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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 2 of 38

II. PROGRAM DESCRIPTION AND HISTORICAL CONTEXT Demonstration Description

The Wyoming “Pregnant by Choice” family planning demonstration expands the provision of family planning services to women aged 19 through 44, with family income at or below 159 percent of the Federal Poverty Level (FPL), who are losing pregnancy-related coverage provided through the Wyoming Medicaid Pregnant Woman Program. These women must not have health insurance and must not be otherwise eligible for another Medicaid program. The demonstration specifically allows enrollees to receive contraception management services and certain medical diagnosis or treatment services that are provided within the context of a visit for contraception management services.

Historical Context

The Wyoming Pregnant by Choice demonstration was initially approved for a 5-year period on September 8, 2008 and implemented by the state on January 1, 2009. The demonstration was granted multiple temporarily extensions from July 9, 2013 through 12-31-2014. A three year extension was approved on 12-30-2014 which was due to expire on 12-31-2017. Multiple temporary extensions were approved from December 5, 2017 through May 31, 2020. On August 5, 2019, the Wyoming Department of Health submitted a request to extend the demonstration for a 5-year period with no changes. CMS is providing a 10-year extension of the demonstration, starting from the date the demonstration was originally set to expire, given the positive program outcomes the state has demonstrated as summarized below.

Since initial implementation, the overall goals of this demonstration are to reduce the incidence of closely spaced pregnancies and decrease the number of unintended pregnancies, thereby achieving cost savings and reducing health risks to women and children in the state. The latest program outcomes reported by the state show that the proportion of demonstration enrollees accessing Medicaid-family planning services has increased almost every year of the demonstration, with only one demonstration year showing a slight decline. As well as, the most recent Pregnancy Risk Assessment Monitoring System (PRAMS) data available in the state shows that the overall rate of unintended pregnancies in Wyoming decreased from 44.4 percent to 36.1 percent from 2007 to 2011.

On April 30, 2025, CMS amended the STCs to identify STI/STD screening services as a family planning service and STI/STD diagnosis services as a family planning related service.

The demonstration is expected to continue to progress these outcomes and promote the objectives of title XIX by:

• Increasing access to family planning services; • Increasing child spacing intervals through effective contraceptive use;