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‘Healthy Frontiers’ program faces hurdle in Legislature

Program aims at helping people take responsibility for preventive health care

A state-funded program designed to help provide preventive care for low-income adults who can’t get insurance could end before it’s fully begun.

The “Healthy Frontiers” program is the result of a bill passed by the 2010 Legislature, which initially set aside $750,000 from the state’s tobacco settlement trust fund to establish personal health savings accounts for as many as 500 participants.

Gov. Matt Mead signed a bill last year that provided $1 million to continue the pilot program, which currently is available to a maximum of 250 people.

But Mead set aside no money for the program in his budget for the 2013-14 biennium. Unless that changes, funding for the program will end June 30.

Meanwhile, Sen. Charles Scott, R-Casper, said he plans to sponsor a bill that would provide $23.4 million to fund the program through the coming biennium and expand it to 2,000 participants.

Ending the program now would be a tragedy, said Justine Larsen of Powell, who enrolled in Healthy Frontiers in December.

The program is administered by Blue Cross-Blue Shield of Wyoming. Blue Cross executive Wendy Curran is administrator of the Healthy Frontiers program.

To qualify, Curran said, people must be working at least 20 hours per week and have a household income between 100 and 200 percent of the federal poverty level, and they must not be eligible for health benefits under any other program.

Money is deposited into participants’ health savings accounts, also known as personal health accounts, as an incentive to get preventative care.

Healthy Frontiers is an insurance program designed for people with low incomes; it is not an entitlement, Curran said.

Participants must pay monthly premiums, which are deposited in their personal health accounts. Those premiums vary according to family size and income, with the lowest being $9 per month and the highest being $72 per month, she said.

Mead recently told The Associated Press that his decision not to fund the program was due in part to low participation and because some participants did not fulfill their obligations to the program.

“What we have seen is a fairly large amount of money being dedicated to that,” he said. “We’ve had a limited number of participants so far show up. Some of them have already over-expended their health savings accounts. We have had some who have difficulty making the minimum payment to their health savings account.”

But Larsen countered, “How do you call a program a failure or ineffective if it hasn’t even been promoted?”

Larsen, who works 30 hours per week in her job with the school district, said she heard about Healthy Frontiers through Women’s Wellness/Caring Program for Women.

“I immediately applied,” she said. “I am one of the first people in the area of Northern Wyoming to apply for this, and I know there are many others that would apply and be good candidates for this program.”

Curran said it took a long time to develop rules for the program. Now that it is up and running, “it hasn’t been marketed in the true sense of marketing, mostly because of the pilot nature of the program the Legislature approved.”

Instead, participants are recruited through other agencies and organizations that provide services to residents with low incomes, she said.

Curran said Healthy Frontiers started up in the Cheyenne and Casper areas, then recently expanded to the Powell/Lovell area, and soon will be in Lander as well.

While only 49 people had enrolled in the program mid-October, enrollment had doubled to 102 as of last week. 

Curran noted that the program requires physicians, as well as participants, to be enrolled.

“This is a different kind of program,” she said. “It takes a lot of explanation, and it takes health professionals who are willing to practice in a different way.”

Dr. Mike Tracy is the only physician who is signed up in Powell so far, Curran said, but demand has outstripped his ability to provide care through the program.

Curran said she plans to be in Powell this week to sign up another physician to help meet increased demand. She also plans to speak to members of the Powell Rotary Club about the program on Wednesday.

“This program has been very popular in the Powell area,” she said.

Curran said Healthy Frontiers uses financial incentives to encourage preventive health care and promote personal responsibility for health care decisions.

Once enrolled, participants receive $300 in a health savings account, and another $200 after they see a physician for a wellness visit and have completed any recommended screenings or tests. After six months, if participants doctors certify that participants are following all recommendations and taking all prescribed medications, another $300 is deposited in their personal health accounts, Curran said.

“The purpose is to keep them healthy and teach them how to be healthy,” she said.

The premium pays for up to five  office visits for preventive care and monitoring chronic diseases. Participants also have access to low-cost generic prescriptions

The program provides a maximim of $50,000 for covered medical care per year, with participants responsible for a 20 percent co-pay up to a maximum of $3,000 in out-of-pocket expenses. Participants can use their health savings account to help with the co-pay costs, she said.

Curran said responsibility is one of the key principles behind Healthy Frontiers.

“People do get canceled (from the program) if they have three nonpayments in a row,” she said. “Unlike Medicaid, this does have some personal responsibility requirements.”

Scott told The Associated Press that the program offers Wyoming its best chance at reining in soaring Medicaid costs.

“We’ve got a choice to make,” he said. “Are we just going to go along and do it the way we’ve always done it, and raise the taxes to pay for it, or are we going to try something different?”

Rep. Dave Bonner, R-Powell, sponsored the original bill to create Healthy Frontiers. Bonner, who also is publisher of the Powell Tribune, said the program needs more time to prove itself.

“The program funds a health savings account that is managed by the patients and puts them in contact with a primary care physician who provides preventive care instruction and treatment that is more akin to ‘health’ care than ‘sick’ care,” he said.

Bonner said Healthy Frontiers is an insurance program that aims to hold down the number of people on Medicaid.

It “provides an alternative to seeking higher-cost treatment in the emergency room, which can lead to uncompensated care for hospitals and cost-shifting that affects everyone,” he said.

“It is too soon to judge whether the program can be successful ... It is way too early, and health care is far too complex, to make an evaluation on the basis of less than 100 participants.”

“My position is the same as it was in the last legislative session. Let’s provide enough funding to give the program for 500 participants a chance, compile the data and see what it tells us.”

However, he said, “I don’t favor an expansion of the program to 2,000 participants at a cost of $23.4 million now.”

Mead clarified his position on Monday.

“I am committed to exploring state-driven resolutions to health care,” he said. “Healthy Frontiers has shown promise as a program to transition people into better health care decisions, introducing people to preventive health care measures and educating people on payment alternatives. The results of this pilot program are not yet in, but it clearly will not provide a complete solution to all health care issues in Wyoming.

“Substantial funds have already been set aside for the program. At this time, rather than advocating to put any additional funds into Healthy Frontiers, I would support continuing coverage for those enrolled, while at the same time exploring other programs that, in partnership, might provide an opportunity for comprehensive coverage.”

Larsen said Healthy Frontiers has given her a way to obtain needed medical care she wouldn’t get otherwise.

She said the program reaches people who can’t afford insurance, aren’t covered in their job or who make too much to qualify for Medicaid.

“To have it is a gift,” she said. “This is where people need it.”

The issue is one of many that will be sorted out during the coming 2012 Legislature, which begins Monday, Feb. 13.

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