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Evaluation Design State of Wyoming Pregnant by Choice, Family Planning Waiver Program • Annual follow up exam for reproductive health/family planning purposes, including Pap smear and testing for sexually transmitted diseases when indicated. Includes follow up office visits related to family planning • Removal of contraceptive devices • Necessary family planning/reproductive health-related laboratory procedures and diagnostic tests • Sterilization services and related laboratory services (with properly completed sterilization consent form) and medications required as part of a procedure done for birth control purposes The Wyoming Family Planning Waiver, Pregnant by Choice Program was initially approved in 2009 (Demonstration Year 1) as Project Number 11-W-00238/8. The Program has seen several extensions since 2009, with the most current demonstration extension approved in 2020, giving Wyoming approval to operate the Pregnant by Choice Program through December 31, 2027. This Evaluation Design applies to the continued extension of the Pregnant by Choice Demonstration operating through December 31, 2027. Key dates are included in the table, below.

Demonstration Years CMS Approval Coverage Period Demonstration Year 1, Waiver Approval 10/8/2008 10/1/08-9/30/13 Demonstration Year 5, Extension 11/13/2014 10/1/13-12/31/14 Demonstration Year 6, Extension 12/30/2014 1/1/15-12/31/17 Demonstration Year 10, Extension 12/23/2019 1/1/18-1/31/20 Demonstration Year 11, Extension 2/28/2020 2/1/20-3/31/20 Demonstration Year 12, Extension 4/7/2020 4/1/20-12/31/27

Over the course of the Pregnant by Choice Program (Demonstration Years 1-13) from October 2008 through now, the program has seen enrollment decrease, with a significant decline in enrollment with the implementation of the Affordable Care Act. At this time, many women covered under the Pregnant by Choice Program left to find a full benefit plan from the Health Insurance Exchange Marketplace at a reduced cost or free of charge. Enrollment dropped from its peak of approximately four hundred (400) enrollees to the current enrollment numbers of less than ten (10) enrollees (as of September 2021).

More information on the Program, including brochures in English and Spanish, can be found on the Wyoming Medicaid Pregnant by Choice webpage: https://health.wyo.gov/healthcarefin/medicaid/pregnant-by-choice/

B. Evaluation Questions & Hypotheses The demonstration's core evaluation questions, hypothesis, and recommended data sources and analytic approaches are provided in the below table.