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Wyoming Medicaid

Wyoming Medicaid is a joint federal and state government program that pays for medical care for some low-income and medically needy individuals and families.

Contact Info:

122 W 25th St., 4th Floor West
Cheyenne, WY 82001
(307) 777-7531
Fax: (307) 777-6964

Care Management Entity

The Medicaid Care Management Entity acts as a central accountable hub to deliver community-based intensive care coordination services for children and youth with complex behavioral health needs using an evidence-based practice called “High Fidelity Wraparound.” Wyoming Medicaid selected Magellan Healthcare, Inc., as the care management entity (CME) for qualifying children and their families, including children served by the Medicaid Children’s Mental Health Waiver (CMHW). Magellan began statewide operations July 1, 2015. Medicaid uses a combination of 1915(b) & (c) waivers as well as state plan targeted case management services to operate the CME program. There are four provider types delivering CME High Fidelity Wraparound services: 

  • Family Care Coordinators (FCC)-All families and youth enrolled with the CME must choose an FCC to work with during their enrollment with the CME
  • Family Support Partner (FSP)
  • Youth Support Partner (YSP)
  • Respite Providers

Children already eligible for Wyoming Medicaid may apply for CME services directly with Magellan. For more CME information, please visit https://www.magellanofwyoming.com or contact Magellan via e-mail at: WyomingInfo@MagellanHealth.com or call the customer service center at: 1-855-883-8740 [TDD/TTY: 1-800-424-6259]. Children not currently financially eligible for Wyoming Medicaid and who meet clinical eligibility criteria for CME services may also apply for participation in through the CMHW program by enrolling in the Children’s Mental Health Waiver. The financial qualification is determined based solely on the child/youth’s own income and resources.

Qualifications for Children and /Youth to be Served by the Care Management Entity

  1. Children and youth between the ages of 4-21
  2. Meets the definition of serious emotional disturbance or serious mental illness
  3. Meets at least one Medicaid criteria for inpatient psychiatric hospitalization
  4. CASII composite score of 20-27 (between ages of 6-20) or a score of 18 or > on the ECSII (ages 4-5)

Helpful Links

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CME Reports, Audits and Notices

External Quality Review Audits

 

SFY23. Federal regulation mandates states to conduct an annual external quality review (EQR) of Medicaid services delivered through managed care entities. Wyoming Medicaid contracted with Guidehouse Inc. as the external quality review organization (EQRO) to perform the external quality review of Magellan Healthcare Inc. for services delivered in State Fiscal Year (SFY) 2023 and produce this Technical Report and appendices as set forth in 42 CFR  § 438.364.

SFY22. Federal regulation mandates states to conduct an annual external quality review (EQR) of Medicaid services delivered through managed care entities. Wyoming Medicaid contracted with Guidehouse Inc. as the external quality review organization (EQRO) to perform the external quality review of Magellan Healthcare Inc. for services delivered in State Fiscal Year (SFY) 2022 and produce this Technical Report and appendices as set forth in 42 CFR  § 438.364.

SFY21. Federal regulation mandates states to conduct an annual external quality review (EQR) of Medicaid services delivered through managed care entities. Wyoming Medicaid contracted with Guidehouse Inc. as the external quality review organization (EQRO) to perform the external quality review of Magellan Healthcare Inc. for services delivered in State Fiscal Year (SFY) 2021 and produce this Technical Report and appendices as set forth in 42 CFR  § 438.364.

SFY20. Description: Federal regulation mandates states to conduct an annual external quality review (EQR) of Medicaid services delivered through managed care entities. Wyoming Medicaid contracted with Guidehouse Inc. as the external quality review organization (EQRO) to perform the external quality review of Magellan Healthcare Inc. for services delivered in State Fiscal Year (SFY) 2020 and produce this Technical Report and appendices as set forth in 42 CFR  § 438.364.

SFY19. Federal regulation mandates states to conduct an annual external quality review (EQR) of Medicaid services delivered through managed care entities. Wyoming Medicaid contracted with Guidehouse Inc. as the external quality review organization (EQRO) to perform the external quality review of Magellan Healthcare Inc. for services delivered in State Fiscal Year (SFY) 2019 and produce this Technical Report as set forth in 42 CFR  § 438.364.

Independent Assessments & MCPAR
Public Notices
Annual Accreditation

The federal government requires each state Medicaid agency to publicly post whether any managed care entity contract with the state has been accredited by a private independent accrediting entity and post that information annually on their website. This posting verifies that the state’s Care Management Entity has not been accredited by a private independent accrediting entity specific to the work performed under the contract with the state Medicaid agency.

Quality Review Strategy

SFY24. The federal government requires each state Medicaid agency who contracts with a managed care entity to draft and implement a written quality strategy for assessing and improving the quality of services furnished by the managed care provider. This report contains Wyoming Medicaid’s current CME quality strategy.

Page last updated on August 27, 2024.