Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 2 - STATE LICENSED SHELTER CARE ELIGIBILITY AND SERVICES
Section 2-15 - Eligibility for state licensed shelter care services
Universal Citation: WY Code of Rules 2-15
Current through September 21, 2024
(a) Eligibility for state licensed shelter care services is limited to individuals that:
(i) Are elderly;
(ii) Are not eligible for Medicaid because of
excess income;
(iii) Meet the
medical necessity requirements of Section 17;
(iv) Reside or intend to reside in a nursing
facility designated by WDH pursuant to (b); and
(v) Are financially eligible pursuant to (c);
or
(vi) Were receiving state
licensed shelter care services on April 1, 1991, or
(vii) Receive partial month care.
(b) Designation of nursing facility. WDH shall designate the nursing facility in which the applicant must reside. WDH shall designate the nursing facility which:
(i) Has an appropriate bed; and
(ii) Has the lowest per diem rate, as of
January 1 of the current calendar year, of any nursing facility located in:
(A) The county in which the recipient
resides; or
(B) Any county which is
adjacent to the county in which the recipient resides, unless the county is not
connected by an interstate, primary or secondary highway.
(C) If placement in the nursing facility
selected pursuant to (A) or (B) would result in an undue hardship, the
individual may remain in the nursing facility where he or she resides, or enter
a nursing facility in the community where the individual resides.
(iii) This subsection shall not
apply if:
(A) The recipient is eligible
pursuant to paragraph (a)(vi); or
(B) A private source agrees, in writing, to
pay at least twenty-five (25) percent of the difference between the recipient's
contribution to the cost of care and the cost of care at the nursing facility
of the recipient's choice.
(c) Financial eligibility.
(i) Income eligibility. An individual's
income must be:
(A) Greater than
three-hundred percent of the SSI eligibility standard; and
(B) Less than the seventy-fifth (75th)
percentile of Wyoming nursing facility private pay rates as determined pursuant
to paragraph (ii).
(ii)
HCF shall determine the seventy-fifth percentile of Wyoming nursing facility
private pay rates, to be used in determining eligibility for the twelve months
beginning January 1 of each year.
(iii) A change in a private pay rate or
result of a reconsideration appeal of a nursing facility rate used in the array
as a result of a desk review or a field audit pursuant to Chapter VII shall not
result in a recalculation of the seventyfifth percentile pursuant to paragraph
(ii).
(iv) Resource eligibility. An
individual's resources may not exceed the Medicaid resource standards as set
forth in Chapter II.II.
(v) Spousal
impoverishment. The provisions of Chapter II.II, Section 8, apply and are
incorporated by reference.
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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