Wyo. Code R. 048-0037-18
Medicaid
Chapter 18: Medicaid Eligibility
Effective Date: 09/07/2012 to 05/22/2014
Rule Type: Superceded Rules & Regulations
Reference Number: 048.0037.18.09072012
This Chapter is promulgated pursuant to Title XIX of the Social Security Act, 20 C.F.R., Ch. III, Pt. 416, 42 C.F.R., Ch. IV, Subch. C, Pt. 435, 45 C.F.R., Subtitle B, Ch. II, Pt. 233, the Medical Assistance and Services Act at W.S. § 42-4-101, et seq., the Wyoming Administrative Procedure Act at W.S. § 16-3-101, et seq., and W.S. § 9-2-106.
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.
(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) Applicants shall be notified in writing if eligibility is denied, the reasons for the action, the specific regulation supporting the action, and an explanation of the right to request a hearing, as specified in 42 C.F.R. § 435.912.
(iv) A record of all action taken shall be documented in the case file, as specified in 42 C.F.R. § 435.913.
(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 anytime during that period, and would have been eligible for Medicaid had they applied, as specified in 42 C.F.R. § 435.914, 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, as required by 42 C.F.R. § 435.906.
(ii) Applicants may be accompanied, assisted, or represented by an individual or individuals of their choice during the application process, as required by 42 C.F.R. § 435.908.
(iii) Applicants may request assistance completing the applications or obtaining required verification.
(iv) Applicants shall be informed of the following information in writing and 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 are confidential and shall not be disclosed, except as follows:
(A) To ensure any medical assistance does not duplicate any benefit payment made by another state agency, insurer, group health plan, third party administrator, health maintenance organization or similar entity, upon request of the state agency, insurer or similar entity, the Department may disclose the client's name, social security number, amount of payment, charge for services, date of services, and services rendered, as provided by W.S. § 42-4-112.
(B) To ensure any medical assistance does not duplicate any benefit payment made by another state agency, insurer or similar entity, the Department may request the limited information listed in (A) above from such entities.
(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.
(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 assign to the Department any right to medical support and to payment for medical care 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 begins the first day of the month in which the individual is eligible, as specified in 42 C.F.R. § 435.914 and the Medicaid State Plan under Title XIX of the Social Security Act, except that eligibility under the Presumptive Pregnant Women Program begins the day the application is submitted and approved, as specified in Section 1920 of the Social Security Act.
(B) Eligibility Period. Individuals under age 19 and women on the Family Planning Waiver are 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 under Section 6 (Family and Children's Eligibility), Section 7 (Aged, Blind or Disability Eligibility), Section 8 (Special Eligibility Group), Section 9 (Employed Individuals with Disabilities Eligibility Group) or Section 10 (Medicare Savings Programs) of this Chapter, applicants must meet all of the following to be eligible for Medicaid:
(a) Citizenship and Alienage. Applicants must 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 11 of this Chapter. (b) Identification. Applicants must provide proof of identity, as specified in 42 C.F.R. § 435.407. (c) Residency. Applicants must 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 must provide a social security number.
Section 6. Family and Children's Eligibility.
(a) The following individuals are eligible for Medicaid:
(i) Children born to a Medicaid eligible woman are 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 Section 1902 of the Social Security Act. (ii) Children birth through age five (5), whose countable family income does not exceed one hundred thirty-three percent (133%) of Federal Poverty Level (FPL), are eligible for Medicaid. (iii) Children age six (6) through age eighteen (18), whose countable family income does not exceed one hundred percent (100%) of FPL, are eligible for Medicaid. (iv) Foster care children are 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) are 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 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)(1) of the Social Security Act, are eligible for Medicaid until age twenty-one (21).
(viii) Poverty-Level Pregnant Women. A woman who is pregnant and whose family income does not exceed one hundred thirty-three percent (133%) of FPL is eligible for Medicaid during the pregnancy and through a sixty (60) day period beginning on the last day of the pregnancy, as specified in Sections 1902(a)(10)(A)(i)(IV) and 1902(l)(1)(A) of the Social Security Act.
(ix) 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 is 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)(1) of the Social Security Act. Qualified Pregnant Women must cooperate in establishing paternity, and obtaining medical support during the sixty (60) day postpartum period, as specified in 42 C.F.R. § 433.147.
(x) Presumptive Eligibility for Pregnant Women. A woman who is pregnant and whose family income does not exceed one hundred thirty-three percent (133%) of FPL is eligible for temporary outpatient services while her eligibility for Medicaid benefits is being determined, as specified in Sections 1902(a)(47) and 1920 of the Social Security Act.
(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 thirty-three percent (133%) of FPL and is transitioning from the Pregnant Women Program is eligible for Medicaid coverage for certain family planning services under the authority of Section 1115(a) of the Social Security Act.
(xii) Family Care. Caretaker relatives of a dependent child under the age of nineteen (19) whose family income does not exceed the income eligibility levels specified in the Medicaid State Plan under Title XIX of the Social Security Act are 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 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 child support, and who have received Family Care benefits for three (3) of the last six (6) months are eligible for an extension of Medicaid benefits for four (4) months, as specified in Sections 1902(a)(10)(A)(i)(I) and 1925 of the Social Security Act.
(xiv) Twelve 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 are eligible for Medicaid for an extended period of time, as specified in Sections 1902(a)(10)(A)(i)(I) and 1925 of the Social Security Act. Funding for the Twelve Month Extended Medicaid group is re-evaluated annually. Coverage for this group is contingent on availability of funding.
(b) Treatment of Income.
(i) For all eligibility categories described in Section 6(a) of this Chapter which include an income requirement, income includes earned and unearned income, as specified in 42 U.S.C. § 1382a.
(ii) For all eligibility categories described in Section 6(a) of this Chapter which include an income requirement, income of a parent is considered to be available to a child under the age of eighteen (18) unless the child is in DFS custody, is married, or is not living in the parent's household.
(iii) For all eligibility categories described in Section 6(a) of this Chapter which include an income requirement, income of a child is considered to be available to a parent, except that the earned income of a child is not considered to be available to a parent when the child is a full-time student.
(iv) For all eligibility categories described in Section 6(a) of this Chapter which include an income requirement, income of a spouse is considered to be available to the other spouse when both spouses reside in the same household.
(v) Income disregards are designated by the Department, as specified in the Medicaid State Plan in accordance with Title XIX of the Social Security Act.
(c) Treatment of Resources. A resource test does not apply to any of the groups described in Section 6(a).
(d) Reporting Changes. Clients are responsible for reporting changes in any of the following circumstances to the Department:
(i) Income;
(ii) Household size;
(iii) Health insurance; and
(iv) Address.
Section 7. Aged, Blind or Disabled Eligibility.
(a) Eligibility Requirements.
(i) Aged, Blind, or Disabled. The applicant/client shall be:
(A) Age sixty-five (65) or over;
(B) Legally blind, as certified by an optical professional or the Social Security Administration (SSA); or
(C) An individual who is determined disabled by the SSA or the Department, as specified in Section 1614(a)(3) of the Social Security Act, 42 C.F.R. Ch. IV, Subch. C, Pt. 435, Subpart F and 20 C.F.R. Ch. III, Pt. 416, Subpart I.
(b) The following individuals are eligible for Medicaid:
(i) Individuals entitled to Supplemental Security Income (SSI) are eligible for Medicaid, as specified in Section 1902(a)(10)(A)(i)(II) of the Social Security Act.
(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, is eligible for Medicaid, 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 is eligible for Medicaid.
(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, are eligible for Medicaid.
(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, are eligible for Medicaid. Individuals must reside in a medical institutional 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 is available to the other spouse for individuals described in Section 7(a) above.
(ii) A parent's income is 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 is not available to a child if the child is married, or is institutionalized for more than thirty (30) days, or applies for assistance under a Home and Community Based Services waiver pursuant to Section 1915(c) of the Social Security Act or the Employed Individuals with Disabilities program.
(iii) Income of a spouse is not deemed available to the other spouse when applying for Inpatient Hospital Care, Nursing Home, Hospice or Home and Community Based Services under a waiver pursuant to Section 1915(c) of the Social Security Act.
(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.
(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 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, Subpart L.
(ii) Resources shall be determined to be 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 determined to be 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) "Qualified Long-Term Care Partnership Policy." A policy that meets all of the requirements set forth in W.S. § 42-7-102(a)(v).
(v) Resources shall not exceed the SSI resource limits as specified in 42 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 as specified in Section 1915(c) of the Social Security Act shall receive an additional Community Spouse allowance as specified in Section 1924 of the Social Security Act.
(vi) Trusts.
(A) Revocable Trusts. The principal of a revocable trust shall be 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 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 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 determined to be 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 income of the individual.
(C) Special Needs Trusts shall be established in accordance with W.S. § 42-2-403(f)(i) and Section 1917 of the Social Security Act.
(I) To qualify for a Special Needs Trust exception and exclude the resources within the trust, the Special Needs Trust shall:
(1.) Be irrevocable;
(2.) Be established for the sole benefit of an individual who is under age sixty-five (65) and disabled according to the criteria set forth in 42 U.S.C. § 1382c(a)(3);
(3.) Contain only the assets of a disabled individual who is under age sixty-five (65) when the trust is established. Any assets placed in the trust after age sixty-five (65) are not subject to the exception;
(4.) Be established by a parent, grandparent, legal guardian or a court consistent with W.S. §§ 42-2-403(f), 4-10-401(a)(iv) and 3-3-607(a)(vi); and
(5.) Provide that the state shall receive all amounts remaining in the trust upon the death of such individual up to an amount equal to the total amount of medical assistance paid on behalf of the individual.
(II) 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, and the Department shall be joined as a party to any such proceedings and served with a copy of all pleadings.
(III) The Department is a qualified beneficiary pursuant to W.S. § 4-10-103, and shall consent to termination of a Special Needs Trust pursuant to W.S. §§ 4-10-412 and/or 4-10-415 prior to death when a court order is entered providing that the Department shall be fully reimbursed from the Special Needs Trust.
(IV) All Special Needs Trusts shall have a valid spendthrift provision that complies with the laws of every state in which the individual has received Medicaid benefits.
(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 may 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 can 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.
(VI) 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.
(VII) Structured Settlements, Annuities. When the trust has been or will be the client of annuity payments, structured settlement payments, or any other periodic payments, these payments shall be titled in the name of the Special Needs Trust.
(VIII) Accountings. The Trustee shall provide an annual accounting of the trust income and expenditures. The Department may request more frequent accountings at its discretion.
(IX) Income. All distributions to or for the benefit of the individual, unless paid directly to a third party, shall be income to the individual.
(X) Principal. No portion of the principal shall be available to the individual.
(XI) 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 that provides an accounting within two (2) months after the individual's death.
(D) Pooled Trusts shall be established in accordance with W.S. § 42-2-403(f)(iii) and Section 1917 of the Social Security Act.
(I) To qualify for a Pooled Trust exception and exclude the resources, including the principal within the trust, the pooled trust shall:
(1.) Be irrevocable;
(2.) Be established for the sole benefit of an individual who is under age sixty-five (65) and disabled according to the criteria set forth in 42 U.S.C. § 1382c(a)(3), by the parent, grandparent, legal guardian of the disabled individual, by the disabled individual, or by a court;
(3.) Be established and managed by a non-profit association;
(4.) Maintain a separate account and Joinder Agreement for each beneficiary, but for the purposes of investment and management of funds, the accounts are pooled; and
(5.) Provide that to the extent that amounts remaining in a beneficiary's account upon the death of the individual beneficiary are not retained by the trust, the trust pays to the state from the remaining amount in the account an amount equal to the total amount of medical assistance paid on behalf of the beneficiary.
(II) Distributions. The pooled trust shall provide that all distributions must 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 considered available income.
(2.) Distributions for funeral expenses may not be paid after the beneficiary's death until the Department and all other state Medicaid agencies are fully reimbursed.
(III) Transfer Penalties. 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 in accordance with the Social Security Act, 42 C.F.R. Ch. IV, Subch. C, Pt. 435, 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 is not allowed when a physician verifies the client will not be able to return to the home within six (6) months; and
(B) The deduction is not allowed if the client has a spouse who is not institutionalized.
(iv) Deductions for a community spouse who lives in the community when his/her married partner 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, Subpart I, and the Medicaid State Plan.
(g) Benefits. Benefits begin:
(i) After completion of thirty (30) consecutive days in a medical institution or thirty (30) days after a hospice election. Benefits 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 begin on the first day of the month during which the plan of care is approved by the Department.
(h) Transfer penalties are imposed as follows:
(i) A transfer penalty shall be imposed 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 prescribed in Section 1917(c) of the Social Security Act, 42 U.S.C. § 1396p(c), and W.S. § 42-2-402.
(ii) Undue hardship as specified in Section 1917(c) of the Social Security Act, shall apply to transfer of resource penalties. Undue hardship 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 size; (iv) Health insurance; and (v) Address.
Section 8. Special Eligibility Groups.
(a) Breast and Cervical Cancer Treatment Program.
(i) The Department's Public Health Division's Breast and Cervical Cancer Early Detection Program determines financial eligibility in accordance with the State Plan under Title XIX of the Social Security Act and identifies applicants in need of treatment.
(ii) Medicaid benefits are available to individuals who are financially eligible and in need of treatment, as specified in Section 1902 of the Social Security Act.
(iii) Review of Eligibility. Eligibility shall be reviewed by the Department for continued eligibility every twelve (12) months.
(iv) Reporting Changes. Clients shall be responsible for reporting to the Department any changes in the following:
(A) Health insurance; (B) Address; and (C) Conclusion of treatment.
(b) Tuberculosis Assistance Program.
(i) Medicaid benefits are available to individuals who are infected with tuberculosis, as specified in Section 1902 of the Social Security Act. (ii) Treatment of Income. Countable income does not exceed the maximum amount of income a disabled individual described in Section 1902(a)(10)(A)(i) of the Social Security Act may have and obtain medical assistance under the plan, as specified in Section 1902(z)(1) of the Social Security Act. (iii) Treatment of Resources. Resources shall not exceed the SSI resource limit, as specified in 42 C.F.R. § 416.1205. (iv) Reporting Changes. Clients shall be responsible for reporting to the Department any changes in the following:
(A) Income; (B) Resources; (C) Household size; (D) Health insurance; and (E) Address.
Section 9. Employed Individuals with Disabilities Eligibility Group.
(a) Medicaid benefits are available to individuals with disabilities who work and pay a monthly premium for their healthcare coverage, as specified in Section 1902(a)(10)(A)(ii)(XV) of the Social Security Act and 42 U.S.C. § 1396a(a)(10). (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, as specified in 42 C.F.R. § 435.1005. (c) Treatment of Resources. Resource tests do not apply for this eligibility group. (d) Age Requirement. Individuals must be age sixteen (16) through sixty-four (64). (e) Employed. An individual shall be employed part-time or full-time during a specified payroll period. The individual can be considered employed when not working, but on temporary absence due to medical leave. (f) Premium. The individual shall pay a monthly premium calculated according to 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 size; (iii) Health insurance; and (iv) Address.
(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)(1) of the Social Security Act.
(i) Individuals must be entitled to Medicare Part A and B. (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 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 must be entitled to Medicare Part A and B. (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 can 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 must be entitled to Medicare Part A and B. (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 size; (iv) Health insurance; and (v) Address.
Section 11. 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 12. 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 13. 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 14. 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 15. Severability. If any portion of these rules is found invalid or unenforceable, the remainder shall continue in effect.