Wyoming Gov. Matt Mead (R) (Photo courtesy Gov. Matt Mead’s office)

Wyoming Gov. Matt Mead (R) was once among the handful of state executives to sue the federal government over the Affordable Care Act. Now, he says he wants his state to expand Medicaid under the ACA to cover thousands of low-income residents.

In a Monday press conference, Mead said he would press the state legislature to act on a Medicaid expansion plan put forward last week by the state Department of Health.

“I agree it is not a good piece of legislation, but, as I see where we are, I think we have to be realistic and say this is the current law of the land and we need to either go forward with this or if the legislature wants to come up with a different plan, I certainly would be open to that,” Mead said Monday, according to the Casper Star-Tribune. “But I don’t think we can say to those people in Wyoming who are working who cannot get insurance that we’re not going to do anything.”

Wyoming is one of a handful of Republican-led states that has negotiated with the federal Department of Health and Human Services to come up with their own version of Medicaid expansion. The Wyoming Health Department’s plan, called the Strategy for Health, Access, Responsibility and Employment, would set up two tiers for Medicaid recipients: All participants would make co-payments, and those with higher incomes would pay monthly premiums of $25 to $50. Participants would have access to employment assistance programs like job search services and vocational rehabilitation programs.

The SHARE plan would cover an estimated 17,600 low-income Wyoming residents and help reduce the $200 million in uncompensated care state hospitals provide. The Health Department said it would add 800 jobs without any additional costs to the state. Accepting federal funding would mean up to $100 million for the state.

Republicans who control the state legislature have been extremely skeptical of Medicaid expansion plans. The state Senate voted 21-9 against expanding Medicaid in February, though they did allow the Health Department to negotiate with the Centers for Medicare and Medicaid Services to seek a waiver to conduct the program their own way.

Mead himself said last December he didn’t want his state to accept federal money to expand the program, in the wake of the ACA’s disastrous roll-out.

There’s no guarantee legislators will go along with the Mead-backed plan. State Sen. Charlie Scott (R) said a preliminary committee, meeting in advance of next year’s legislative session, will take up a version of Medicaid expansion that would use federal dollars to create health-savings accounts, similar to an approach taken by Arkansas last year.

So far, 27 states and the District of Columbia have agreed to expand Medicaid to cover low-income residents, including nine states with Republican governors. Tennessee Gov. Bill Haslam (R) and North Carolina Gov. Pat McCrory (R) have also said they will consider ways to expand the program.

Many of those Republican governors, facing reluctant state legislatures, have negotiated with HHS to expand Medicaid in unique ways, often by calling expansion something else. Indiana Gov. Mike Pence (R) sought and received a waiver that allowed federal money to expand the Healthy Indiana Plan, which creates personal health funds linked to insurance plans with high deductibles. Outgoing Pennsylvania Gov. Tom Corbett (R) sought a waiver that would have included work requirements.

Democratic governors who lead states with Republican legislatures have used alternative means to accept federal Medicaid expansion dollars. New Hampshire Gov. Maggie Hassan (D) and Arkansas Gov. Mike Beebe (D) pushed a version that would pay for private insurance for low-income residents, both of which won approval from Republicans in the legislature.

“There’s a lot of trying to say they’re not doing Obamacare so that they can call it something different,” Diane Rowland, a health policy expert and executive vice president at the Kaiser Family Foundation, said in an interview earlier this year. “They’re trying to put some distance between the straight concept of a Medicaid expansion so they can build a coalition in the legislature.”