Page 55

13

Evaluation Design State of Wyoming Pregnant by Choice, Family Planning Waiver Program E. Methodological Limitations. There are no known limitations for procuring quantitative data that is currently foreseen. The only known limitation for procuring qualitative data is that women surveyed may decline to participate or demographic information has not been updated and the Program does not have correct address and phone number on file; and therefore, some women may not be reachable.

With regard to the quality of the data, it would have been helpful for Centers for Medicare and Medicaid to provide the procedure and diagnosis codes Wyoming should use when determining the Number of Beneficiaries Tested for any Sexually Transmitted Disease. For this measure, Wyoming is using a list of codes they have defined and consider comprehensive. Not knowing what codes other states may use, this may not be an “apples to apples” comparison for CMS to compare state outcomes.

With regard to qualitative beneficiary survey data quality, Wyoming intends to survey one hundred percent (100%) of beneficiaries for the reportable demonstration year. Even surveying all beneficiaries, the sample size is extremely small with under ten (10) monthly beneficiaries. The sample size and number of Program beneficiaries limits Wyoming’s ability to draw conclusions based on survey outcomes. It should also be noted that Wyoming should be tentative of conclusions that are made based on the beneficiary survey outcomes since minimal data could easily skew conclusions.

Wyoming believes that in reality, there are quite a few women who are eligible for the Pregnant by Choice Program; however, they do not elect for limited reproductive health coverage. Instead, Wyoming believes they are able to obtain an affordable or free health insurance plan through the Health Insurance Marketplace. Wyoming has determined this as the case because historically, pre-Affordable Care Act, there were hundreds of women on the Pregnant by Choice Program. Once the Affordable Care Act became a nation-wide option for anyone to obtain free or reduced health insurance coverage, Wyoming saw an exodus of beneficiaries from the Program. Wyoming believes the significant drop in the number of beneficiaries is directly related to the implementation of the Affordable Care Act. There have been no changes in how Wyoming Eligibility sends PBC coverage materials and renewal information out, before or after the implementation of the Affordable Care Act – the only difference is that women are now able to get free and reduced comprehensive health insurance coverage through the Health Insurance Marketplace.

Also, Wyoming has no authority to auto-enroll any woman transitioning off of the Pregnant Women Program after having her baby. Meaning, Wyoming may not be enrolling all eligible beneficiaries since this is at the woman’s discretion to elect PBC coverage. Wyoming designed efforts to increase outreach and encourage enrollment into PBC before women transition off of their Pregnant Women Program benefits. Here is a quick overview of how the process works to initially notify and send renewal documents: Monthly, the Eligibility Customer Service Center pulls a report for individuals who have babies due that month and this generates a notice to be sent out to