Wyoming’s public health system is mixed (centralized and decentralized), with four independently run county health departments, one county with 100% State staff, and the remaining 18 counties utilizing both State and county staff. WY MCH works closely with both state and county staff in all 23 counties to assure access to home visiting and care coordination services for CSHCN, high-risk pregnant women, and high-risk infants. Assuring access to these services is especially important in rural and frontier communities with limited providers. Ten counties have no obstetricians/gynecologists and 12 counties have no pediatrician. Limited access to both primary care and specialty providers means that many families seek care across state lines.This makes the health care delivery system in Wyoming unique and challenging.

Using primarily matching funds, WY MCH’s Children’s Special Health (CSH) program provides gap-filling financial assistance and care coordination services for eligible high-risk pregnant women, high-risk infants, and children with special health care needs. WY MCH is the payer of last resort; in order to be eligible for assistance, families must first apply for Medicaid, the Child Health Insurance Program Kid Care CHIP, and the Federal Marketplace. The program provides reimbursement to eligible providers for covered services provided to eligible clients. Program eligibility is determined based on financial and medical criteria.

CSH care coordination services are provided by state-level MCH/CSH Benefits and Eligibility Specialists and local-level PHNs. Examples of care coordination services provided include:

• Working with the client/family to identify needs, concerns, and priorities
• Supporting families in following the client’s plan of care and recommended preventive well child visits (e.g. tracking and providing appointment reminders based on care plan and Bright Futures periodicity chart)
• Locating, accessing, and connecting families to needed community services and resources
• Assuring services are coordinated among interdisciplinary team members and across programs and agencies
• Assuring families have access to health care coverage (e.g. helping families sign up for Medicaid, Kid Care CHIP, Marketplace, etc.)
• Investigating billing problems
• Providing support for transition to adult health care services
• Providing support for interpretation and translation services
• Evaluating the effectiveness of service delivery in meeting client and family needs

In 2016, WY MCH and the MCH Epidemiology Program completed the Levels of Care Assessment Tool (LOCATe) in order to better understand the system of perinatal care in Wyoming. Results confirmed that Wyoming is the only state without a Level III/IV maternal or neonatal care hospital. This means that many pregnant women, children, and families must seek care out-of-state. Over 10% of births occur outside of Wyoming, thought there is limited data available to determine the reason for delivering outside of the state. There are future plans to repeat LOCATe statewide using the revised tool. The act of completing the assessment has significantly increased engagement with the Wyoming Hospital Association and with individual facilities and helped to formally establish the Wyoming Perinatal Quality Collaborative. This is an example of WY MCH’s efforts to provide a systems-building approach to ensuring access to high-quality health care services for Wyoming pregnant women and infants.  

Partnership with Medicaid

In Wyoming, Title V and Medicaid are housed within one agency, allowing for frequent communication and partnership. Partnership is formalized by a 2013 interagency agreement and is strongly supported by WDH leadership. Specifically, senior administrators for PHD and Healthcare Financing (Medicaid) meet monthly to discuss ongoing and new collaboration opportunities. WY MCH routinely provides updates to the PHD Senior Administrator to discuss during these partnership meetings. WY MCH and Medicaid actively partner to address the following state priority needs, including new (2021-2025) and old (2016-2020) priorities:

• Reduce infant mortality
• Improve access to and promote the use of effective family planning
• Promote preventive and quality care for children and adolescents
• Prevent maternal mortality

Examples of current WY MCH and Medicaid collaborative projects include:

• Bright Futures Implementation Task Force and associated activities within four subcommittees (Provider Education, Consumer Education, Medical Coding, and Access to Care). The Wyoming Medicaid Medical Advisory Group voted to adopt Bright Futures, 4th Edition after participating in a WY MCH-facilitated presentation by a nationally recognized Early and Periodic Screening, Diagnosis, and Treatment/Bright Futures expert. Both WY MCH and Medicaid participated in the development of a Bright Futures Implementation Guide for Wyoming, led by two Title V Internship Program interns. The task force used the guide to inform development of its membership, structure, and activities.  
• Long Acting Reversible Contraception (LARC) Workgroup and associated activities to unbundle reimbursement for LARC insertion, device, and removal in federally qualified health centers and rural health clinics and in hospitals (i.e. immediate postpartum LARC). This work was originally funded through a grant from the National Institute of Reproductive Health but is ongoing with support from WY MCH and Wyoming Primary Care Association leadership.
• Medicaid Innovation Accelerator Program (building partnerships and data analytic capacity to address maternal mortality and severe maternal morbidity). 
• Maternal Mortality Review Committee. The Medicaid Medical Director is a member of the newly formed UT-WY MMRC, a cross-state committee reviewing Utah and Wyoming maternal deaths; Wyoming maternal deaths will be reviewed twice annually.
• Wyoming Perinatal Quality Collaborative. The Medicaid Medical Director, Health Management Contract Manager, and representatives from the Medicaid Health Management Contractor (WYhealth) attend regularly and participate in projects.
• Meetings with Medicaid, WYhealth, and PHN to identify opportunities to improve coordination of services for CSHCN, pregnant women, and families with children. A draft crosswalk was developed to show how different program services overlapped and each entity has agreed to present on its program services to the workgroup.

The TItle V-Title XIX interagency agreement was last updated in 2013. In FFY21, the WY MCH plans to facilitate collaborative discussions regarding current language and proposed updates.

Early Childhood Home Visiting System

Both MCH and PHN participate in the Wyoming Home Visiting Network (WYHVN). This network of committed stakeholders promotes a system of high-quality home visiting from pregnancy through age three as a core early childhood service available to all Wyoming families. Key stakeholders include Early Head Start, Early Intervention Services (Parts B and C), Parents as Teachers (i.e. Wyoming Maternal, Infant, Early  Childhood Home Visiting (MIECHV) grantee), and Family Spirit (a tribal home visiting program). Parents as Teachers provides infrastructure and leadership for the WYHVN.

Partnership with the University of Wyoming

Wyoming has one university. The Department of Health has a formal Affiliation Agreement with the University of Wyoming to support internship opportunities for students. In addition, many public health programs have established relationships with faculty and staff to advance public health initiatives. The Community Health Section Chief is leading efforts to further establish partnership opportunities with the WWAMI (Wyoming, Washington, Alaska, Montana, Idaho) Program, which serves as Wyoming’s medical school.