Wyoming performs well on Medicaid expansion status, redetermination performance, private coverage retention, Medicaid spending growth, per-enrollee cost growth, Medicaid budget exposure, improper payment performance, independent NP practice, optimal PA scope of practice, and IMLC participation. Even so, Wyoming’s overall score is held down by no early work requirement activity, no MCO presence, weak MFCU enforcement activity, no APCD activity, active CON laws, and low primary care provider supply.