Specific numbers aren't in, but budget cuts announced recently by Gov. Dave Freudenthal will squeeze a variety of health care providers and their patients across Wyoming, medical and state officials say.

About $25.6 million of the $42.9 million cut from the Wyoming Department of Health will come from the state's Medicaid program, said Teri Green, the state's Medicaid agent.

The majority of the $25.6 million will come from decreases in provider reimbursement for health care services, she said.

"A lot of people will be impacted," Green said. "We hope that our Medicaid providers can hang in there with us during this difficult time."

At this point, no specific rate decreases have been detailed, and it is difficult to determine the exact impact of the announced reductions. But the medical community has its concerns.

About 80,000 Wyomingites receive Medicaid benefits, and almost every provider in the state accepts some level of Medicaid.

Dennis Ellis, executive director of the Wyoming Medical Society, said he should learn more details later this week after Freudenthal meets with the Legislature's Joint Appropriations Committee. The Wyoming Medical Society is Wyoming's physician advocacy group.

"It's hard to comment on what docs will get," Ellis said. "The ball is in their court, but doctors should take a big hit."

Because Medicaid is a federal matching program, the Wyoming Medicaid system will actually lose $2 for every dollar the governor cuts, Ellis said.

Green said the federal government pays 56 percent of the program while Wyoming pays 44 percent, so Wyoming Medicaid could lose about $53.9 million.

Before Freudenthal announced his plans for $231 million in state government spending cuts, the physician group sent a letter to the governor's office asking him not to reduce Medicaid reimbursement.

Health care took one of the biggest hits in the governor's budget cut proposals.

"I understand everyone has to do their part, their 10 percent," Green said. "Medicaid has only one place to do it, and that's provider reimbursement. I hope the end result isn't people go without care."

Dr. Mike Jording, a primary care physician at Cedar Hills Family Clinic in Newcastle, said the practice would continue business as usual for the time being, but the new cuts will make the profit margin for providing health care even tighter.

About 25 percent of the clinic's patients are on Medicaid. Jording said the cuts are beyond his control, and he understands the government had to cut somewhere.

As it is now, doctors recoup only about 40 percent of health care costs for Medicaid patient, Ellis said. They are already losing money on those patients.

There are no standards requiring physicians to accept Medicaid, and if doctors begin opting out of the program or limiting the number of Medicaid patients they see, it will leave people without care.

"As the economy tanks, more people will go on Medicaid," Ellis said. "Providers are being asked to see more and more of these patients, and if they get less and less for them, they are pinched in the middle."

Hospitals aren't worried about cuts directed at their facilities but are concerned how the cuts will affect the health care delivery system, said Dan Perdue, president of the Wyoming Hospital Association.

"We are concerned about cuts levied at the physician level," he said. "If those physicians stop seeing Medicaid patients, they will end up in the emergency room. As you know, it's very expensive to treat people in the ERs. It will only add our hospitals' expenses."

Mike Huston, director of Central Wyoming Counseling Center, has heard some good news about his facility regarding Medicaid cuts so far. There was a lot of anxiety at the facility when the cuts were announced, because the center serves about 300 Medicaid clients on an outpatient basis, Huston said.

However, he received an e-mail from the state health department that said there would be no reduction in reimbursement for outpatient services "at this time," he said.

Cuts in the mental health and substance abuse arena will most likely take place in out-of-state services and some for inpatient treatment, but Huston said Medicaid covers very little inpatient treatment.

Contact health reporter Allison Rupp at (307) 266-0534 or allison.rupp@trib.com.</>