The State Plan is a contract between a State and the Federal government, enabling the delivery of health care. It ensures that a State abides by Federal rules and gets FFP. The State Plan sets out groups to be covered, services provided and limitations, reimbursement methodologies, and administrative requirements.
To view the process on getting a State Plan Amendment approved click on the flow chart link.
Region 8 Medicaid SPA Process Flow Chart
Public Notices for Pending State Plan Amendments
Public and Tribal Notice
Wyoming Department of Health
State Plan Amendment for Attachment 4.19-A – Inpatient Hospital Reimbursement
April 29, 2025
Public notice is hereby given that the Wyoming Department of Health intends to submit a State Plan Amendment (SPA) to the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services. The amendment will make changes to Inpatient Hospital Reimbursement including the removal of provider categories receiving Diagnosis Related Group (DRG) base rates and the specific categories for which policy adjustors are applied.
The effective date will be July 1, 2025. Copies of the Wyoming Medicaid State Plan will be available at the Department of Health, Division of Healthcare Financing. To obtain a copy of the State Plan Amendment or provide comment, please contact:
Elizabeth Lovell-Poynor
Medicaid Benefits Quality Control Manager
Division of Healthcare Financing
122 W. 25th St., 4th Floor West
Cheyenne, WY 82002
307-777-8088
Public comment will be accepted from May 1, 2025 – May 31, 2025.
Public and Tribal Notice
Wyoming Department of Health
Wyoming Medicaid State Plan Amendment – Consolidated Appropriations Act of 2023
March 13, 2025
The Wyoming Department of Health intends to submit a State Plan Amendment (SPA) to the Centers for Medicare & Medicaid Services (CMS) to comply with Sections 5121 and 5122 of the Consolidated Appropriations Act, 2023. This amendment allows additional Medicaid services for eligible juveniles in correctional settings and modifies the Wyoming Medicaid State Plan accordingly.
The proposed amendment attests to Wyoming’s mandatory compliance with Section 5121, which requires Medicaid coverage for screening, diagnostic services, and targeted case management (TCM) for eligible juveniles transitioning from a public institution. Medicaid must attempt to provide these services within 30 days before release and at least 30 days following release. If services cannot be provided before release, screenings and diagnostics may be delivered within one-week post-release or as soon as practicable.
This amendment applies to eligible juveniles under age 21, and eligible former foster care individuals ages 18-26 who have been adjudicated and are held in state, local, and tribal correctional institutions following a court-ordered disposition. Screening services include physical screenings, behavioral health assessments, and immunizations in accordance with EPSDT guidelines. TCM, as defined at 42 C.F.R. § 440.169, supports transition and healthcare coordination.
Wyoming has also elected to adopt non-mandatory provisions under Section 5122, allowing Medicaid to extend full benefits to eligible juveniles in correctional institutions pending disposition of charges. This amendment permits Medicaid-covered services for juveniles held pre-adjudication in public institutions.
Wyoming Medicaid is also submitting a separate TCM SPA attesting to compliance with requirements related to the TCM service for the population described above.
Wyoming expects projected expenditures of $36,305 in FFY 2025, and $48,407 in FFY 2026. However, these preventative and diversionary services are anticipated to be cost neutral by diverting from more expensive institutional services like Psychiatric Residential Treatment Facilities.
The proposed SPAs modify the Wyoming Medicaid State Plan to reflect these changes. Copies of the Wyoming Medicaid State Plan will be available at the Wyoming Department of Health, Division of Healthcare Financing. To request a copy of the State Plan Amendment or for further information, please contact:
Denzel Clifton
Division of Healthcare Financing
Wyoming Department of Health
122 W. 25th Street, 4th Floor West
Cheyenne, WY 82002
Phone: 307-777-2554
Denzel.Clifton1@wyo.gov
Public and Tribal Notice
Wyoming Department of Health
Wyoming Medicaid State Plan Amendment – Four Walls Exception for Clinic Services
March 17, 2025
The Wyoming Department of Health, Division of Healthcare Financing (Wyoming Medicaid), intends to submit a State Plan Amendment (SPA) to the Centers for Medicare & Medicaid Services (CMS) to implement changes required by the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule, published on November 27, 2024. This amendment modifies Wyoming’s Medicaid State Plan to authorize exceptions to the “four walls” requirement for clinic services under 42 C.F.R. § 440.90.
This SPA applies a mandatory exception for Indian Health Service (IHS) and Tribal clinics, allowing Medicaid-covered clinic services to be provided outside the physical clinic setting.
Wyoming is also electing to cover services provided outside of a clinic that is primarily organized for the care and treatment of outpatients with behavioral health disorders, including mental health and substance use disorders, when provided by clinic personnel under the direction of a physician, in accordance with 42 C.F.R. § 440.90(d). This coverage is subject to the limitations described in Attachment 3.1A, Item 13d, Pages 1-7 of Wyoming’s Medicaid State Plan.
Additionally, this SPA supersedes Attachment 3.1A, Section 9: Clinic Services, and retains all previously covered clinic services, with the inclusion of Behavioral Health Clinics.
The proposed SPA will modify the Wyoming Medicaid State Plan to reflect these changes. Copies of the Wyoming Medicaid State Plan will be available at the Wyoming Department of Health, Division of Healthcare Financing. To request a copy of the State Plan Amendment or for further information, please contact:
Amy Guimond
Benefits Quality Control Manager, Tribal Liaison
Division of Healthcare Financing
Wyoming Department of Health
122 W. 25th Street, 4th Floor West
Cheyenne, WY 82002
Phone: 307-777-3427
Amy.Guimond@wyo.gov
Public and Tribal Notice
Wyoming Department of Health
Wyoming Medicaid State Plan Amendment – Recovery Audit Contractor Exception
March 18, 2025
Wyoming Department of Health, pursuant to the requirements outlined in 42 CFR 447.205, hereby gives notice of the following proposed amendment to the State Plan altering the requirement to maintain a Recovery Audit Contractor (RAC).
Recovery Audit Contractor (RAC): Under Section 1902(a)(42)(B)(i) of the Social Security Act, States and Territories are required to establish programs to contract with one or more Medicaid RACs. Wyoming Medicaid is requesting an exception to this requirement. The State of Wyoming currently has a dedicated Program Integrity Section, with many of the capabilities of a RAC already built into its functions and operational units. The utilization of a RAC is not cost effective for either the State or Contractors that have previously assisted the State. The State of Wyoming is requesting an exception to the requirement to maintain an RAC.
Estimated fiscal impact: None.
Copies of the Wyoming Medicaid State Plan will be available at the Wyoming Department of Health, Division of Healthcare Financing. To request a copy of the State Plan Amendment or to submit questions or comments, please contact:
Andrew W. Chapin
Program Integrity Manager
Wyoming Medicaid
122 West 25th St., 4th Floor West
Cheyenne, WY 82002
Andrew.Chapin@wyo.gov
Public Notice Archives
- Public Notice – posted 1/30/20 CCW Waiver Amendment
- Public Notice – posted 02/18/20 Reasonable Limits on Amounts for Necessary Medical or Remedial Care Not Covered
- Public Notice – posted 06/24/20 Hospital Affiliated Professional Services Supplemental Payment Program
- Public Notice – posted 09/01/20 Streamlined Application Changes
- Public Notice – posted 10/5/20 Proposed Medicaid Managed Care State Quality Review Strategy
- Public Notice – posted 11/18/20 MEBS Update Support Act 1012
- Public Notice – posted 12/09/20 Durable Medical Equipment
- Public Notice – posted 12/09/20 Indian Health Facilities
- Public Notice – posted 12/15/20 Rehabilitative Services
- Public Notice – posted 01/05/21 Dental Service Providers
- Public Notice – posted 01/25/21 Physician Service Providers
- Public Notice – posted 2/26/21 Drug Coverage
- Public Notice – posted 2/26/21 Medication Assisted Treatment
- Public Notice – posted 3/12/21 Covered Services
- Public Notice – posted 4-26-21 40 Quarters Requirement Change
- Public Notice – Posted 4/20/21 Removal of PACE
- Public Notice -Posted 9/29/21 Deprivation Removal
- Public Notice – Posted 1/21/22 School Based Services
- Public Notice – Posted 1/26/22 COVID-19 Vaccine DR SPA
- Public Notice – Posted 3/03/22 Clinical Trials
- Public Notice – Posted 01/10/2023 Home and Community Based Services for Psychosocial Rehabilitative Services
- Public Notice – Posted 03/10/2023 Streamlined Application Changes – Third Party Liability
- Public Notice – Posted 03/14/2023 Podiatry Services
- Public Notice – Posted 04/12/2023 Federally Qualified Health Centers and Rural Health Clinics
- Public Notice – Posted 04/24/2023 Prescription Signature Requirements During the COVID-19 PHE
- Public Notice – Posted 05/02/2023 Durable Medical Equipment and Supplies
- Public Notice – Posted 05/02/2023 Hospice Services
- Public Notice – Posted 05/10/2023 Streamlined Application Changes – 12 Month Postpartum Coverage
- Public Notice – Posted 05/22/2023 Ground Ambulance Supplemental Payment Program
- Public Notice – Posted 07/07/2023 Psychiatric Residential Treatment Facility Supplemental Payment Program
- Public Notice – Posted 09/28/2023 Outpatient Drug Coverage
- Public Notice – Posted 08/30/2023 Inpatient Hospital Reimbursement
- Public Notice – Posted 08/30/2023 Other Types of Care Attachment 4.19-B
- Public Notice – Posted 11/30/2023 Preventative Services
- Public Notice – Posted 3/19/2024 Psychosocial Rehabilitation – Clubhouse
- Public Notice – Posted 6/25/2024 Beneficiary Cost Sharing for Pharmacy Claims – Limited Dates
- Public Notice – Posted 7/31/2024 Third Party Liability Changes
- Public Notice – Posted 01/13/2025 Core Sets Reporting
Section 1 - Single State Agency Organization
Section 1 – Single State Agency Organization
This section provides information regarding the State’s designation of the Wyoming Medicaid Single State Agency, the authority under which it operates and a description of the organization, statewide operation and the State Medical Care Advisory Committee.
1.4 State Medical Care Advisory Committee
1.5 Pediatric Immunization Program
Section 2 - Coverage and Eligibility
Section 2 – Coverage and Eligibility
This section outlines coverage and eligibility conditions for Wyoming Medicaid such as the categories of eligible persons and the levels of income, resources and assets required to assess financial eligibility for the various programs and groups.
2.1 Application, Determination of Eligibility and Furnishing Medicaid
2.2 Coverage and Conditions of Eligibility
2.4 Blindness
2.5 Disability
2.7 Medicaid Furnished Out of State
Attachments
2.2-A Groups Covered and Agencies Responsible for Eligibility
- Attachment 2.2-A Supplement 2
- Attachment 2.2-A Supplement 3
2.6-A Eligibility Conditions and Requirements
- Attachment 2.6-A Supplement 1
- Attachment 2.6-A Supplement 4
- Attachment 2.6-A Supplement 5
- Attachment 2.6-A Supplement 6
- Attachment 2.6-A Supplement 7
- Attachment 2.6-A Supplement 8
- Attachment 2.6-A Supplement 9
- Attachment 2.6-A Supplement 10
- Attachment 2.6-A Supplement 11
- Attachment 2.6-A Supplement 12a
- Attachment 2.6-A Supplement 13
- Attachment 2.6-A Supplement 15
- Attachment 2.6-A Supplement 16
Section 3 - Services: General Provisions
Section 3 – Services: General Provisions
This section provides information on amount, duration and scope of Wyoming Medicaid services including coordination with Medicare Part B, services for elderly or those in institutions for mental disease, special requirements for sterilization procedures, Medicaid for Medicare cost sharing for qualified Medicare beneficiaries, and ambulatory prenatal care for pregnant women during the presumptive eligibility period.
3.1 Amount, Duration and Scope of Services
3.2 Coordination of Medicaid with Medicare Part B
3.3 Medicaid for Individual Age 65 or Over in Institutions for Mental Disease
3.4 Special Requirement Applicable to Sterilization Procedure
3.5 Medicaid for Medicare Cost Sharing for Qualified Medicare Beneficiaries
3.6 Ambulatory Prenatal Care for Pregnant Women
Attachments
- Attachment 3.1-A Supplement 1
- Attachment 3.1-A Supplement 3
3.1-B Amount, Duration, and Scope of Services Provided Medically Needy Groups
3.1-C Standards and Methods of Assuring High Quality Care
3.1-D Methods of Providing Transportation
3.1-E Standards for the Coverage of Organ Transplant Procedures
Section 4 - General Program Administration
Section 4 – General Program Administration
This section provides information on general program administration, quality and utilization control and provider reimbursement. It also includes sections on hearing for applicants and recipients, fraud detection, facility surveys and inspections and the appeals process.
4.2 Hearings for Applicants and Recipients
4.3 Safeguarding Information on Applicants and Recipients
4.5 Medicaid Agency Fraud Detection and Investigation Program
4.6 Reports
4.8 Availability of Agency Program Manuals
4.9 Reporting Provider Payments to the Internal Revenue Service
4.11 Relations with Standard-Setting and Survey Agencies
4.12 Consultation to Medical Facilities
4.13 Required Provider Agreement
4.14 Utilization/Quality Control
4.16 Relations with State Health and Vocational Rehabilitation Agencies and Title V Grantees
4.17 Liens and Recoveries
4.18 Cost Sharing and Similar Charges
4.19 Payment for Services
4.20 Direct Payments to Certain Recipients for Physicians’ or Dentists’ Services
4.21 Prohibition Against Reassignment of Provider Claims
4.23 Use of Contracts
4.24 Standards for Payments for Skilled Nursing and Intermediate Care Facility Services
4.25 Program for Licensing Administrators of Nursing Homes
4.27 Disclosure of Survey Information and Provider or Contractor Evaluation
4.28 Appeals Process for Skilled Nursing and Intermediate Care Facilities
4.29 Conflict of Interest Provisions
4.30 Exclusion of Providers and Suspension of Practitioners Convicted and Other Individuals
4.31 Disclosure of Information by Providers and Fiscal Agents
4.32 Income and Eligibility Verification System
4.33 Medicaid Eligibility Cards for Homeless Individuals
4.34 Systematic Alien Verification for Entitlements
4.36 Required Coordination Between the Medicaid and WIC Programs
4.38 Nurse Aide Training and Competency Evaluation for Nursing Facilities
4.39 Preadmission Screening and Annual Resident Review in Nursing Facilities
4.40 Survey and Certification Process
4.41 Resident Assessment for Nursing Facilities
4.42 Employee Education About False Claims Recoveries
4.44 Medicaid Prohibition on Payments to Institutions or Entities Located Outside of the United States
Attachments
4.17-A Liens and Adjustments or Recoveries
4.19-A Level of Care Inpatient Hospital Reimbursement
4.19-B Outpatient Hospital Reimbursement System
- Attachment 4.19-B Supplement 1
4.19-C Payments for Reserved Beds
4.19-D Nursing Home Reimbursement System
4.19-E Timely Claims Payment – Definition of Claim
4.22-A Requirements for Third Party Liability – Identifying Liable Resources
- Attachment 4.22-A Supplement 1
4.22-B Requirements for Third Party Liability – Payment for Claims
4.22-C Cost Effective Methods for Employer Based Group Health Insurance
4.30 Sanctions for Psychiatric Hospitals
4.32-A Income and Eligibility Verification System Procedures
4.33-A Method for Issuance of Medicaid Eligibility Cards to Homeless Individuals
4.34-A Requirements for Advance Directives Under State Plans for Medical Assistance
4.35 Enforcement of Compliance for Nursing Facilities
4.38-A Collection of Additional Registry Information
4.39 Definition of Specialized Services
4.40 Survey and Certification Education Program
4.42-A Methodology of Compliance Oversight of the False Claim Act
4.43 Cooperation with Medicaid Integrity Program Efforts
Section 5 - Personnel Administration
Section 5 – Personnel Administration
This section details the standards for personnel administration in the Medicaid program and provides assurances the State is in compliance with Federal Regulations regarding personnel administration standards and training.
5.1 Standard of Personnel Administration
5.2 RESERVED
5.3 Training Programs; Sub-professional and Volunteer Programs
Attachments
None
Section 6 - Financial Administration
Section 6 – Financial Administration
This section provides assurances the State is in compliance with Federal Regulations regarding fiscal policies and accountability, cost allocation and financial participation.
6.1 Fiscal Policies and Accountability
6.2 Cost Allocation
6.3 State Financial Participation
Attachments
None
Section 7 - General Provisions
Section 7 – General Provisions
This section covers additional federal requirements such as State Plan amendments, nondiscrimination and the Governor’s review.
7.1 Plan Amendments
Attachments
None
Section 8 - MAGI
Page Updated 04/29/25