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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 19 of 38

Year Cumulative Target Expenditures Percentage CY 2020 DY 12 budget limit amount +1.75 percent CY 2021 DY 12 through DY 13 combined budget limit amount +1.50 percent CY 2022 DY 12 through DY 14 combined budget limit amount +1.25 percent CY 2023 DY 12 through DY 15 combined budget limit amount +1.00 percent CY 2024 DY 12 through DY 16 combined budget limit amount +0.75 percent CY 2025 DY 12 through DY 17 combined budget limit amount +0.50 percent CY 2026 DY 12 through DY 18 combined budget limit amount +0.25 percent CY 2027 DY 12 through DY 19 combined budget limit amount +0.00 percent

46. Exceeding Budget Neutrality. The state, whenever it determines that the demonstration is not budget neutral or is informed by CMS that the demonstration is not budget neutral, must immediately collaborate with CMS on corrective actions, which includes submitting a corrective action plan or CMS within 21 days of the date the state is informed of the problem.

While CMS will pursue corrective actions with the state, CMS will work with the state to set reasonable goals that will ensure that the state is in compliance.

If at the end of the demonstration approval period, the cumulative budget neutrality limit has been exceeded, the excess federal funds will be returned to CMS. If the demonstration is terminated prior to the end of the budget neutrality agreement, an evaluation of this provision will be based on the time elapsed through the termination date.

IX. EVALUATION 47. Draft Evaluation Design. The Draft Evaluation Design must be developed in accordance with the Evaluation Design Framework incorporated in these STCs as "Appendix B" and submitted by the state, for CMS comment and approval, by no later than 120 days after the effective date of these STCs. The Draft Evaluation Design must minimally include the plan for rigorous evaluation on unintended pregnancy rates within the demonstration, the number and percentage of individuals served under this demonstration, and family planning service utilization. Any modifications to an existing approved Evaluation Design will not affect previously established requirements and timelines for report submission for the demonstration, if applicable. The state may choose to use the expertise of an independent party in the development of the Draft Evaluation Design.

48. Evaluation Budget. A budget for the evaluation shall be provided with the Draft Evaluation Design. It will include the total estimated cost as well as a breakdown of estimated staff, administrative and other costs for all aspects of the evaluation such as any survey and measurement development, quantitative and qualitative data collection and cleaning, analyses and report generation. A justification of the costs may be required by CMS if the estimates provided do not appear to sufficiently cover the costs of the design or if CMS finds that the design is not sufficiently developed, or if the estimates appear to be excessive.

49. Evaluation Design Approval and Updates. The state must submit a revised Draft Evaluation Design within 60 days after receipt of CMS’ comments. Upon CMS approval of the final Evaluation Design, the document will be included as "Appendix D" to these STCs.