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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 1 of 2

CENTERS FOR MEDICARE & MEDICAID SERVICES EXPENDITURE AUTHORITY

NUMBER: 11 -W-00 238/8 TITLE: Wyoming Pregnant by Choice Section 1115 Family Planning Demonstration AWARDEE: Wyoming Department of Health Under the authority of section 1115(a)(2) of the Social Security Act (the Act), expenditures made by Wyoming for the items identified below, which are not otherwise included as expenditures under section 1903 of the Act shall, for the period of this demonstration extension, be regarded as expenditures under the state’s Title XIX plan. All requirements of the Medicaid statute will be applicable to such expenditure authorities (including adherence to income and eligibility system verification requirements under section 1137(d) of the Act), except those specified below as not applicable to these expenditure authorities. The following expenditure authorities and the provisions specified as “not applicable” enable Wyoming to operate its demonstration effective April 7, 2020 through December 31, 2027, unless otherwise stated. Effective through December 31, 2027, expenditures for extending Medicaid eligibility (subject to an annual redetermination) for family planning services to:

a. Women aged 19 through 44, with incomes up to 159 percent of the Federal Poverty Level (FPL) who are losing Medicaid through the Wyoming Medicaid Pregnant Woman Program.

Medicaid Requirements Not Applicable to the Medicaid Expenditure Authorities: All Medicaid requirements apply, except the following:

1. Methods of Administration: Transportation Section 1902(a)(4) insofar as it incorporates 42 CFR 431.53 To the extent necessary to enable the state to not assure transportation to and from providers for the demonstration population.

2. Amount, Duration, and Scope of Services (Comparability) Section 1902(a)(10)(B) To the extent necessary to allow the state to offer the demonstration population a benefit package consisting only of family planning services and family planning-related services.

3. Retroactive Coverage Section 1902(a)(34)