Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 18 - MEDICAID ELIGIBLITY
Section 18-4 - Application Process, Applicant Rights and Responsibilities
Universal Citation: WY Code of Rules 18-4
Current through September 21, 2024
(a) Application Process.
(i) Applicants shall submit an
application in the manner and form prescribed by the Department. The
application shall be completed, dated, and signed by the applicant or by any
person who is assisting the applicant.
(ii) Applications shall be processed 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 documentation from a third party to use in
determining eligibility, or
(III)
Ninety (90) days from the date of application when waiting for a disability
determination to be completed by the Wyoming Department of Health or
designee.
(B) Family and
Children's programs:
(I) Forty-five (45) days
from the date of application, or
(II) Sixty (60) days from the date of
application when waiting on documentation from a third party to use in
determining eligibility.
(iii) Applicants shall be notified in writing
of the reasons for the approval, denial or closure, the specific regulation
supporting the action, and an explanation of the right to request a hearing, as
specified in
42 C.F.R. §
431.210 and W.S. §
42-4-108.
(iv) Any individual who has been determined
eligible by the Social Security Administration for Supplemental Security Income
(SSI) is not required to complete an application.
(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 and
verbally as appropriate:
(A) The eligibility
requirements;
(B) Available
Medicaid services; and
(C) The
rights and responsibilities of individuals.
(v) If an administrative hearing is
requested, it shall be conducted in accordance with Wyoming Medicaid Rules,
Chapter 4, Medicaid Administrative Hearings.
(c) Applicant Responsibilities.
(i) Applicants shall cooperate in the
eligibility process by providing all information and documentation requested by
the Department, including, but not limited to, income, resources, and
trusts.
(ii) Applicants who fail to
cooperate or provide the information requested by the Department shall be
denied eligibility.
(d) Eligibility Period and Redeterminations.
(i)
Medicaid eligibility begins the first day of the month in which the individual
is eligible, except for eligibility under the Presumptive Programs, eligibility
begins the day the application is submitted and approved.
(ii) Individuals under age nineteen (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 review.
(iii) The Department shall redetermine an
individual's eligibility every twelve (12) months.
Disclaimer: These regulations may not be the most recent version. Wyoming may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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