Medicaid rejects Wyoming's request to have Medicaid cover air-ambulance service for all in the sparsely populated state

Government Accountability Office photo

"The Centers for Medicare and Medicaid Services this month rejected a proposal that Wyoming health department officials hoped would allow the state to rein in the high cost of air ambulance service" by having Medicaid cover it for anyone in the state, Andrea Noble reports for Route Fifty.

Rural residents rely disproportionately on air ambulances, especially in Wyoming, the nation's least populous state and, except Alaska, the one with the lowest population density. But many patients are faced with high surprise bills, even those who have private insurance. So, Wyoming health officials asked the CMS for a waiver to treat the industry like a public utility and expand Medicaid coverage to all Wyoming residents for the specific benefit of access to air ambulances, Noble reports.

"In its waiver request, Wyoming estimates that about 4,000 people were taken to the hospital by air ambulance in 2018. Approximately 90 percent of those patients do not have to pay for the cost of transport because of insurance coverage. For the remaining 10% of patients, the average out-of-pocket cost per flight is $2,250. But out-of-pocket costs have reached upwards of $40,000 in a handful of cases, the state said," Noble reports. "The state said that its proposal would have allowed Medicaid to determine statewide requirements for air ambulance coverage, issue competitive bids for providers and establish a centralized call center that would direct air ambulance traffic. The price for transport would likely have been lowered through the competitive bidding process, the state said."

CMS rejected the idea in a Jan. 3 letter, calling it an inappropriate attempt to circumvent federal aviation law, which would be a misuse of Medicaid, and that it would cost too much, Noble reports.