Demographics, Geography, and Economy
Geographically, Wyoming is the tenth largest state in the United States (U.S.), spanning 97,813 square miles. Wyoming is a rural/frontier state with 23 counties ranging in ecoregion from the Great Plains to the Rocky Mountains. The Wind River Indian Reservation (WRIR), located toward the center of the state, is home to two federally recognized tribes, the Eastern Shoshone and Northern Arapaho. Two counties, Laramie and Natrona, each have a town with over 60,000 people and are considered urban. Seventeen of the remaining 21 counties are considered frontier, with fewer than six people per square mile. These 17 counties are home to 45% of the population (Wyoming Economic Analysis Division (WY EAD), 2022).
Wyoming Counties by Rural, Urban, and Frontier Classification
Wyoming is the least populous state in the U.S., with a July 2022 estimated population of 581,381–an increase of 0.3% from July 2021 (U.S. Census Quick Facts, 2022). The population is predominantly White alone (92.4%). The remaining population is Black or African American alone (1.2%), American Indian and Alaska Native alone (2.8%), Asian alone (1.1%), Native Hawaiian and Other Pacific Islander alone (0.1%), two or more races (2.4%), and 10.6% of the population is Hispanic or Latino. In 2022, 93% of the population aged five years and older spoke only English at home, and 7% spoke a language other than English (U.S. Census Quick Facts, 2022). According to WY EAD, the minority population, and groups other than single-race, Non-Hispanic White increased by 34.4% between 2010 and 2020, accounting for nearly all the growth in Wyoming from 2010 to 2020 (WY EAD, 2021).
Nearly one quarter (22.9%) of the population is under the age of 18, and 17.9% is over the age of 65. Almost 94% of people over the age of 25 have a high school education or higher, with 28.5% of this group having at least a bachelor’s degree. The median household income in 2022 was $68,002, just slightly less than the median household income in the U.S. of $69,021. Persons in poverty are estimated to be 11.4% of the population, compared to 11.6% nationally (U.S. Census Quick Facts, 2022).
According to the WY EAD, Wyoming’s economy continued to rebound in the fourth quarter of 2022, as energy businesses maintained their drilling activities. However, this was still slower than the U.S average. In 2022, employment in Wyoming increased 2.0% (5,700 jobs), compared with a U.S. growth of 3.4%. Unemployment in Wyoming increased to 3.9%, slightly higher than the national average of 3.6% (WY EAD, 2023).
Strengths and Challenges
According to the 2022 Annual America’s Health Rankings Report, Wyoming ranks 35th in the nation in overall health outcomes, and 33rd in the nation in all health determinants (social and economic factors, physical environment, clinical care, and behaviors). The listed strengths for Wyoming in the report include high fourth grade reading proficiency, low prevalence of violent crime, low incidence of chlamydia, low income inequality and low levels of air pollution. Also, the report highlighted HPV vaccination increasing 80% from 26.7% to 48% of adolescents ages 13-17 between 2016 and 2021. Food Insecurity decreased 15% from 13.2% to 11.2% of households between 2015-2017 and 2019-2021. The listed challenges in Wyoming include high rates of low birthweight, occupational fatalities, high school graduation racial disparities, premature death racial disparities and adverse childhood experiences. Also, the report highlighted premature death increasing 14% from 8,000 to 9,141 years lost before age 75 per 100,000 population between 2019 and 2020.
As noted, Wyoming is considered a rural/frontier state, which presents unique challenges. According to the Health Resources and Services Administration’s (HRSA) Designated Health Provider Shortage Areas (HPSA) Quarterly Summary Report (Second Quarter of Fiscal Year 2023, 3/31/2023), Wyoming had a total of 44 Primary Care HPSA designations, with 186,622 residents residing in primary care shortage areas. There were 29 dental HPSA designations in the state with a total of about 49,361 Wyoming residents residing in these areas. Finally, the entire state (comprising five regions) is considered an HPSA for mental health. Per HRSA's Designated HPSA Quarterly Summary, only 41.22% of the mental health needs are being met and 28 full-time psychiatrists are needed to meet the needs of the population.
According to the Wyoming Office of Rural Health, in 2023 there are currently 48 physicians practicing obstetrics and gynecology (OB/GYN) in Wyoming and 61 practicing pediatricians. Eleven counties do not have an OB/GYN and 11 counties do not have a pediatrician. Over 16,900 Wyoming women of childbearing age (15-44) live in a county with no practicing OB/GYN, and approximately 25,800 Wyoming children and youth (<18 years of age) live in a county with no practicing pediatrician (CDC Wonder, 2023).
There are 274 family practice physicians in the state. Fifty-one individuals practice in Natrona County, 69 in Laramie County, 16 in Park County, and 18 in Fremont County. Five counties have five or fewer family practice physicians (Wyoming Office of Rural Health, 2023).
Total Number of Practicing Pediatricians by Wyoming County
Total Number of Practicing Obstetricians & Gynecologists by Wyoming County
Access to care is a challenge in Wyoming, given the rural/frontier nature of the state. This is especially pertinent to the MCH population, given the absence of Level III facilities, few specialist providers, and a high uninsured population. In 2022, 14.8% of Wyoming residents under the age of 65 years had no health insurance coverage, compared to 9.8% of the population nationally (U.S. Census Quick Facts, 2022). During the 2023 Wyoming legislative session, a Medicaid extension bill (HB0004), extending Medicaid coverage up to 12 months postpartum was passed, but has a sunset date of March 31, 2027, thus is time-limited.
Additionally, Wyoming is one of ten states that has not expanded Medicaid. During the 2023 Wyoming legislative session, a Medicaid expansion bill (HB0080) initially passed the Revenue Committee but was not considered for Committee of the Whole. This is the ninth time a Medicaid expansion bill has failed. HB0080 proposed expanding Medicaid, contingent on the state continuing to receive a 90% federal match assistance percentage for the expansion population and at least 55% for the traditional Medicaid population. A similar bill in the 2022 session (HB0020) was drafted but was not considered for introduction. Health insurance options in the Federal Health Insurance Marketplace for Wyoming are limited to Blue Cross Blue Shield and Mountain Health co-op. During open enrollment for 2023 coverage, 38,565 residents enrolled in private individual-market plans through the Wyoming exchange, which was a record high.
Health Equity
According to the 2023 Robert Wood Johnson County Health Rankings & Roadmaps, Wyoming fares better than the nation for the proportion of children in poverty, with 12% of children in poverty versus 17% nationally. However, within Wyoming, the proportion of children in poverty continues to vary widely by county, with rates ranging from 6% (Teton County) to 19% (Niobrara and Fremont County) (County Health Rankings & Roadmaps, 2023).
Wyoming’s overall high school graduation rates rose steadily from 78.6% (2013-2014) to 82.4% (2020-2021), and was 81.8% for the 2021-2022 school year. However, racial and ethnic disparities continue to be observed in regards to high school graduation rates. While 84.1% of White youth graduated from high school in the 2021-2022 school year, 76.4% of Hispanic youth and 49.3% of American Indian youth (a drop from 52.9% the previous year) graduated during the school year (Wyoming State Four-Year Graduation Rates).
The definition used for health equity by the Robert Wood Johnson foundation is:
“Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.”
Due to the unique nature of Wyoming, a number of barriers to measuring health equity exist. Small population numbers (particularly for minority populations) at the state and county levels make stratification by geographic region, race, and ethnicity challenging. Wyoming continually monitors MCH outcomes for minority populations through the calculation of rolling rates and data aggregation. Too often, even with multiple years, numbers are too small to report, which can contribute to the erasure of their experiences. During the 2021-2025 Title V cycle, WY MCH established a Title V priority to build workforce capacity to operationalize all of its core values, with specific emphasis on health equity. The operationalization of health equity will consider ways in which we can increase our capacity to present data through a health equity lens and mitigate the effects of small numbers.
Agency Organizational Structure and Role
The Maternal and Child Health Services Title V Block Grant is managed by the WY MCH within the CHS and PHD of the WDH. WDH’s mission is to “promote, protect, and enhance the health of all Wyoming residents.” PHD’s mission is to “To promote, protect, and improve health in Wyoming.”
PHD is one of four divisions within WDH, joining the Aging, Behavioral Health, and Health Care Financing (Wyoming Medicaid) Divisions. Please see the attached organizational chart for a visualization of PHD’s structure. WDH is an executive branch state agency, with an appointed director, that has been granted authority and responsibility to govern health services through Wyoming statutes §§ 9-2-101 through 9-2-127. Specific to PHD, Wyoming statutes §§ 35-1-201 through 35-1-244 contain provisions for public health and safety responsibilities. Various other statutes offer provision for public health services carried out by PHD.
PHD employs approximately 290 staff in a mostly-centralized public health system. All but four PHN offices are administered through a state-county partnership. The remaining four are independent local health departments.
PHD provides a wide range of services that promote, protect, and improve health in Wyoming. The following is a list of PHD sections and units, services provided are in line with the 10 Essential Public Health Services:
- Community Health Section - optimizes quality of life through the promotion of health, protection of community health, and prevention of disease and injury
- Health Readiness and Response Section - coordinates preparedness and response for public health emergencies; coordinates efforts to improve the health of rural, medically underserved residents; and maintains and enhances the Emergency Medical Services and Trauma Systems across Wyoming
A summary of the PHD organizational structure is included below.
Public Health Division Organizational Chart as of May 2023
PHD is working toward public health accreditation. The division completed a State Health Assessment (SHA) in 2018 and will update it in the near future.
PHD has recently undergone strategic planning efforts to refresh its priorities following the COVID-19 pandemic.
The draft PHD strategic plan contains guiding principles that act as the underlying foundation to guide the division’s work. The plan will also contain operational and population health goals. Tentatively, those goals are:
-
Population Health
- Promote mental and physical wellbeing
- Improve access to healthcare and public health services
- Prevent injury and disease
- Prepare for, monitor, and respond to public health issues
- Monitor EMS agencies for compliance
- Conduct timely and complete infectious and communicable disease surveillance and diagnostic activities
- Conduct timely and relevant chronic disease surveillance
WY MCH staff are participating in the division’s strategic planning process wherever staff engagement opportunities are present. WY MCH does and will continue to align Title V priorities and strategies with PHD goals and plans.
WY MCH administers the Title V MCH Services Block Grant and provides leadership for state- and local-level efforts that improve the health of the MCH population. The unit’s programs are divided according to the population groups they serve. This structure aligns well with the Title V population domain framework and assures dedicated resources within each domain. Programs collaborate to ensure consideration of the life course perspective in program planning and decision making, and where domain populations overlap. WY MCH programs include:
- Women and Infant Health Program, focusing on women of reproductive age and infants through age one (Women/Maternal Health and Perinatal/Infant Health domains)
- CYSHCN Program, focusing on all children one through 21 years, including those with special health care needs (Child Health and Children and Youth with Special Health Care Needs [CYSHCN] domains)
- Youth and Young Adult Health Program, focusing on the unique needs of youth and young adults ages 12-24 (Adolescent Health domain)
WY MCH Mission and Vision
WY MCH’s vision is a Wyoming where all families and communities are healthy and thriving. WY MCH’s mission, updated in 2023, is to partner with communities and families to promote and advocate for optimal health and wellbeing, using a public health approach. WY MCH core values include:
- Data-driven: WY MCH uses data, evidence, and continuous quality improvement
- Engagement: WY MCH cultivates authentic collaboration and trust with families and community partners
- Health Equity: WY MCH integrates an understanding of how differences in social, economic, cultural, and environmental factors across generations and throughout the lifespan impact health
- Life Course Perspective: WY MCH integrates an understanding of how risk and protective factors influence health across the lifespan and across generations
- Systems-Level Approach: WY MCH prioritizes work that addresses community structures, social norms, environment, and policies to maximize impact
The 2020 MCH Needs Assessment resulted in the selection of seven priorities for 2021-2025:
- Prevent Maternal Mortality (Women/Maternal Domain)
- Prevent Infant Mortality (Perinatal/Infant Domain)
- Promote Healthy and Safe Children (Child Domain)
- Promote Adolescent Motor Vehicle Safety (Adolescent Domain)
- Prevent Adolescent Suicide (Adolescent Domain)
- Improve Systems of Care for Children and Youth with Special Health Care Needs (CYSHCN Domain)
- Strengthen MCH Workforce Capacity to Operationalize MCH Core Values (Cross-Cutting Domain)
WY MCH benefits from participating in and aligning with the PHD SHA and strategic plan. This provides opportunity for intra-division partnership and coordination.
Systems of Care and Services for CYSHCN
CYSHCN Program Overview and Population Served
In 2020-2021, approximately 26,200 (19.7%) of Wyoming children and youth ages 0-17 had a special health care need. The prevalence of CYSHCN whose parents reported receiving care in a well-functioning system in Wyoming was 18.0% in 2020-2021, compared to 12.7% in 2019-2020, and the U.S. estimate of 13.7% in 2020-2021 (National Survey of Children’s Health). Currently, WY MCH’s CYSHCN program activities are limited in systems-level scope and serve a small proportion of the overall CYSHCN population in Wyoming. The CYSHCN program is focusing on assessing and improving systems of care for all CYSHCN.
WY MCH’s CYSHCN program (also known as the CSH Program) offers care coordination and limited gap-filling financial assistance as the payer of last resort for enrolled clients (CYSHCN ages 0-18 and high-risk pregnant women and infants requiring Level III care) who meet medical and financial eligibility criteria. In order to be eligible for assistance, families must first apply for Medicaid, Kid Care Children’s Health Insurance Program (CHIP), and/or the Federal Marketplace. The CSH program provides reimbursement to eligible providers for covered services provided to eligible clients. In FFY22, CSH actively served 366 clients. Of all enrolled clients, 306 were CYSHCN, 39 were high-risk infants, and 21 were high-risk pregnant women. Of all clients served, 93% were on Medicaid during the reporting year.
WY MCH works with partners such as PHN, Medicaid, Kid Care CHIP, in-state and out-of-state primary care and specialty providers, early intervention providers, and home visiting providers, to assure child populations, especially CYSHCN, have access to health insurance; a primary care provider or, ideally, a certified medical home; specialty care services; support for transitioning to adult healthcare settings; and other supports and services based on identified family needs.
Health Services Infrastructure and Integration of Services
Wyoming lacks a children’s hospital and has a significant shortage of pediatric specialists in the state, leading families to rely heavily on bordering states’ infrastructure for Level III hospital care and pediatric specialty care. WY MCH maintains an updated map of pediatric specialty clinics offered in Wyoming, and directly funds in-person and telehealth genetic clinic services due to an absence of an in-state geneticist and long wait times for out-of-state appointments.
Strengthening partnerships with out-of-state providers and neighboring Title V agencies helps to build Wyoming’s health services infrastructure. For example, the Wyoming Newborn Screening and Genetics Programs contract with the Colorado Department of Public Health and the Environment (CDPHE) for newborn screening laboratory and short-term follow-up services, and the University of Colorado Medicine for in-person and telehealth genetics services and consultation. Additionally, WY MCH partnered with the Utah Department of Health to apply for a CDC ERASEMM grant to expand the scope of the well-established Utah Perinatal Mortality Review Committee to include review of Wyoming cases.
Financing of Services
Wyoming is one of two remaining states whose Medicaid payments are based on fee for service. Overall, children make up 67% of Wyoming residents covered by Medicaid and Kid Care CHIP. Wyoming Medicaid and Kid Care CHIP serve a large portion of Wyoming’s child population, including 100% of children in foster care, 55% of children who live in or near poverty, 34% of children with disabilities or special health care needs, and 29% of infants, toddlers, and preschoolers (Georgetown University Health Policy Institute Wyoming Snapshot 2019).
Additionally, 2019 data indicated that only 79% of Wyoming eligible children were enrolled, the lowest of any state. During COVID-related continuous coverage, Wyoming ranked second among states for child enrollment growth (38%) in Medicaid and Kid Care CHIP from February 2020 through August 2022 (Georgetown Center for Children and Families).
The most current eligibility requirements for Wyoming Medicaid and Kid Care CHIP are as follows:
- Kid Care CHIP is available to the children of parents, whose income is below 200% of the federal poverty level (FPL).
- Wyoming Medicaid:
State Statutes Relating to MCH
Three state statutes directly impact the work of WY MCH.
The NBS statute, Wyoming Statutes (Wyo. Stat.) §§ 35-4-801 and 802, mandates newborn screening be available to all newborns, and that WDH provides necessary education on newborn screening to hospitals, providers, and families. WY MCH’s NBS and Genetics Programs fulfill this statutory requirement in partnership with families, providers (including midwives), hospitals, CDPHE (laboratory services and short-term follow up contractor), and a contracted courier service. The Wyoming NBS and Genetics Coordinator is funded by both Title V and state Trust and Agency funding (comprised of hospital fees charged for NBS services), which demonstrates the partnership between Title V and WDH to assure access to newborn screening statewide.
Wyo. Stats. §§ 35-27-101, 102, 103, 104, Public Health Nurses Infant Home Visitation Services, was passed in 2000. This statute directs PHN to contact eligible women to offer home visitation services. The initial intent of the legislation was to implement Nurse Family Partnership (NFP), an evidence-based home visiting model, in all 23 counties. Due to challenges meeting growing fidelity requirements and a small birth cohort in many communities (limiting the number of women eligible for the program), NFP implementation in Wyoming reduced from statewide implementation to zero sites over the course of 20 years. Since 2021, the statute requirement is met by a new evidence-based home visitation model, Maternal Early Childhood Sustained Home-Visiting (MECSH), a model selected for its fit for Wyoming’s unique characteristics and needs. The newly named program, Wyoming Hand in Hand, launched in spring 2021 and is funded by TANF funding and State General Funds that count toward the required Title V match.
During the 2020 legislative session, Wyo. Stat. § 21-2-202 was updated to authorize the State Superintendent of Public Instruction to employ a state school nurse if/when non-state funds were available. Together, the WDE and WY MCH agreed to contribute funding for this position through September 10, 2024. The selected candidate started in June 2021. Through a Memorandum of Understanding (MOU), the state school nurse works closely with MCH to support and promote Title V priorities, identify and support professional development needs for Wyoming school nurses, educate school nurses and district boards on public health issues, collect aggregate data on a range of medical and health conditions impacting schools and students, develop best practice standards for school nursing, and assist in a range of other education and guidance development.
To Top
Narrative Search