In Wyoming:
As of 2013, 59,992 individuals were eligible for Health Check (the Early and Periodic Screening, Diagnostic, and Treatment, or EPSDT, benefit) through Wyoming’s Medicaid program. According to CMS data from 2013, Wyoming achieved an EPSDT screening ratio of 63% and a participation ratio of 45%. 23,541 children received dental services of any kind, with 21,296 receiving preventive dental services.
Last updated June 2014
Medical Necessity
Wyoming Rules and Regulations define Medical Necessity for the Health Check program as follows:
  • “Medically necessary.” A health service that is required to diagnose, treat, cure or prevent illness, injury or disease which has been diagnosed or is reasonably suspected, to relieve pain or to improve and preserve health and be essential to life. The services must be:
    • Consistent with the diagnosis and treatment of the recipient’s condition;
    • Recognized as the prevailing standard or current practice among the provider’s peer group;
    • Required to meet the medical needs of the recipient and undertaken for reasons other than the convenience of the recipient and the provider; and
    • Provided in the most efficient manner and/or setting consistent with appropriate care required by the recipient’s condition.
Initiatives to Improve Access
Reporting & Data Collection
Behavioral Health
The target population for the Care Management Entities created under the Wyoming CHIPRA Quality Demonstration Grant includes Medicaid-enrolled children and south with serious emotional disturbance, as well as children in Psychiatric Residential Treatment Facilities (or at risk of such a placement). Medicaid-enrolled children whose use of prescription drugs does not conform to state prescribing guidelines are also targeted under the grant.
The children that meet these criteria, and live in the southeastern part of the state (the focus area for the pilots), are eligible to be treated by a Care Management Entity (CME). The CME is an organizational entity that serves as a centralized accountable hub to coordinate all care for youth with complex behavioral health needs and who are receiving care in multiple systems. The authority Wyoming uses to run the CMEs is its 1915(i) State plan Home and Community-Based Services benefit, which was approved in July 2013.
Wyoming also offers ongoing case management for Medicaid beneficiaries under age 21 with a behavioral health disorder.  This includes linking beneficiaries to needed services; monitoring and follow-up; referrals; other advocacy on behalf of the beneficiary; and crisis intervention.
Support to Providers and Families The Wyoming Health Check website has information for families about the EPSDT benefit, a provider list, and newsletters about EPSDT.
Care Coordination
Wyoming, in partnership with Maryland and Georgia, received a CHIPRA Quality Demonstration Grant in 2010 to implement and/or expand a Care Management Entity (CME) provider model using high fidelity wraparound and intensive care coordination. Through this grant Wyoming seeks to improve clinical, functional, and cost outcomes, access to home and community-based services, and youth and family resiliency of Medicaid children and youth with serious behavioral health challenges.
The coordination services the CMEs offer include:
  • Family Care Coordination (FCC)
  • Family Support Partner
  • Youth Support Partner
  • Youth and Family Training and Support
  • Service Intensity Evaluation
  • High Fidelity Wraparound Supervisor/Coach
Wyoming believes that this program will demonstrate improved access, reduced use of restrictive services, improved clinical and financial outcomes for children in the target population, reductions in disproportional use of restricted services by racial and ethnic minorities, and improved quality of care.
Wyoming’s 1915(i) State Plan Amendment also establishes that Family Care Coordinators will work to coordinate care and secure wraparound services for children. Care Management Entities and primary care physicians are expected to work together to track EPSDT requirements and coordinate care.
Oral Health
All children in Wyoming Health Check receive dental services on a fee-for-service basis. The Health Check brochure details which services are covered by age group. Other dental services are provided as deemed medically necessary.