Download Wyoming

1) State: Wyoming
2) Own or Federal Exchange? Federal Exchange
Source: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/wyoming.html
3) Medicaid Expansion? No
Source: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/wyoming.html
4) What kind of coverage is available for mental health/substance abuse treatment through
Medicaid?
The Wyoming Medicaid program is designed to assist eligible recipients in obtaining medical care within
the guidelines specified by Wyoming policy. Medicaid will pay only for medical services which are
therapeutically essential and are sponsored under program directives. The services shall be:
a. Consistent with the diagnosis and treatment of the patient’s condition.
b. In accordance accepted norms of mental health/substance abuse therapeutic services.
c. Only those services required to meet the mental health/substance abuse needs of the patient.
d. Performed in the most appropriate setting required by the patient’s condition. The provider’s records
shall substantiate the need for service by the findings and information to support treatment necessity
and detailing the care rendered.
e. All claims are subject to both prepayment and post-payment review for treatment necessity.
Should the review determine that services do not meet all the criteria listed above, payment will be
denied or, if the claim has been paid, action will be taken to recoup payment for those services
NON-COVERED SERVICES:
a. Hospital liaison services that include institutional discharge functions that are Medicaid reimbursable
to the institution.
b. Consultation to other persons and agencies about non-clients, public education, public relations
activities, speaking engagements and education.
c. Clinical services not provided through face-to-face contact with the client, other than collateral
contacts necessary to develop/implement the prescribed plan of treatment.
d. Residential room, board, and care.
e. Substance abuse and mental health prevention services.
f. Recreation and socialization services.
g. Vocational services and training.
h. Appointments not kept.
i. Day care.
j. Psychological testing done for the sole purpose of educational diagnosis or school placement.
k. Remedial or other formal education.
l. Travel time.
m. Record keeping time.
n. Time spent writing test reports with the exception of three hours allowed for report writing by a
licensed psychologist for the purpose of compiling a formal report of test findings and time spent
completing reports, forms and correspondence covered under case management services.
Source: https://wyequalitycare.acs-inc.com/manuals/Manual_MHSA.pdf
5) Does the state allow the court to order treatment and still have it paid by Medicaid?
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The court can order treatment and have it paid by Medicaid if the services are covered by
Medicaid (shown in the question above).
6) Are there restrictions related to treatment providers for probationers, substance abuse, or mental
health treatment? Will only certain providers be covered?

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The Wyoming Behavioral Health Division oversees mental health and substance abuse
treatment in the state. The Division works with mental health agencies to provide a safety net
of services and programs, designed to assist those coping with mental illness and substance
abuse.
Treatment providers must be contracted with Wyoming Behavioral Health Division and must
have the appropriate license and certification to treat patients in Wyoming.
Source: http://health.wyo.gov/mhsa/about/about.html
7) Is there coverage for residential substance abuse treatment? What are the parameters?

Wyoming has limited services available for Medicaid adult beneficiaries. All beneficiaries may
receive only residential mental health and substance abuse services that are therapeutically
necessary, and beneficiaries must have prior authorization from the Medicaid agency. (See
question 4)
Source: https://wyequalitycare.acs-inc.com/manuals/Manual_MHSA.pdf
8) What is the process and what are the regulations for treatment providers to be able to participate?


Providers must be licensed or certified to practice in the state of Wyoming. They also must be
Wyoming Medicaid Certified to receive reimbursements.
Medicaid reimbursement is available for mental and behavioral health services covered under
various service categories: physician services, inpatient and outpatient hospital services,
licensed practitioner’s services, clinics, and rehabilitative services.
Source: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/MentalHealth-Services-.html
9) Is dental care covered?

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Dental care is an option in the Marketplace, but is not included in the basic plan (except for
children).
Wyoming Medicaid adult dental care coverage is limited to an exam and cleaning one time per
year. Other services are limited to emergency treatment, x-rays and basic restorative
procedures, including extractions.
Source: http://kff.org/medicaid/state-indicator/dental-services/#