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Many people covered by Medicaid will need to comply with new work reporting requirements in order to get or keep their health insurance under Republicans' signature tax and spending law.

People living with mental health conditions are especially at risk of losing coverage. According to the National Alliance on Mental Illness, 88,000 Wyoming adults have a serious mental illness, and four in 10 reported symptoms of anxiety and depression.

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Deborah Steinberg, senior health policy attorney for the Legal Action Center, said there are still work reporting exemptions for people with disabling mental disorders.

"How can we get more people diagnosed?," Steinberg asked. "One of the things would be to increase access to universal screening, making sure there are more opportunities for people to get screened for a mental health condition."

Starting in 2027, the new law will require people to prove they are working at least 80 hours a month or participating in community engagement in order to maintain Medicaid coverage. Across the country, 15 million nonelderly adults rely on Medicaid for mental health and substance use disorder services.

Steinberg argued states can mitigate the coverage loss by implementing as many protections as possible. She added hospitals and clinics in Wyoming and other rural states relying heavily on Medicaid reimbursements are at greatest risk.

"These strategies are so important everywhere," Steinberg acknowledged. "But especially in the rural areas that are going to be hit the hardest by this trillion dollars of cuts."

A recent report from the National Alliance on Mental Illness called on states to identify individuals who are receiving or have received medications, services and supports for disabling mental health conditions, and to expand integrated care services. Individuals who fail to meet the work requirements and are unenrolled from Medicaid will not be eligible for any remaining financial aid for health plans under the Affordable Care Act.