End Stage Renal Disease Program (ESRD)
End Stage Renal Disease
The Wyoming End Stage Renal Disease Program (ESRD) helps low-income Wyoming residents who have been diagnosed with End Stage Renal Disease cover their related expenses. ESRD can help with patient expenses that remain after Medicare and private insurance have paid their share. The program does not pay for any medical treatment or hospitalization not directly related to kidney dialysis.
In the case of Kidney Transplants, the program covers immunosuppressant medications only.
Wyoming currently has 9 dialysis treatment centers that work closely with the ESRD Program. Each facility provides patients with information regarding the program and assists those who may qualify for program benefits.
Current Benefits Provided by the Program:
Co-payments for medical services and prescriptions directly related to dialysis
Mileage reimbursement for clients who travel outside of their city of residence for dialysis
Per diem lodging, if the client is required by their physician to stay overnight for dialysis purposes
Reimbursement for health insurance premiums, including Medicare B and D premiums, for the client only
Transplant Clients - Reimbursement of immunosuppressant medications only
Income Eligibility based on 185% of US Federal Poverty Guidelines.
Medical Eligibility is determined by the State of Wyoming, Department of Health, Staff Physician.
To apply: Download the application. Complete all items on the application. Use the application check list to assure all required documents are included prior to sending to ESRD.
The application must be completed in its entirety and the original must be sent to the program with the patients CMS (HCFA) 2728, which can be obtained from their Nephrologist or dialysis center. Without this information, the application will not be processed. If eligible, the eligibility date is the date the complete application, including the CMS 2728, is received in the ESRD office.
Existing Clients - Forms for download:
1. Mileage Reimbursement Form- updated 08/16/13
2. Pre-authorization for Travel Form - updated 7/26/2011
3. Change of Information Form
Approved Drug List:
ESRD Formulary 12/05/2011
Standard Flat Rate Dialysis Payments:
Effective 9/01/2011 - Standard Flat Dialysis Rate
For additional information, please visit the following websites:
Wyoming Dialysis Centers
National Kidney Foundation
For more information, please contact:
Cherame Serrano, Program Manager
6101 Yellowstone Road, Suite 420
Cheyenne, WY 82002