Wyo. Code R. 048-0037-18
Medicaid
Chapter 18: Medicaid Eligibility
Effective Date: 05/22/2014 to 04/11/2018
Rule Type: Superceded Rules & Regulations
Reference Number: 048.0037.18.05222014
This Chapter is promulgated pursuant to the Wyoming Medical Assistance and Services Act at W.S. § 42-4-104, the Wyoming Administrative Procedure Act at W.S. § 16-3-102 and W.S. § 9-2-106.
(a) This Chapter describes the rights and responsibilities associated with eligibility for Medicaid, establishes uniform procedures used in determining eligibility for Medicaid, and defines the eligibility groups. (b) The requirements of Titles XI, XVI and XIX of the Social Security Act, 20 C.F.R., Ch. III, Pt. 416, 42 C.F.R. Ch. IV, Subch. C, Pt. 433, 42 C.F.R. Ch. IV, Subch. C, Pt. 435, 42 C.F.R. Ch. IV, Subch. C, Pt. 440, 45 C.F.R. Subtitle B, Ch. II, Pt. 233 and 42 C.F.R. Ch. 7, Subch. XIX also apply to Medicaid and are incorporated by this reference as of the effective date of this Chapter, and may be cross-referenced throughout this Chapter where applicable. This incorporation by reference does not include any later amendments or editions of the incorporated matter. The incorporated matter may be viewed at http://www.ecfr.gov/cgi-bin/ECFR and www.ssa.gov or may be obtained at cost from the Department.
Except as otherwise specified in Chapter 1, the terminology used in this Chapter is the standard terminology and has the standard meaning used in health care, Medicaid, and Medicare.
(i) Applicants shall submit an application in the manner and form prescribed by the Department, except when the individual is eligible for Supplemental Security Income (SSI). The application shall be completed, dated, and signed by the applicant or by any person who is assisting the applicant. (ii) The Department shall act on applications within the following time frames: (A) Aged, Blind and Disabled programs: (I) Forty-five (45) days from the date of application, or (II) Sixty (60) days from the date of application when waiting on verification from a third party, or
(III) Ninety (90) days from the date of application when waiting for a disability determination.
(B) Family and Children’s programs:
(I) Forty-five (45) days from the date of application.
(iii) If eligibility is denied, applicants shall be notified in writing of the reasons for the action, the specific regulation supporting the action, and an explanation of the right to request a hearing.
(iv) A record of all action taken shall be documented in the case file.
(v) Applicants shall be allowed to receive retroactive Medicaid benefits not to exceed three (3) calendar months prior to the application if the individual received Medicaid covered services at any time during that period, and would have been eligible for Medicaid had they applied, unless restricted by other federal and state laws and regulations.
(b) Applicant Rights.
(i) Applicants shall be allowed the opportunity to apply for Medicaid without delay.
(ii) Applicants may be accompanied, assisted, or represented by an individual or individuals of their choice during the application process.
(iii) Applicants may request assistance completing the applications or obtaining required verification.
(iv) Applicants shall be informed of the following information in writing or verbally as appropriate:
(A) The eligibility requirements;
(B) Available Medicaid services; and
(C) The rights and responsibilities of applicants and clients.
(v) Confidentiality. Applications and other personal identifying information shall be confidential and shall not be disclosed, except for administration of the program or as otherwise permitted by law.
(vi) Administrative Hearing. If an administrative hearing is requested, it shall be conducted in compliance with Chapter 4.
(vii) Civil Rights. Applicants shall not be excluded, denied benefits, or otherwise discriminated against on the grounds of race, color, sex, religion, political belief, national origin, age, or disability except as allowed by law.
(c) Applicant Responsibilities.
(i) Applicants shall cooperate in the process of determining eligibility by providing all information and documentation requested by the Department, including, but not limited to, income, resources, and trusts.
(ii) Applicants shall be deemed to have assigned to the Department any right to medical support and to payment for medical benefits from a third party to the extent that Medicaid has paid for medical services.
(d) Eligibility Period and Redeterminations.
(i) Effective Dates of Benefits.
(A) Begin dates. Medicaid eligibility shall begin the first day of the month in which the individual is eligible.
(B) Eligibility Period. Individuals under age nineteen (19) and women on the Family Planning Waiver shall be deemed to be continuously eligible for Medicaid for twelve (12) months from the effective date of eligibility or for twelve (12) months from the last periodic review.
(ii) Redetermination of Eligibility. The Agency shall redetermine an individual's eligibility every twelve (12) months, or earlier if the Agency receives a reported change that may affect eligibility.
Section 5. General Eligibility Requirements. In addition to meeting the requirements of the specific program, applicants shall meet all of the following to be eligible for Medicaid:
(a) Citizenship and Alienage. Applicants shall be citizens or nationals of the United States, as specified in 42 C.F.R. § 435.406. Applicants who are not citizens or nationals of the United States, but otherwise meet the eligibility requirements of the State Plan, are eligible for limited emergency services, as specified in 42 C.F.R. § 440.255, except as set forth in Section 12 of this Chapter.
(i) Pregnant women considered to be lawfully present satisfy the citizenship and alienage eligibility requirement.
(b) Identification. Applicants shall provide the types of proof of identity that are specified in 42 C.F.R. § 435.407.
(c) Residency. Applicants shall reside in Wyoming or meet the criteria specified in 42 C.F.R. § 435.403.
(d) Social Security Number. Applicants who are citizens or nationals of the United States shall provide a social security number.
Section 6. Family and Children's Eligibility.
(a) The following individuals shall be eligible for Medicaid:
(i) Children born to a Medicaid eligible woman shall be deemed to have applied for medical assistance and to have been found eligible on the date of birth and to remain eligible for a period of one (1) year, as specified in 42 C.F.R. § 435.117.
(ii) Children birth through age five (5), whose countable family income does not exceed one hundred fifty-four percent (154%) of Federal Poverty Level (FPL), shall be eligible for Medicaid as specified in 42 C.F.R. § 435.118.
(iii) Children age six (6) through age eighteen (18), whose countable family income does not exceed one hundred thirty-three percent (133%) of FPL, shall be eligible for Medicaid as specified in 42 C.F.R. § 435.118.
(iv) Foster care children shall be eligible for Medicaid under Title IV-E of the Social Security Act.
(v) Foster care children who are not eligible under Title IV-E of the Social Security Act and are in the custody of the Department of Family Services (DFS) shall be eligible for Medicaid, as specified in 42 C.F.R. § 435.222.
(vi) Adopted children who live in Wyoming and are under a Wyoming Subsidized Adoption Agreement shall remain eligible for Medicaid until age twenty-one (21), as specified in 42 C.F.R. §435.145, 42 C.F.R. §435.222 and Section 1902 (a)(10)(A)(ii)(VIII) of the Social Security Act.
(vii) Children who were in DFS custody at the time of their eighteenth (18th) birthday and are released from custody at that time or later, as specified in Sections 1902(a)(10)(A)(ii)(XVII) and 1905(w)(l) of the Social Security Act, shall be eligible for Medicaid until age twenty-one (21).
(viii) Children who were in DFS custody at the time of their eighteenth (18th) birthday and were receiving Medicaid benefits under the State Plan at that time or later, as specified in 42 C.F.R. § 435.150, shall be eligible for Medicaid until age twenty-six (26).
(ix) Poverty-Level Pregnant Women. A woman who is pregnant and whose family income does not exceed one hundred fifty-four percent (154%) of FPL shall be eligible for Medicaid during the pregnancy and through a sixty (60) day period beginning on the last day of the pregnancy, as specified in 42 C.F.R. § 435.116.
(x) Qualified Pregnant Women. A woman who is pregnant and whose family income does not exceed the income eligibility levels specified in the Medicaid State Plan under Title XIX of the Social Security Act shall be eligible for Medicaid during the pregnancy and through a sixty (60) day period beginning on the last day of the pregnancy, as specified in 42 C.F.R. § 435.116, and Sections 1902(a)(10)(A)(i)(III) and 1905(n)(l) of the Social Security Act. Qualified Pregnant Women shall cooperate in establishing paternity, and obtaining medical support during the sixty (60) day postpartum period, as specified in 42 C.F.R. § 433.147.
(xi) Family Planning Waiver. A woman who is age nineteen (19) but under the age of forty-five (45), whose family income does not exceed one hundred fifty-nine percent (159%) of FPL and is transitioning from the Pregnant Women Program shall be eligible for Medicaid coverage for certain family planning services as specified in 42 C.F.R. § 435.214 and Section 1115(a) of the Social Security Act.
(xii) Family Care. Caretaker relatives of a dependent child, as specified in 42 C.F.R. 435.110, whose family income does not exceed the income eligibility levels specified in the Medicaid State Plan shall be eligible for Medicaid. Adults must cooperate in establishing paternity and obtaining medical support, as specified in 42 C.F.R. § 433.147 and Section 1931 of the Social
Security Act.
(xiii) Four (4) Month Extended Medicaid. Caretaker relatives of a dependent child under the age of nineteen (19) whose family income exceeds the Family Care income eligibility levels due to the receipt of spousal support, and who have received Family Care benefits for three (3) of the last six (6) months shall be eligible for an extension of Medicaid benefits for four (4) months, as specified in 42 C.F.R. § 435.115.
(xiv) Twelve (12) Month Extended Medicaid. Caretaker relatives of a dependent child under the age of nineteen (19) whose family income exceeds the Family Care income eligibility levels due to an increase in earning of the caretaker, and who have received Family Care benefits for three (3) of the last six (6) months shall be eligible for Medicaid for an extended period of time, as specified in 42 C.F.R. § 435.112. Funding for the Twelve Month Extended Medicaid group shall be re-evaluated annually. Coverage for this group shall be contingent on availability of funding.
(xv) Tuberculosis Assistance Program. Medicaid benefits shall be available to individuals who are infected with tuberculosis, as specified in 42 C.F.R. § 435.215.
(b) Treatment of Income.
(i) For all eligibility categories described in Section 6(a) of this Chapter which include an income requirement, income shall be calculated using the modified adjusted gross income of the household, as specified in 42 C.F.R. § 435.603 and the State Plan.
(c) Treatment of Resources. A resource test shall not apply to any of the groups described in Section 6(a).
(d) Reporting Changes. Clients shall immediately report changes in any of the following circumstances to the Department:
Section 7. Presumptive Eligibility.
(a) Effective Dates of Benefits. Eligibility shall begin on the date on which a qualified entity or qualified hospital determines that an individual is eligible for presumptive eligibility and ends with the earlier of:
(i) The day on which a Medicaid application is given a determination; or
(ii) The last of day of the month following the month in which the determination of presumptive eligibility was made.
(b) Presumptive Eligibility determinations may be conducted by:
(i) Qualified providers, as specified in Social Security Act § 1920; or (ii) Qualified Hospitals, as specified in 42 C.F.R. § 435.1110.
(c) Presumptive Eligibility shall be limited to:
(i) Pregnant women whose family income does not exceed one hundred fifty-four percent (154%) of FPL shall be eligible for temporary outpatient services, as specified in Sections 1902(a)(47) and 1920 of the Social Security Act. A pregnant woman shall be eligible for one (1) presumptive eligibility period per pregnancy.
(ii) Children under age six (6) whose family income does not exceed one-hundred fifty-four percent (154%) of FPL and children age six (6) through eighteen (18) whose family income does not exceed one-hundred thirty-three percent (133%) of FPL shall be eligible for all services covered under the State Plan, as specified in 42 C.F.R. § 435.1102. A child shall be eligible for one (1) presumptive eligibility period every twelve (12) months.
(iii) Eligibility groups specified in 42 C.F.R. § 435.1102 and 42 C.F.R. § 435.1103 that are elected in the State Plan.
(d) Status as a qualified provider or qualified hospital may be terminated if staff at a qualified provider or qualified hospital knowingly provides false information to influence a presumptive eligibility determination. Providers may seek corrective action by contacting the Department or seek an Administrative Hearing pursuant to Chapter 4 of the Medicaid Rules.
(e) Presumptive Eligibility determinations must be made in accordance with Department policy, 42 C.F.R. § 435.1101, 42 C.F.R. § 435.1102, and 42 C.F.R. § 435.1110.
(a) Eligibility Requirements. The applicant/client shall be:
(i) Age sixty-five (65) or over;
(ii) Legally blind, as certified by an optical professional or the Social Security Administration (SSA); or
(iii) Determined disabled by the SSA or the Department as specified in 42 C.F.R. § 435.541.
(b) The following individuals shall be eligible for Medicaid:
(i) Individuals entitled to Supplemental Security Income (SSI).
(ii) Any aged, blind, or disabled individual who loses eligibility for Supplemental Security Income (SSI) benefits due to an increase in income, but who would be eligible for SSI if the Cost of Living Adjustments (COLA) received since the SSI termination were disregarded, as specified in 42 C.F.R. § 433.147.
(iii) A child who was receiving SSI on the date of the enactment of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 and lost SSI due to the new definition of disability as determined by the SSA.
(iv) Individuals between the ages of fifty (50) and sixty-four (64) who lose SSI benefits due to the entitlement of SSA widow/widower benefits, as specified in Section 1634(b) of the Social Security Act.
(v) Individuals who are Aged, Blind or Disabled and reside in a medical institution, receive hospice services in accordance with a voluntary election, or receive Home and Community Based Services (HCBS) under a waiver pursuant to Section 1915(c) of the Social Security Act and have income at or below three hundred percent (300%) of the Supplemental Security Income (SSI) payment standard, as specified in 42 C.F.R. § 435.1005. Individuals shall reside in a medical institution for thirty (30) consecutive days or more, unless the individual is eligible for SSI or dies before completion of the thirty (30) consecutive days, as specified in Section 1902(a)(10)(A)(ii)(V) of the Social Security Act.
(c) Treatment of Income.
(i) Income of a spouse shall be deemed available to the other spouse for individuals described in Section 8(a) above.
(ii) A parent's income shall be deemed available to a child until the month after the child attains age eighteen (18), when the child lives in the parent's home. A parent's income shall not be available to a child if the child is married, is institutionalized for more than thirty (30) days, or applies for assistance under a Home and Community Based Services waiver or the Employed Individuals with Disabilities program.
(iii) Income of a spouse shall not be deemed available to the other spouse when applying for Inpatient Hospital Care, Employed Individuals with Disabilities, Nursing Home, Hospice or Home and Community Based Services under a waiver.
(iv) To qualify for an Income Trust exception, as specified in Section 1917 of the Social Security Act and W.S. § 42-2-403:
(A) The trust shall be irrevocable;
(B) The trust shall be composed only of pension, Social Security and other income to the individual and accumulated income in the trust;
(C) The trust shall provide that the state will receive all amounts remaining in the trust upon the death of the individual up to an amount equal to the total amount of medical assistance paid on behalf of the individual;
(D) The trust shall allow a monthly distribution of three hundred percent (300%) of the Supplemental Security Income Federal Payment as prescribed in 42 C.F.R. § 435.1005 for programs with no patient contribution, reasonable costs of administering the trust and a Community Spouse allowance according to Section 1924 of the Social Security Act;
(E) The trust shall allow a monthly distribution to pay towards the cost of nursing facility services, less allowable deductions. Deductions shall be allocated as specified in 42 C.F.R. § 435.725, except the trust may provide that the trustee pay any reasonable costs of administering the trust;
(F) No portion of the principal shall be considered available to the individual;
and
(G) Transfer Penalties. Penalties for transferred resources shall not apply to resources transferred into an Income Trust.
(d) Treatment of Resources.
(i) Resources shall be deemed available to the applicant or client when the applicant or client has the legal right, authority or power to make the resource available, as specified in 20 C.F.R. Ch. III, Pt. 416, and Subpart L.
(ii) Resources shall be deemed unavailable to the applicant or client when there is a legal impediment that precludes the disposal of the resource. The applicant or client shall pursue reasonable steps to overcome the legal impediment, unless it is determined by the Department that the cost of pursuing legal action would exceed the resource value of the property or that it is unlikely the applicant or client would succeed in the legal action.
(iii) Real property shall be deemed unavailable if the property cannot be sold because the property is jointly owned and its sale would cause undue hardship because of the loss of housing for the other owner or owners, or because reasonable efforts to sell the property have been unsuccessful.
(iv) Resources shall not exceed the SSI resource limits as specified in 20 C.F.R. § 416.1205, except that individuals who are Aged, Blind or Disabled and reside in a medical institution, receive Hospice Services, or receive Home and Community Based Services under a waiver shall receive an additional Community Spouse allowance as specified in Section 1924 of the Social Security Act.
(v) Trusts.
(A) Revocable Trusts. The principal of a revocable trust shall be deemed an available resource when the applicant or client can revoke the trust and reclaim the trust resources.
(B) Irrevocable Trusts.
(I) The principal of an irrevocable trust shall be deemed an available resource when:
(1.) The resources of the individual or spouse were used to form all or part of the principal of the trust; and
(2.) Payments from the trust could be made available to or for the benefit of the individual or spouse. The portion of the principal from which payments could be made available to or for the benefit of the individual or spouse shall be deemed an available resource. If the terms of a trust provide for the support of the applicant or client, the refusal of a trustee to make a distribution from the trust does not render the trust an unavailable resource.
(II) The principal of an irrevocable trust shall be deemed unavailable when the resources of someone other than the individual or spouse (i.e., a third party) were used to form the principal of the irrevocable trust unless the terms of the trust permit the individual to require the trustee to distribute principal or income to the individual or spouse.
(III) Payments made from the portion of the principal of an irrevocable trust to or for the benefit of the individual shall be deemed income of the individual.
(C) Special Needs Trusts shall be established as specified in W.S. § 42-2-403(f)(i) and Section 1917 of the Social Security Act.
(I) The Trustee shall obtain the consent of the Department prior to early termination of a Special Needs Trust pursuant to W.S. § 4-10-412. The Department shall consent to termination of a Special Needs Trust prior to the individual's death when a court order is entered providing that the Department shall be fully reimbursed from the Special Needs Trust.
(II) All Special Needs Trusts shall have a valid spendthrift provision.
(III) Distributions.
(1.) Distributions from the Special Needs Trust shall be for the sole benefit of the disabled individual and shall be used to provide for the individual's special needs.
(2.) Distributions for funeral expenses shall not be paid after the beneficiary's death until the Department and all other state Medicaid agencies are fully reimbursed.
(3.) Distribution for basic needs shall only be allowed when the Trustee has proven to the Department that the disabled individual's basic needs are not adequately being provided for by government assistance programs.
(IV) Contributions. All contributions from third parties to the trust shall be deemed a completed gift to the disabled individual and the third party may not obtain a refund, redirect resources transferred to the trust, or otherwise exert any interest or control over the resources in the trust.
(V) Structured Settlements, Annuities. When the trust has been or will receive annuity payments, structured settlement payments, or any other periodic payments, the payments shall be titled in the name of the Special Needs Trust.
(VI) Accountings. The Trustee shall provide an annual accounting of the trust income and expenditures. The Department may request more frequent accountings at its discretion.
(VII) Income. All distributions to or for the benefit of the individual, unless paid directly to a third party, shall be deemed income to the individual.
(VIII) Principal. No portion of the principal shall be available to the individual.
(IX) Repayment to the Department and Final Accounting. When the individual beneficiary dies or the trust is terminated, the trustee shall notify the Department and provide a sworn affidavit and an accounting within two (2) months after the individual's death.
(D) Pooled Trusts shall be established as specified in W.S. § 42-2-403(f)(iii) and Section 1917 of the Social Security Act.
(I) Distributions. The pooled trust shall provide that all distributions shall be for the sole benefit of the disabled individual and shall be used to provide for the individual's special needs.
(1.) Any distribution from the trust paid directly to the disabled individual shall be deemed available income.
(2.) Distributions for funeral expenses shall not be paid after the beneficiary's death until the Department and all other state Medicaid agencies are fully reimbursed.
(II) Penalties for transferred resources shall not apply to resources transferred into a Pooled Trust, except that all amounts transferred to the Pooled Trust by an individual or his/her spouse after age sixty-five (65) shall be subject to a transfer penalty as specified in subsection (h) below.
(e) Special Circumstances. If an individual otherwise meets the criteria for the Developmental Disabilities or Acquired Brain Injury Waivers, but does not meet the income and/or resource requirements, the individual may retain waiver services through the Employed Individuals with Disabilities program.
(f) Patient Contribution
(i) Deductions from the client's gross income shall be allowed in determining the amount of the client's monthly contribution to be paid toward the cost of care in a medical facility.
(ii) Allowable deductions shall be applied as specified in the Social Security Act, 42 C.F.R. Ch. IV, Subch. C, Pt. 435, and Subpart I, and the Medicaid State Plan.
(iii) An individual temporarily in an institution shall be allowed a maintenance deduction not to exceed one hundred fifty dollars ($150.00) per month for up to six (6) months to maintain the home, except:
(A) The deduction shall not be allowed when a physician verifies the client will not be able to return to the home within six (6) months; and
(B) The deduction shall not be allowed if the client has a spouse who is not institutionalized.
(iv) Deductions for a community spouse who lives in the community when the client lives in a medical institution, receives services under the Assisted Living Facility, Long Term Care or Developmental Disabilities Waiver, or Hospice Care, shall be applied in the manner prescribed in Title XIX of the Social Security Act, 42 C.F.R. Ch. IV, Subch. C, Pt. 435, and Subpart I, and the Medicaid State Plan.
(g) Benefits. Benefits shall begin:
(i) After completion of thirty (30) consecutive days in a medical institution or thirty (30) consecutive days after a hospice election, benefits shall begin the first day of the month of entry into the medical institution when all eligibility requirements are met.
(ii) Home and Community Based Services shall begin on the first day of the month during which the plan of care is approved by the Department.
(h) Transfer penalties shall be imposed as follows:
(i) For nursing facility or home and community based services when an individual or the individual's spouse disposes of income or resources for less than fair market value on or after the look-back period, as specified in Section 1917(c) of the Social Security Act, 42 U.S.C. § 1396p(c), and W.S. § 42-2-402.
(ii) Undue hardship shall apply to transfer of resource penalties, and may be granted when the following criteria are met:
(A) The penalty period would deprive the individual of food, clothing, shelter, or other necessities of life or medical care such that the individual's health or life would be endangered;
(B) The individual has exhausted all reasonable legal means to recover or regain possession of the transferred resource or income or has demonstrated that effort to access or regain possession of the resource is not likely to succeed; and
(C) The individual or financially responsible person cannot afford the cost of the individual's care for nursing facility or home and community based services.
(i) Reporting Changes. Clients shall be responsible for reporting to the Department any changes in the following:
(i) Income; (ii) Resources; (iii) Household composition; (iv) Health insurance; and (v) Contact information.
Section 9. Special Eligibility Groups.
(a) Breast and Cervical Cancer Treatment Program.
(i) Medicaid benefits are available to individuals who are financially eligible and in need of treatment, as determined by The Department's Public Health Division's Breast and Cervical Cancer Early Detection Program.
(ii) Eligibility shall be reviewed by the Department for continued eligibility every twelve (12) months.
(iii) Reporting Changes. Clients shall be responsible for reporting to the Department any changes in the following:
(A) Health insurance; (B) Contact information; and (C) Conclusion of treatment.
(a) Medicaid benefits shall be available to individuals with disabilities who are employed and pay a monthly premium for their healthcare coverage and who meet the other requirements of this section. (b) Treatment of Income. Countable income shall be less than or equal to three hundred percent (300%) of the Supplemental Security Income (SSI) payment standard. (c) Treatment of Resources. Resource tests shall not apply for this eligibility group. (d) Age Requirement. Individuals shall be sixteen (16) through sixty-four (64) to be eligible under this group. (e) Employed. An individual shall be employed part-time or full-time during a specified payroll period. The individual shall be considered employed when not working, but on temporary absence due to leave. (f) Premium. The individual shall pay a monthly premium as specified in W.S. § 42-4-115 and 42-4-116. (g) Reporting Changes. Clients shall be responsible for reporting to the Department any changes in the following:
(i) Income; (ii) Household composition; (iii) Health insurance; and (iv) Contact information.
(a) Qualified Medicare Beneficiary (QMB). Medicaid shall assist individuals eligible for QMB with paying their Medicare premiums, cost sharing and deductibles, as specified in Sections 1902(a)(10)(E)(i) and 1905(p)(l) of the Social Security Act.
(i) Individuals entitled to Medicare Part A and B shall be eligible for this program. (ii) Treatment of Income. Countable income shall be equal to or less than one hundred percent (100%) of the Federal Poverty Level (FPL).
(iii) Treatment of Resources. Countable resources shall not exceed three (3) times the SSI resource limit, as adjusted annually by the increase in the consumer price index.
(iv) Benefits shall begin the first day of the following month after eligibility is determined.
(b) Specified Low-Income Medicare Beneficiary (SLMB). Medicaid shall assist individuals eligible for SLMB with paying their Medicare premiums, as specified in Section 1902(a)(10)(E)(iii) of the Social Security Act.
(i) Individuals entitled to Medicare Part A and B shall be eligible for this program.
(ii) Treatment of Income. Countable income shall be more than one hundred percent (100%) of the FPL but less than or equal to one hundred twenty percent (120%) of the FPL.
(iii) Treatment of Resources. Countable resources shall not exceed three (3) times the SSI resource limit, as adjusted annually by the increase in the consumer price index.
(c) Qualified Individual (QI). Medicaid shall assist eligible individuals with paying their Medicare premiums, as specified in Section 1902(a)(10)(E)(iv)(I) of the Social Security Act.
(i) Individuals entitled to Medicare Part A and B shall be eligible for this program.
(ii) Treatment of Income. Countable income shall be more than one hundred twenty percent (120%) of the FPL but less than or equal to one hundred thirty-five percent (135%) of the FPL.
(iii) Treatment of Resources. Countable resources shall not exceed three (3) times the SSI resource limit, as adjusted annually by the increase in the consumer price index.
(d) Review of Eligibility. Eligibility shall be re-determined by the Department every twelve (12) months for all groups within this section.
(e) Reporting Changes. Clients shall be responsible for reporting to the Department any changes in the following:
(i) Income;
(ii) Resources;
(iii) Household composition;
(iv) Health insurance; and
(v) Contact information.
Section 12. Emergency Services. Applicants who are not citizens or nationals of the
United States, but otherwise meet the eligibility requirements of the State Plan, are eligible for limited emergency services, as specified in 42 C.F.R. § 440.255. Applicants who do not meet the citizenship and alienage requirements shall not be eligible for emergency services under the Nursing Home, Home and Community Based Services under a waiver pursuant to Section 1915(c) of the Social Security Act, Hospice, Presumptive Eligibility, Family Planning Waiver, EID, Breast and Cervical Cancer, and Tuberculosis programs.
Section 13. Delegation of Duties. The Department may delegate any of its duties under this rule to the Wyoming Attorney General, HHS, any other agency of the federal, state or local government, or a private entity which is capable of performing such functions, provided that the Department shall retain the authority to impose sanctions, recover overpayments or take any other final action authorized by this Chapter.
Section 14. Interpretation of Chapter.
(a) The order in which the provisions of this Chapter appear is not to be construed to mean that any one provision is more or less important than any other provision.
(b) The text of this Chapter shall control the titles of its various provisions.
Section 15. Superseding Effect. This Chapter supersedes all prior rules or policy statements issued by the Department, including manuals and/or bulletins, which are inconsistent with this Chapter.
Section 16. Severability. If any portion of these rules is found invalid or unenforceable, the remainder shall continue in effect.