Medicaid Benefits: Online Database

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Acute Care Services

Institutional and Clinic Services

Practitioner Services

Prescription Drugs

Physical Therapy and Other Services

Products and Devices

Transportation Services

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Long-Term Care Services

Community Based Care

Institutional Care

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Benefits by State: Wyoming (October 2008) Notes

Acute Care Services

Is the Benefit Covered?	Copayment Requirement	Prior Approval Requirement	Coverage Limitations	Reimbursement Methodology	Populations Covered

Institutional and Clinic Services
Clinic Services, by an organized facility or clinic not part of a hospital: Freestanding Ambulatory Surgery Center
Yes				Prospective rate per episode of care at 90% of Medicare rate	CN
Clinic Services, by an organized facility or clinic not part of a hospital: Public Health and Mental Health Clinics
Yes				Fee for service	CN
Federally Qualified Health Center Services
Yes	$2/visit			Prospective cost based rate/visit	CN
Inpatient Hospital Services, other than in an Institution for Mental Diseases
Yes				Prospective payment/discharge based on LOC at admission	CN
Outpatient Hospital Services
Yes	$6/non-emergency visit in ER		12 visits/year in combination with physician office visits, therapy services must be restorative and are limited to 20 visits/year across all therapy providers	Payment based on Medicare Outpatient Prospective Payment System methodology	CN
Rehabilitation Services: Mental Health and Substance Abuse
Yes				Fee for service	CN
Rural Health Clinic Services
Yes	$2/visit			Prospective cost based rate/visit	CN
Practitioner Services
Certified Registered Nurse Anesthetist Services
Yes				Fee for service	CN
Chiropractor Services
No
Dental Services
Yes			Exam and cleaning 1/year, 2 emergency treatments/year, frequency of x-rays limited by type, crowns not covered	Fee for service	CN
Medical and Remedial Care - Other Practitioners

Medical/Surgical Services of a Dentist
Yes				Fee for service	CN
Nurse Midwife Services
Yes				Fee for service at 83% of physician fee	CN
Nurse Practitioner Services
Yes	$2/office or home visit			Fee for service at 83% of physician fee	CN
Optometrist Services
Yes	$2/visit		Limited to diagnosis and treatment of medical eye problems as permitted by law and post-cataract surgery follow-up care	Fee for service	CN
Physician Services
Yes	$2/office or home visit		12 visits/year in combination with outpatient hospital visits	Fee for service	CN
Podiatrist Services
No
Psychologist Services
Yes	$2/therapy service			Fee for service	CN
Prescription Drugs
Prescription Drugs
Yes	$1/generic or preferred brand Rx, $3/non-preferred brand Rx	Non-preferred brand drugs, obesity products, over the counter drugs		AWP-11%, plus $5.00 dispensing fee	CN
Physical Therapy and Other Services
Occupational Therapy Services
Yes			Post-trauma/illness only, therapy services must be restorative and are limited to 20 visits/year across all therapy providers	Fee for service	CN
Physical Therapy Services
Yes			Post-trauma/illness only, therapy services must be restorative and are limited to 20 visits/year across all therapy providers	Fee for service	CN
Services for Speech, Hearing and Language Disorders
Yes			Speech pathology for post-trauma/illness only, rehab potential required	Fee for service	CN
Products and Devices
Dentures
Yes			1 denture/lifetime	Fee for service	CN
Eyeglasses
Yes			Limited to post-cataract surgery lenses	Fee for service	CN
Hearing Aids
Yes				Fee for service	CN
Medical Equipment and Supplies
Yes		Specified items and services		Fee for service, some items paid acquisition cost plus 15% shipping and handling charge	CN
Prosthetic and Orthotic Devices
Yes				Fee for service	CN
Transportation Services
Ambulance Services
Yes				Fee for service	CN
Non-Emergency Medical Transportation Services
Yes				See service-specific FN	CN
Other Services
Diagnostic, Screening and Preventive Services
No
Early and Periodic Screening, Diagnosis and Treatment
See service-specific FN.
Extended Services for Pregnant Women

Family Planning Services
See service-specific FN.
Laboratory and X-Ray Services, outside Hospital or Clinic
Yes				Fee for service	CN
Targeted Case Management
Yes				Fee for service	CN

Long-Term Care Services


Community Based Care
Home and Community Based Services Waiver
Yes		Services for the following populations: 1, 2, 4 & 8 - See service-specific FN	Dependent upon the services provided	CN
Home Health Services, includes nursing services, home health aides, and medical supplies/equipment
Yes		Therapy must be restorative	Visits paid fee for service, med supplies paid reasonable charge	CN
Hospice Care
Yes			Prospective rates based on Medicare methodology	CN
Personal Care Services
No
Private Duty Nursing Services
No
Program of All-Inclusive Care for the Elderly
No
Institutional Care
Inpatient Hospital, Nursing Facility and Intermediate Care Facility Services In Institutions for Mental Diseases, age 65 and older
Yes		14 leave days of any type/year	Private facilities paid contracted rates, public facilities paid prospective cost based per diem	CN
Inpatient Psychiatric Services, under age 21
Yes	Level of care at admission		Acuity adjusted contracted rate	CN
Intermediate Care Facility Services for the Mentally Retarded
Yes		14 leave days of any type/year	Prospective cost based per diem with limits	CN
Nursing Facility Services, other than in an Institution for Mental Diseases
Yes	Admission of a child under 21	14 leave days of any type/year	Prospective per diem based on cost with efficiency incentives, higher rates for heavy care residents	CN
Religious Non-Medical Health Care Institution and Practitioner Services
No

Notes: This State’s Medicaid program is called EqualityCare and the State has added the optional Medicaid buy-in group of disabled adults permissible through the Ticket to Work and Work Incentives Improvement Act (TWWIIA) in a program called Employed Disabled Individuals (EDI). These beneficiaries are allowed to continue Medicaid coverage, and receive full benefits, if their income is at or below the federal poverty level.