The Wyoming Department of Health is inching closer to a state-friendly way of expanding health care services for the poor and uninsured, its director said.

"The question is, what is applicable and what is more likely to work in Wyoming," Tom Forslund said Saturday.

"Because Wyoming with its frontier nature of its medical system, we just can't replicate what other states have done and just slap it into Wyoming," Forslund said.

"Frontier" is a technical term in health care for very rural areas.

The Wyoming Legislature repeatedly has rejected about $50 million in federal funds to expand Medicaid -- the joint federal-state health insurance program for the poor -- to about 17,000 residents. Under the expanded program, the federal government would pay 100 percent of the costs for the first several years for new enrollees, then drop that to 90 percent.

The state's share of paying for the program depends on its economic condition, which is very good in Wyoming now. The current ratio is 50 percent federal and 50 percent state.  In leaner years, Wyoming has received a greater share of federal funding.

Some legislators and Gov. Matt Mead have objected to the expansion, saying the federal government may not make good on its promise of continued financial support. However, the 2014 Legislature directed Mead to explore alternatives.

Forslund has worked with Mead and others to find an acceptable program, he said. "Hopefully there will be something that will be available for the Legislature to consider for this next session."

Most states that have accepted the Medicaid expansion have enrolled the new patients into their traditional Medicaid programs, Forslund said.

But some Republican-leaning states, such as Arkansas, have crafted alternatives that put  new enrolled patients into a marketplace with Medicaid subsidies to buy private insurance, he said. Iowa split the difference between the traditional system and the Arkansas system, he added.

If Wyoming participates, the health care system will see the results of "pent-up demand," Forslund said.

"You have people people who haven't had insurance, who have deferred care, and so once they get insurance they will come into their physician's office, to the hospital, to whatever health care facility and get care," he said.

While results of expanded Mediciad program are just now arriving, Forslund said participating states have reported more people obtaining care because they have their bills paid.

Uncompensated care -- charity care and bad debt caused by people not paying their bills -- offered by hospitals has decreased and is expected to decrease further, he said.

And the overall health of individuals and communities appears to be improving, Forslund said. "Additionally, the people who are receiving services for the first time in maybe forever are getting better health outcomes."