Medicaid Nursing Home Rates by State

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Wyoming

Medicaid nursing facility payment · Peer-group price · researched October 2026

Wyoming’s Medicaid agency and its state plan are the official source for these rules. This page summarizes them as researched in October 2026; check the state’s own documents, listed under Sources, before relying on them.

At a glance

Rate method

Peer-group price

Case-mix level

Facility average

Classification

PDPM

Rate updates

Quarterly

Managed care (LTC)

No

Quality program

None

Paid outside the rate

Large

Bed hold

Not paid

Published rates

Rates only

Assisted living

Covered

Personal needs allowance

$50 / month

Overview

• Wyoming splits a budget set by the Legislature into four parts.
• Property is paid first, as a fair-rental 'property rental rate' based on building age ($10.64-$15.55/day base table, indexed by Marshall Swift).
• Exempt costs come second and are each home's own pass-through: property tax, property insurance and CNA training fees.
• The rest becomes two statewide prices: an operating price ($107.73/day from 7/1/2026) and a health care (nursing) price ($114.85/day).
• The health care price is scaled each quarter by the home's average Medicaid case mix relative to the statewide average.
• Each bed-size group then gets a percentage adjustment so the groups' cost coverage is within 5% of each other.
• The 10/1/2026 file lists 32 homes: median $259.81/day, range $212.89-$352.96.
• Small rural homes sit at the top ($332-$353) and large urban homes near $213-$240.

What matters in Wyoming

• Posted rates run $212.89-$352.96/day (median $259.81, Oct 2026). Small rural homes earn about $100/day more than large urban ones.
• Prices come from a fixed legislative budget, not inflation; SFY2027 prices barely moved (health care $114.85, operating $107.73).
• PDPM facility-average case mix since April 1, 2025; the state plan amendment was still pending at CMS in mid-2026.
• Supplemental payments add about 37%: $33.5M in SFY2025 versus $89.7M in claims, funded by the homes' own bed tax.
• Medicaid pays nothing for hospital or therapeutic leave (none since 10/1/2016). There is no quality incentive program.
• Medicare crossovers are paid lesser-of: Medicaid pays only up to its own rate minus Medicare's payment, often $0.

Frequently asked

How does Wyoming Medicaid set nursing home prices each year?

Not from inflation. The Legislature's budget pays property rental rates first, then each home's exempt costs. The rest is split between statewide health care and operating prices in proportion to audited costs. For 7/1/2026 those prices are $114.85 and $107.73 per day.

Why do small Wyoming nursing homes have much higher Medicaid rates than large ones?

Rates get a percentage adjustment by bed-size group so each group's cost coverage is within 5% of the others (3% before 2026). Small rural homes post $332-$353/day, while large urban homes post about $213-$240.

Has Wyoming's PDPM switch for nursing homes been approved by CMS?

Not as of mid-2026. Wyoming began paying on PDPM in April 2025 and wrote it into rule effective 1/7/2026. Its state plan amendment, submitted 9/22/2025 and requesting a 7/1/2025 effective date, was still pending in June 2026 notices.

How much is paid outside the posted rate in Wyoming?

Large: $33.5M in SFY2025 supplemental payments against $89.7M in claims, mostly returned from the homes' own assessment.

What does Wyoming Medicaid pay on Medicare coinsurance days?

Lesser-of: Medicaid pays coinsurance only up to its rate minus Medicare's payment, often $0.

Does Wyoming require a minimum share of spending on care?

None.

How is the Wyoming nursing home provider tax charged?

A uniform per-day assessment on all non-Medicare days, set each October 1, returned as quarterly UPL payments per Medicaid day.

How the rate is set

How the method got here

Verified October 11, 2026

Cost basis

Uses cost reports

Yes

Cost report

Medicare cost report (CMS-2540) plus the Wyoming Financial Report for Long Term Care (state supplement), due 5 months after fiscal year end. If the complete report is more than 10 days late, the per diem is cut 25%; after 60 days all Medicaid payments are suspended (Ch. 7 Sec. 5).

Base year and rebasing

Rates effective each July 1 use desk-reviewed or audited cost reports for periods that ended two calendar years earlier (Ch. 7 Sec. 13(c)). The database is rebuilt every year. Costs set each home's exempt-cost per diem and the statewide health care/operating split, but the health care and operating prices themselves are not built from any one home's cost.

Components

Component	Method	Notes
health care (direct nursing)	statewide price, the same starting price for every home ($114.85/day from 7/1/2026; $115.24 from 1/1/2026). Each quarter it is multiplied by the home's Medicaid CMI / statewide average Medicaid CMI.	Covers RN, LPN, CNA and contract nursing wages and benefits, medical records and social services (Sec. 9(b)).
operating	statewide flat price, the same for every home regardless of cost ($107.73/day from 7/1/2026; $107.49 from 1/1/2026)	Administrative and general (including home office and management fees), plant, laundry, housekeeping, dietary, nursing administration, supplies, activities, medical director, and all other allowable costs.
capital (property rental rate)	price by building age: a 2015 base table from $15.55 (age 0) to $10.64 (age 40+). Ages rise one year each July 1, the table is indexed by Marshall Swift (Western Region, Class D nursing home), and renovations can re-age a building.	Paid in place of depreciation, interest and rent. If total property pay would exceed 10% of the budget, the property rates are rebased lower (Sec. 17).
exempt costs	each home's own cost per diem (pass-through)	Property taxes, property insurance, and fees for CNA classes, texts and exams. Utilities were exempt in the 2019 rule but are not listed in the 1/7/2026 rule.
bed-range adjustment	a percentage up or down by licensed-bed group so each group's average cost coverage is within a maximum 5% deviation of the others (Sec. 15(b))	The tolerance was +/-3% in the 2015-2019 rules. The number of groups and the factors are not published.

Inflation

None for private homes; any increase depends on the Legislature's appropriation. (The SFY2025 benchmarking study says NF rates are updated with 'predetermined inflation indices', but Chapter 7 has none; only the property table uses Marshall Swift.) State-owned homes alone are inflated by the SNF market basket.

Verified October 11, 2026

Case mix

System

PDPM

Applied at

Facility average

How it works

One rate per home per quarter. Health care price x (home's day-weighted Medicaid CMI from the prior quarter / simple statewide average of facility Medicaid CMIs), so every Medicaid resident in the home gets the same per diem (Ch. 7 Sec. 16(a)).

Classification

PDPM case-mix classification per Ch. 7 Sec. 16(d)(i) (1/7/2026 rule). The Department's pre-rate roster reports each resident's 'PDPM Nursing Component classification', so the index appears to use nursing-component weights; this is not confirmed. The Department sets default groups and weights for residents discharged before the first assessment and for untimely assessments.

Applies to

Health care (direct nursing) price only. Operating, property and exempt are not case-mix adjusted.

Acuity measured from

Medicaid residents only: non-PPS MDS assessments with a valid Medicaid number in A0700, weighted by days in each class during the prior quarter. The statewide average is the simple average of facility Medicaid CMIs.

Updated

quarterly (Jan 1, Apr 1, Jul 1, Oct 1)

Move to PDPM

After CMS ended RUG-IV support, Wyoming required the Optional State Assessment from October 2023 to keep computing RUG-IV. It switched to PDPM for rates starting April 1, 2025, and dropped the OSA for assessments after 1/1/2025 (bulletin 1/27/2025). Chapter 7 was amended to PDPM effective 1/7/2026. The SPA was submitted to CMS 9/22/2025 (requested effective date 7/1/2025, stated cost-neutral) and was still pending per public notices of June 18 and 26, 2026. Wyoming said it would resubmit with a 7/1/2026 date if needed. As of Oct 2026 it does not appear on medicaid.gov's approved-SPA list.

Verified October 11, 2026

Low-acuity residents

None found (checked Chapter 7, the 1/7/2026 rule, and the Institutional Provider Manual ch. 18). Because case mix is a facility average, low-acuity residents only pull down the home's quarterly CMI; there is no flat or reduced per-resident rate. Related: residents with untimely MDS assessments get a Department-designated default case-mix group and weight (Sec. 16(d)(ii)(B)).

Verified October 11, 2026

Capital

Fair rental-style price ('property rental rate') by building age. 2015 base: $15.55 at age 0 declining about $0.12 per year to $10.64 at 40+. Ages advance one year each July 1, the table is indexed annually by Marshall Swift (Western Region Class D), and renovations re-age a building by R = 40 x (renovation expense / square feet x current construction cost per sq ft). Buildings of unknown age default to 40 years. Property taxes and insurance are paid separately as exempt costs. If property pay exceeds 10% of the budget, the table is rebased down.

Verified October 11, 2026

Budget adjustment factor

No separate factor: the whole method is budget-constrained. Each year's appropriation funds property rates, then exempt costs, and the remainder becomes the health care and operating prices (Sec. 15). Each quarter the CMI ratio uses the statewide average, so case mix shifts pay between homes without changing the total. Recent legislative actions: about +20% on 7/1/2023, and +5% on 7/1/2024 (made permanent in the 2025 session). Earlier: a Governor's 2.5% cut and a temporary 5% increase (July 2021-June 2022). For SFY2027 the prices are essentially flat: health care $115.24 -> $114.85, operating $107.49 -> $107.73. The 2019 rule allowed last-quarter budget adjustments (Sec. 15(g)); the 2026 rule allows a new rate after a 'legislative budget change' (Sec. 13(b)).

Verified October 11, 2026

Add-ons and money outside the rate

Paid outside the posted rate

Level

large

Estimate

About 37% of base, gross: SFY2025 'Nursing Facilities Supplemental Payments' of $33.5M against $89.7M of nursing facility claims expenditures. In SFY2023 it was about 68% ($54.0M vs $79.3M), before the 20% rate increase used up UPL room. Net of the homes' own assessment the gain is smaller; the assessment total was not found.

Components

UPL adjustment payments funded by the provider assessment, paid quarterly to all non-state homes (most of the $33.5M). Nursing Facility Gap Payment, an annual lump sum to non-state government homes (2016 SPA estimate about $1.74M total computable per year).

Source

https://health.wyo.gov/wp-content/uploads/2026/02/SFY-2025-An…

Verified October 11, 2026

Payments by owner type

Applies

yes

Detail

Only non-state government-owned homes (county and hospital-district homes, e.g. Sublette County Hospital District, Crook County, South Lincoln, Weston County Manor) can get the annual Gap Payment from leftover NSGO-class UPL room. It is shared by each home's Medicaid-vs-Medicare gap after its assessment UPL payment, and homes with a negative gap get nothing; the 2016 estimate was about $1.74M per year in total. State-owned homes are paid their own uncapped, inflated cost instead of prices and are exempt from the assessment and the assessment payments. Private and government homes otherwise receive the same per diem and assessment payments.

Funding

Gap payment state share: the SPA does not name an IGT source on the payment pages, but the CMS program title was 'Nursing Facility IGT Program' (WY-16-007). Assessment payments are funded by the provider tax. No lease or management workaround for private operators was found.

Source

https://www.medicaid.gov/State-resource-center/Medicaid-State…

Verified October 11, 2026

Quality program

Active

No

Notes

None. Chapter 7 (1/7/2026) has no quality or value-based component, and MACPAC 2019 also reported none. The distressed-facility contract considers complaints and survey results, but it is a rescue rate, not an incentive.

Verified October 11, 2026

Provider tax

Charged

per non-Medicare day

Standard amount

Uniform per non-Medicare resident day, recalculated each October 1 (amount not published online; not found)

Tiers

Who	Test	Amount
state-owned nursing facilities	public	exempt
new facilities opening during the assessment year	other	not assessed until the next Oct 1 year

Lower for high-Medicaid homes

no

Returned in the rate

Not in the per diem. It is returned as quarterly UPL 'adjustment payments' allocated by each home's Medicaid days (from cost reports ending in the prior calendar year). The statute requires the money to raise NF payments above the 10/1/2010 rate level; the assessment ends if rates fall below that level plus the assessment-funded increase (W.S. 42-8-109).

Source

https://wyoleg.gov/statutes/compress/title42.pdf

Verified October 11, 2026

Provider tax notes

Nursing Care Facility Assessment (W.S. 42-8-101 to 109; Ch. 7 Sec. 21(b)). A uniform per-resident-day amount on all non-Medicare days, set prospectively each Oct 1-Sep 30 year and paid quarterly within 45 days after the quarter. Medicare days excluded from the base include traditional Medicare, Medicare Advantage/SNP and Medicare hospice days. The total is capped at the lesser of the amount needed or the 42 CFR 433.68 indirect-guarantee threshold. Proceeds plus federal match fund the quarterly UPL adjustment payments; administration is capped at 1%. State-owned homes are exempt. The per-day amount was not found in public sources.

Verified October 11, 2026

Supplemental payments

(1) Provider Assessment / UPL adjustment payments (since 4/1/2011): quarterly payments to all non-state homes, allocated by Medicaid days from the MMIS, within the Medicare UPL (Ch. 7 Sec. 21(a); W.S. 42-8-108). (2) Nursing Facility Gap Payment (SPA WY-16-007, effective 7/1/2016): an annual lump sum to non-state government-owned homes from UPL room left in the NSGO class after the assessment payments. It is shared by each home's Medicaid-vs-Medicare gap, and the home must attest to ownership each October. The 2016 SPA estimated about $1.74M total computable per year. Total 'Nursing Facilities Supplemental Payments' were $54.0M in SFY2023, $33.4M in SFY2024 and $33.5M in SFY2025 (WDH annual reports). No directed payments (no managed care).

Verified October 11, 2026

Other add-ons

None in the posted per diem beyond the components above. Extraordinary-care negotiated add-ons (per resident, prior authorized) are the only per-resident add-on.

Verified October 11, 2026

Units paid separately

Extraordinary care (Sec. 19; manual 18.10): per diem plus a negotiated add-on, prior authorized by Telligen, capped at actual cost. It covers ventilator dependence (automatic), tracheostomy, morbid obesity, psychiatric care for significant behaviors, and case-by-case complex care. It is reviewed at 15, 30 and 90 days, then every 6 months; the manual still cites an ADL score of 10 or more. Distressed facilities (Sec. 20): a temporary contract rate above the per diem but no more than the lesser of the Medicare rural PDPM federal rate or 200% of the home's per diem, and no more than actual cost; at most 12 months in any 5 years. State-owned homes (Sec. 18): own audited cost inflated by the SNF market basket, with no cap (e.g. Veterans' Home $366.47, Wyoming Retirement Center $353.12 in Jan 2026). Tribal PL 93-638 homes: a per diem updated annually by the OMB rate change (Morning Star Care Manor $613.69 in Jan 2026). Out-of-state homes: lesser of the home-state Medicaid rate, Wyoming's day-weighted average rate, or usual and customary charge, with no case mix. Hospital swing beds are billed under the same NF policy at posted swing-bed rates that match a nursing home's rate.

Verified October 11, 2026

Payment rules

Managed care for long-term care

Status

no

Detail

Wyoming Medicaid has no capitated managed care. Nursing facility services are paid fee-for-service on Chapter 7 per diems through the state MMIS. WYhealth (Optum) is a care-management and utilization-management contract, not a managed care plan. PACE is the only capitated long-term care option.

Verified October 11, 2026

Who pays

fee_for_service

Verified October 11, 2026

Managed care rate floor

Not applicable: there are no Medicaid managed care plans paying nursing homes in Wyoming.

Verified October 11, 2026

Included in the daily rate

All-inclusive (Ch. 7 Attachment A; manual 18.1.1). Included: room and board, all nursing, PT/OT/speech therapy (if the home sends a resident to an outside therapist, it pays), oxygen and concentrators, OTC drugs, nutritional supplements, medical/surgical supplies, standard wheelchairs, walkers, beds, transport by the facility. Paid separately: physician, lab, x-ray, hospital, prescription drugs, ambulance, dental, audiology, eye care, hearing aids, podiatry, prosthetics/orthotics, customized or electric wheelchairs (Sec. 12).

Verified October 11, 2026

Bed hold

Hospital stays

Not paid (since 10/1/2016).

Leave days

Not paid. An absence under 24 hours is billed as a normal covered day; 24 hours or more is billed as non-covered (value code 81).

Occupancy rule

n/a (the pre-10/2016 rule paid 14 days/year only when monthly occupancy was 90% or more)

Notes

The home may charge the resident or family to hold a bed only if it gave written notice beforehand (Sec. 8(b)).

Source

https://rules.wyo.gov/DownloadFile.aspx?source_id=25186&sourc…

Verified October 11, 2026

Personal needs allowance

Per month

50

Effective

unknown (in place as of Oct 2026)

Notes

WDH lists a '$50.00 for personal needs' deduction in the patient contribution. SPA WY-25-0005 (effective 7/1/2025) adds a $20/month deduction for the administrative fees of a Miller (qualified income) trust. Not COLA-indexed as far as found. Institutional income limit is 300% of the SSI FBR, and the home equity limit is $1,000,000 from 7/1/2026 (WY-26-0004).

Source

https://health.wyo.gov/healthcarefin/medicaid/programs-and-el…

Verified October 11, 2026

Medicare coinsurance days

Method

lesser_of

Rule

Institutional Provider Manual 6.5.1 and 7.4.1: 'Medicaid reimburses the lesser of the assigned coinsurance and deductible amounts or the difference between the Medicaid allowable and the Medicare paid amount.' Part A crossovers are priced at the header level. Medicare Advantage coinsurance days are billed to Medicaid with value code 82 (MA coinsurance rate x days); no separate MA rule was found, so lesser-of is assumed. Medicaid's payment is payment in full; QMB and dual residents cannot be balance-billed.

Effect

Medicare's Part A SNF rate is usually far above the $213-$353 Medicaid per diem, so Medicaid usually pays $0 of the days 21-100 coinsurance.

Source

https://www.wyomingmedicaid.com/portal/sites/default/files/in…

Verified October 11, 2026

Required care spending

Applies

no

Rule

None. Health care and operating are prices regardless of cost, with no direct-care spending floor or recoupment. Only the exempt pass-through and extraordinary-care rates are limited to actual cost.

Source

https://rules.wyo.gov/DownloadFile.aspx?source_id=25186&sourc…

Verified October 11, 2026

Occupancy rules

Applies

no

Rule

No minimum-occupancy test on rates (property is a flat age-based price). Minor: when computing capital cost on the cost report for homes under 90% occupancy, Medicare days are restated to reflect Medicare occupancy (Sec. 28(a)(i)(I)(III)), which does not affect the property price. Low occupancy is a factor for the distressed-facility contract rate.

Source

https://rules.wyo.gov/DownloadFile.aspx?source_id=25186&sourc…

Verified October 11, 2026

MDS accuracy penalties

No percentage penalty. Before each quarter the Department sends a resident roster (PDPM nursing class, days, CMI, payer) to correct in QIES. If a later Department review finds MDS errors that changed the CMI, the rate is retroactively adjusted for every affected quarter and over- or underpayments are settled (Sec. 16(e)). Untimely assessments get a Department-set default case-mix weight.

Verified October 11, 2026

Published rates and changes

How often rates change

A home's rate changes

quarterly

When

Prices and property ages reset each July 1 (state fiscal year). Every home's rate changes Jan 1, Apr 1, Jul 1 and Oct 1 as its prior-quarter Medicaid CMI is recomputed. Desk reviews, audits or legislative budget changes can also reset rates.

Verified October 11, 2026

When rates change

July 1 annual rate year; quarterly case-mix updates Oct 1, Jan 1, Apr 1. The provider assessment and UPL adjustment payments run on an Oct 1-Sep 30 year.

Verified October 11, 2026

Posted rates

Home-level rates published

Yes

Where

https://health.wyo.gov/healthcarefin/medicaid/fee-schedules/

Format

pdf

Cadence

quarterly

History

The current file (NH-Rates-October-2026.pdf) has quarterly tables back to 10/1/2025 and a summary table from 4/1/2024 to 7/1/2025.

Home identifier

NPI and facility name

Verified October 11, 2026

Rate build-ups

Published

No

What they show

Not published. The quarterly file shows only each home's total rate plus the statewide health care ('Base Rate') and operating prices. CMI, property, exempt and bed-range factors go only to each home in a rate letter (Myers and Stauffer is the rate contractor per the provider manual).

Verified October 11, 2026

Recent changes

Verified October 11, 2026

Assisted living

Medicaid assisted living

Covered

yes

Program

Community Choices Waiver (CCW), 1915(c), Wyoming Medicaid Rules Chapter 34; Assisted Living Facility Services is a listed waiver service

What is paid

Services only: an all-inclusive per diem covering personal care, 24-hour supervision and medication assistance. Case management is paid separately. Room and board are excluded and paid by the participant under a lease (Ch. 34 Sec. 12(b)).

Rate

A per diem tied to the participant's functional assessment (WDH annual report). Current dollar amounts were not found in public sources.

Limits

Nursing facility level of care required; income at or below 300% of FBR. Enrollment is capped statewide with a chronological waitlist and possible priority groups (Ch. 34 Sec. 6). The waiver was renewed in 2026 (provider renewal training Sept 2026).

Source

https://rules.wyo.gov/DownloadFile.aspx?source_id=22997&sourc…

Verified October 11, 2026

Sources

1. Wyoming Medicaid Rules Chapter 7: Nursing Facility Payment and Assessment (eff. 01/07/2026) · regulation
2. Wyoming Medicaid Rules Chapter 7 (eff. 04/26/2019-01/07/2026, superseded) · regulation
3. Wyoming Medicaid Rules Chapter 7 (eff. 05/29/2012-06/14/2017, superseded; cost-based) · regulation
4. Wyoming Nursing Care Facility Assessment Act, W.S. 42-8-101 to 109 (Title 42 compiled) · statute
5. SPA WY-15-003, Attachment 4.19-D (nursing facility price-based methodology, eff. 7/1/2015) · state plan
6. SPA WY-16-007, Attachment 4.19-D p.32D Addendum 5 (NSGO nursing facility supplemental/Gap payment, eff. 7/1/2016) · state plan
7. medicaid.gov SPA search, Wyoming (WY-25-0005 PNA trust deduction; WY-26-0004 home equity; no PDPM SPA approved) · agency page
8. WDH Medicaid State Plan page: public notices for the Nursing Home Reimbursement System (PDPM) SPA, June 18 and June 26, 2026 · agency page
9. Wyoming Medicaid Nursing Home Rates by Quarter (10/1/2026 file, with history) · rate file
10. Wyoming Medicaid Swingbed Rates 2026 · rate file
11. WDH Fee Schedules page · agency page
12. Provider Bulletin: Provider Rate Changes Effective July 1, 2026 (NFs not listed) · agency page
13. Bulletin: Optional State Assessment Discontinued (PDPM starting April 1, 2025), 1/27/2025 · agency page
14. Wyoming Medicaid Institutional Provider Manual v20.0 (10/1/2026), ch. 6.5, 7.4, 18 · agency page
15. Nursing Home & Swing Bed Billing and PASRR Requirements bulletin (7/13/2021) · agency page
16. WDH SFY 2025 Medicaid Annual Report (Table 1, Tables 32-33, Table 62) · agency page
17. WDH SFY 2023 and SFY 2024 Medicaid Annual Reports (NF supplemental payment totals) · agency page
18. SFY 2025 Wyoming Medicaid Reimbursement Benchmarking Study, Main Report · agency page
19. WDH Programs and Eligibility page ($50 personal needs deduction) · agency page
20. Wyoming Medicaid Rules Chapter 34: Community Choices Waiver Program (eff. 01/03/2024) · regulation
21. CCW Program Application and Fact Sheet (07/2026) · agency page
22. MACPAC Nursing Facility Payment Policies compendium (2019 baseline; out of date) · secondary

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