Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 35 - MEDICAID BENEFIT RECOVERY
Section 35-6 - Duties of Applicants and Clients

Universal Citation: WY Code of Rules 35-6

Current through September 21, 2024

(a) Notification of third party liability. An applicant or client shall notify the Social Security Administration or the Department of the possibility of third party liability at the time of application, at the time of an eligibility redetermination, and within ten (10) days after any event creating third party liability or any change in potential third party payers.

(b) Notice to providers. A client shall present the client's eligibility card to a provider at the time the client requests services. A client shall also inform a provider of the existence or possible existence of a third party payer at the time the client requests services from the provider and upon request from the provider.

(c) Cooperation in establishing paternity and obtaining medical support. As a condition of eligibility or continued eligibility, an applicant or client shall cooperate with the Department and local agency in establishing paternity of a child eligible for Medicaid or applying for Medicaid, and identifying and collecting from any third party payer. Cooperation includes:

(i) Appearing at the Department or local agency office to provide information or evidence regarding paternity;

(ii) Appearing as a witness at a court or other proceeding to testify regarding paternity;

(iii) Paying to the Department any medical support or medical payments received that are covered by the assignment of benefits;

(iv) Upon request from the Department or local agency, taking any other reasonable steps to assist in establishing paternity, determining third party liability and securing payment from third party payers; and

(v) Cooperating with the Department and the Department of Family Services in establishing paternity for applicable Medicaid births for the purposes of recovery of birth cost pursuant to W.S. §§ 42-4-122 and 14-2-1001 through 14-2-1008. Pursuant to W.S. § 14-2-1003, not more than sixty (60) days after an unmarried client of Medicaid gives birth to a child, the Department shall notify the Department of Family Services of the total birth cost. Total birth cost shall include:
(A) Maternity related expenditures including prenatal and postpartum care from nine (9) months prior to delivery through two (2) months after delivery, but not to exceed the average birth cost paid by Wyoming Medicaid.

(d) The refusal to cooperate in establishing paternity as set forth above, or the refusal to cooperate in locating third party payers or recovering payments from such payers, shall render such person ineligible for Medicaid, except as provided in 42 C.F.R. § 433.147 and 433.148.

(e) Incentive allowance for Estate Recovery.

(i) The Department may allow an incentive payment to the heirs, legatees or other person(s), when the following conditions are met:
(A) An incentive allowance shall be the lesser of ten percent (10%) of the net proceeds from the sale of the asset(s), or two-thousand ($2,000.00) dollars:

(B) An incentive allowance shall be permitted only upon approval in writing by the Department or their designee, and only if the Medicaid benefits paid on behalf of the client exceeds the net proceeds; and

(C) The net proceeds from the sale shall be determined by deducting from the sale price the costs of discharging any encumbrances on the property and other reasonable expenses incurred preserving or disposing of the asset(s).

(f) If a Medicaid client is enrolled with a private health insurer, the client must follow the rules of the primary insurance, including using an in-network provider.

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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