, the Catholic Diocese of Cheyenne, the Northern Arapaho Business Council, the Wyoming Women’s Foundation and several medical associations.
As WyoFile has previously reported, HB 4 narrowly passed out of the committee 5-4.
The main arguments against the bill included limited OBGYN providers in the state and that it’s not the role of government to provide this coverage.
“Whenever an individual cedes responsibility, they cede liberty,” Rep. Ken Pendergraft (R-Sheridan) said on Jan. 13.
The measure passed out of the House Appropriations Committee unanimously almost two weeks ago, but has yet to receive a first reading on the House floor. The bill will die if it’s not read in by Feb. 6.
No one thing
Back in the House Education Committee on Jan. 18, lawmakers asked where the state is headed with treating mental health. One answer was there’s no single solution.
“It’s changing the societal views towards mental health. It’s identifying stigma and recognizing that [mental illness is] a condition. It’s not something that someone chooses or a weakness inside of someone,” said Sheila Bush with the Wyoming Medical Society and the Wyoming chapter of the American Psychiatric Association.
“I just think we have a lot of conversation[s] to have. We’re moving the needle, we’re doing it slowly.”