(a) Eligibility
shall begin on the date on which a qualified provider or qualified hospital
determines that an individual is eligible for presumptive eligibility and ends
with the earlier of:
(i) The day on which
Medicaid eligibility is determined; 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 provider, or
(ii) Qualified Hospital.
(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. 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. A child shall be eligible for one (1)
presumptive eligibility period every twelve (12) months.
(iii) Parents and other Caretaker relatives
of a dependent child, whose family income does not exceed the income
eligibility levels specified in the Medicaid State Plan shall be eligible for
all services covered under the State Plan for this group. The individual shall
be eligible for (1) presumptive eligibility period every twelve (12)
months.
(iv) Certain individuals
needing treatment for Breast or Cervical Cancer whose income does not exceed
two hundred fifty percent (250%) of FPL shall be eligible for all services
covered under the State Plan for this group. The individual shall be eligible
for (1) presumptive eligibility period every twelve (12) months.
(v) Former foster care 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, shall be eligible
for all services covered under the State Plan for this group up to age
twenty-six (26). The individual shall be eligible for (1) presumptive
eligibility period every twelve (12) months.
(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 request reconsideration by
contacting the Department and then request an Administrative Hearing in
accordance with Chapter 4 of the Wyoming Medicaid Rules.
