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Wyoming Pregnant by Choice CMS Extension Approved: April 7, 2020; Effective through December 31, 2027 Amendment Approved: April 30, 2025 Page 17 of 38

an amount not to exceed the non-federal share of title XIX payments. Under all circumstances, health care providers must retain 100 percent of the claimed expenditure. Moreover, no pre-arranged agreements (contractual or otherwise) exist between health care providers and state and/or local government to return and/or redirect any portion of the Medicaid payments. This confirmation of Medicaid payment retention is made with the understanding that payments that are the normal operating expenses of conducting business, such as payments related to taxes, (including health care provider-related taxes), fees, business relationships with governments that are unrelated to Medicaid and in which there is no connection to Medicaid payments, are not considered returning and/or redirecting a Medicaid payment.

VIII. MONITORING BUDGET NEUTRALITY The following is the method by which budget neutrality will be monitored for the Wyoming “Pregnant by Choice” family planning section 1115(a) Medicaid demonstration.

42. Limit on Title XIX Funding. The state shall be subject to a limit on the amount of federal Title XIX funding it may receive on selected Medicaid expenditures during the period of approval of the demonstration. The budget neutrality expenditure targets are set on a yearly basis with a cumulative budget neutrality expenditure limit for the length of the entire demonstration. Actual expenditures subject to budget neutrality expenditure limit shall be reported by the state using the procedures described in STC 33.

43. Budget Neutrality Annual Expenditure Limits. For each demonstration year (reflected as “DY” in the below table), an annual budget limit will be calculated for the demonstration. For the purposes of this demonstration, the state’s demonstration cycle is based on calendar year (reflected as “CY” in the below table) January 1 to December 31.

PMPM Cost. The following table provides the “per member/per month” (PMPM) (total computable) cost ceiling for each demonstration year represented in this demonstration approval period. The PMPM cost ceilings were constructed based on the state’s historical expenditures for demonstration year 10 (i.e., January 1, 2018 – December 31, 2018) and increased by a 4.6 percent rate of growth; which is the trend rate included in the President’s Medicaid Budget for federal fiscal year 2020 for the same period of time as demonstration year 12 through demonstration year 19 as outlined below.

The budget limit for each demonstration year will be calculated using the below per PMPM cost multiplied by the actual number of member months (as calculated in accordance with STC 36) and the Composite Federal Share.

Current Year (CY) CY2020 CY2021 CY2022 CY2023 CY2024 CY2025 CY2026 CY2027 Demonstration Year (DY) DY12 DY13 DY14 DY15 DY16 DY17 DY18 DY19 Per Member Per Month (PMPM) Costs $11.56 $12.10 $12.65 $13.23 $13.84 $14.48 $15.15 $15.84