Application Year Plan (FFY24):

This section presents strategies/activities for 2021-2025 MCH priorities related to the CSHCN domain. See Five-Year State Action Plan Table for more information.

The NSCH (2020-21) estimates there are 26,199 CSHCN ages 0-17 in Wyoming. In Wyoming, 18% of CSHCN receive care in a well-functioning health care system, compared to 13.7% nationally (NSCH, 2020-21). Components of a well-functioning system are the following: family partnership, medical home, early screening, adequate insurance, easy access to services, and preparation for adult transition.

Of the May 2023 public input survey respondents, 73% of those who indicated that they have a child aged 2-11 in their household and 92.9% who indicated they have a teen or young adult aged 12-24 in their household indicated that they believe the CSH Program’s focus on medical homes and the family advisory council fits well or very well with the needs of their family or community.

Responses to the 2023 public input survey also underscore the need for CYSHCN families to have access to care. One respondent shared: “One of the biggest issues we’re facing right now is access to care. My kids have both been diagnosed with asthma, and have trouble accessing their medications when they need them. We’ve had to travel long distances and wait in long lines at pharmacies just so we can get the medication they need - sometimes even having to pay out-of-pocket for something that should be covered by our insurance.”

Known barriers, such as lack of specialty care, distance to travel, transportation, and affordability of care were also reflected in survey responses. Additionally, it was noted by respondents that knowledge and awareness of existing services may also require improvements so families are aware of what is available in the state.

WY MCH will leverage and expand existing relationships with family-serving organizations to understand and improve systems of care for CYSHCN. Building on the technical assistance received in FFY21 for the National Standards of Systems of Care for CYSHCN as it relates to Wyoming programming, the CYSHCN program has  renewed assessment and planning efforts to determine any strategic programmatic shifts or actions that would allow CYSHCN Program to better reach and serve the CYSHCN population and strengthen the system of care for CYSHCN and their families.  To date, this has included establishing a small advisory group to help direct initial assessment and planning efforts, and who will help identify community and family engagement strategies. The CYSHCN Program has made significant progress in gathering data to inform planning and engagement. This includes:

• A comprehensive review of NSCH data across domains to better understand CYSHCN population overall, and potential disparities faced by CYSHCN
• Reviewing current CSH program data to better understand quantitatively and qualitatively who and how well the program is serving clients, and identifying potential opportunities for improvement
• Comprehensive review of past work to assess the national standards in Wyoming
• Comprehensive review of the national standards and other frameworks, such as the Blueprint for Change.

In FFY24, CYSHCN program anticipates moving more deeply into planning and implementation. CYSHCN will work to ensure community and family engagement in the process.

Additionally, the CYSHCN program anticipates aligning the planning efforts with the anticipated updated Title V guidance to assure CYSHCN strategies incorporate the Blueprint and are appropriate for the revised NPM structure.

WY MCH continues to partner with Uplift (Family Voices Affiliate) under a formal subaward. Under this subaward, Uplift will provide technical assistance to WY MCH staff to engage parents and families in MCH program planning, implementation, and evaluation.

The CYSHCN program will continue to implement the following strategies to improve systems of care for CYSHCN and address NPM 11:

1. Work with other MCH Programs to assess the utility of a broader MCH Advisory Council, of which CYSHCN can be a part of. This may involve requesting more detailed technical assistance.

2. Identify and implement internal CYSHCN program changes that support implementation of the Blueprint. Work to make programmatic shifts are expected to be done in partnership with PHN, Medicaid, and engage communities and families. .

3. Continue to partner with Medicaid to serve MCH populations, including CYSHCN, through a range of collaborative projects, policy decisions, and the renewal and update of the IAA.

Other Programmatic Activities

Children’s Special Health Program

Unless or until any programmatic shifts are made more broadly for CYSHCN, the existing CSH Program will continue to provide services to children and youth (ages 0-18) with special health care needs who have, or are at increased risk for, a chronic physical, developmental, behavioral, or emotional condition, and who require health and related services of a type or amount beyond that generally required by children. Currently, CSH clients must meet both medical and financial eligibility to receive gap-filling financial assistance, however, the program encourages public health nurses to serve families of CYSHCN in need of care coordination services only, even if they narrowly miss eligibility requirements for gap-filling financial assistance.

Continued services for the sub-programs MHR and NBIC will also be provided in FFY24. MHR serves Wyoming women experiencing high-risk pregnancies that receive Level III obstetric and maternity care services and/or deliver in a Level III facility. MHR provides language access services, transportation or lodging expenses, or copay and deductible support for individuals with private insurance, and assistance navigating Medicaid or the marketplace if uninsured. NBIC supports services available to high-risk infants who are delivered at, or transferred to, an out-of-state Level III nursery. Up-front emergency travel assistance will continue to be available, as well.

These direct, gap-filling financial expenses will shift to our Title V budget due to state general fund budget reductions. The reduction, however, will not impact our ability to meet the MOE requirement of the grant.

Newborn Screening and Genetics

WY MCH will continue to operate the newborn screening program using Title V MOE/match funding. Additionally, WY MCH will continue to offer telehealth and in-person genetics clinics in partnership with the University of Colorado and PHN, leveraging Title V dollars, until any strategic programmatic shifts are determined. Broader resource allocation will be considered in all strategic planning for CYSHCN in FFY24.