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DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-26-12 Baltimore, Maryland 21244-1850

April 30, 2025

Lee Grossman Senior Administrator and State Medicaid Agent Healthcare Financing Division Wyoming Department of Health 122 W 25th St. 4th Floor West Cheyenne, WY 82001

Dear Administrator Grossman:

The Centers for Medicare & Medicaid Services (CMS) is approving an amendment to Wyoming’s section 1115(a) demonstration titled “Wyoming Pregnant By Choice (Family Planning) Demonstration” (Project Number: 11-W-00238/8) (the “demonstration”), in accordance with section 1115(a) of the Social Security Act (“the Act”). This amendment will be effective on the date of approval, through December 31, 2027, upon which date, unless extended or otherwise amended, all authorities granted to operate this demonstration will expire.

CMS determined that this demonstration categorized sexually transmitted infection (STI) / sexually transmitted disease (STD) diagnosis services as a family planning service, which does not conform with State Medicaid Director Letters #10-0130F1, #14-0031F2, and #16-0082F3. In this guidance, CMS clarified that family planning related services are those services that are medical diagnosis services, including for STI/STDs, that are provided pursuant to a family planning service. Family planning services must be for the purpose of preventing or delaying pregnancy. Therefore, in this amendment, CMS has identified STI/STD screening services as a family planning service and STI/STD diagnosis services as a family planning related service.

Additionally, CMS updated attachments in the Special Terms and Conditions (STCs) to come into compliance with Executive Order 14168 ‘Defending Women’.

Budget Neutrality

There is no change to budget neutrality for this amendment.

Monitoring and Evaluation

There is no change to monitoring or evaluation requirements for this amendment.

1 https://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/SMD10013.pdf 2 https://www.medicaid.gov/federal-policy-guidance/downloads/smd-14-003.pdf 3 https://www.medicaid.gov/federal-policy-guidance/downloads/sho16008.pdf