Page 5

Wyoming Pregnant by Choice CMS Extension Approved: April 7, 2020; Effective through December 31, 2027 Amendment Approved: April 30, 2025 Page 1 of 38

Centers for Medicare & Medicaid Services SPECIAL TERMS AND CONDITIONS

NUMBER: 11 -W-00238/8 TITLE: Wyoming “Pregnant by Choice” Section 1115 Family Planning Demonstration AWARDEE: Wyoming Department of Health

I. PREFACE The following are the Special Terms and Conditions (STCs) for Wyoming’s “Pregnant by Choice” program, a Medicaid section 1115(a) family planning demonstration (hereinafter “demonstration”). The parties to this agreement are the Wyoming Department of Health and the Centers for Medicare & Medicaid Services (CMS). These STCs set forth in detail the nature, character, and extent of federal involvement in the demonstration and the state’s obligations to CMS during the approved demonstration period specified in these STCs. The STCs are effective April 7, 2020, the date of the CMS approval letter that accompanied these STCs, through December 31, 2027, unless otherwise specified. All previously approved STCs and expenditure authorities are superseded by the STCs set forth below.

The STCs have been arranged into the following subject areas:

I. Preface II. Program Description and Historical Context III. General Program Requirements IV. Eligibility and Enrollment V. Benefits and Delivery Systems VI. General Reporting Requirements VII. General Financial Requirements VIII. Monitoring Budget Neutrality IX. Evaluation X. Schedule of State Deliverables during the Demonstration

Appendix A: Annual Monitoring Report Template Appendix B: Developing the Evaluation Design Appendix C: Preparing the Evaluation Report Appendix D: Demonstration Evaluation Plan (reserved for CMS approval)