Current through September 21, 2024
(a) Introduction. This section is intended to
provide uniform procedures for determining eligibility for the PDAP.
(b) Application process. DFS shall follow the
process described below when an individual makes a request for the PDAP
program:
(i) An application form shall be
provided;
(ii) A separate
application shall be required for each assistance unit, and the applicant shall
be notified, in writing, of the result;
(iii) The application shall be accepted when
complete, and date stamped;
(iv)
Applicants shall be informed of the eligibility criteria and their rights and
responsibilities for and services available under the program;
(A) An application shall be approved if the
applicant is found to be eligible; or
(B) An application shall be denied if the
applicant:
(1) is found to be ineligible;
(2) does not provide all required
information;
(3) has withdrawn the
application;
(4) is an inmate of a
public institution; or
(5) is not
a resident of Wyoming.
(v) Documentation of the action taken and the
reasons for the action shall be placed in the applicant's case file.
(vi) DFS shall provide written notice,
delivered by first-class United States mail, to the applicant of the
determination.
(vii) A completed
application shall be acted upon within forty-five (45) calendar days from the
date it is received;
(c)
Rights of applicants. Applicants have the following rights:
(i) To apply without delay at the DFS office
of choice;
(ii) To be accompanied
or assisted by the person of choice in requesting or completing an
application;
(iii) To request
assistance from DFS in completing an application;
(iv) To apply for PDAP in the DFS office of
choice, either in person or by mail, to leave the application at that DFS
office, to have eligibility determined and maintained in that DFS
office;
(v) The application and all
personally identifiable information shall be kept confidential and shall not be
disclosed except as necessary to determine or verify eligibility or in
accordance with the rules of the Department.
(vi) To be treated with respect and
nondiscrimination in accordance with applicable federal and state
laws.
(vii) Persons requesting
program assistance shall be informed:
(A)
Orally or in writing of the program eligibility factors and required
verifications;
(B) In writing of
the effective date of eligibility; and
(C) In writing of their rights and
responsibilities.
(viii)
The denial of an application for benefits is an adverse action and an applicant
is entitled to reconsideration and an administrative hearing pursuant to
W.S.
16-3-102 and W.S. W.S.
W.S.
9-2-104(a)(vii).
(d) Responsibilities of
applicants.
(i) An applicant must complete an
application in the form and in the manner specified in writing by the
Department. The application must be:
(A)
Completed;
(B) Dated; and
(C) Signed under penalty of perjury by the
applicant.
(ii) An
applicant must cooperate fully in the process of determining eligibility,
including the following:
(A) Provide any and
all necessary information required by the application; and
(B) Promptly provide a notice of change to
reflect change in income, a change of address, or a change in health insurance
coverage.
(iii) An
applicant who is eligible for the Medicare approved prescription drug discount
card, if cost effective, must:
(A) Upon
application, provide the cardholder information; and
(B) Use the subsidy provided by the
card.
(e)
Verifications. The following information shall be documented, and such
documentation shall be maintained in the individual's case file:
(i) Wyoming residence; and
(ii) The reasons for the denial of
eligibility.
(f)
Residents. Eligibility is limited to residents of Wyoming.
(g) Eligible persons. Eligibility shall be
limited to persons whose income is less than or equal to the Federal poverty
level.
(h) Income. Eligibility
shall be determined using the countable income of the assistance unit in which
the applicant lives.
(i) Except as specified
in paragraph (ii), eligibility shall be determined based on the applicant's
family's countable income during the most recently completed calendar
month.
(ii) Income from
self-employment shall be based on the monthly average of the assistance unit's
annual countable income for the previous twelve month period.
(i) Resources. Eligibility shall
be limited to those with countable resources less than Two Thousand Five
Hundred Dollars ($2,500).
(j)
Eligibility redetermination. DFS shall conduct twelve month periodic reviews to
determine continuing eligibility. Such reviews shall be done on forms and in
accordance with procedures developed and specified in Manuals or Bulletins by
the Division.
(k) Duration of
eligibility. After being determined eligible, a recipient shall remain eligible
for twelve months following the effective date of eligibility, or until the
recipient becomes eligible for Medicaid or the recipient enters a public
institution, whichever comes first, unless there is a change in income which
renders the recipient ineligible.
(l) Copayments. Each recipient will be
responsible for making co-payments pursuant to this subsection.
(i) Generic prescription drugs: $10.00 per
prescription; and
(ii) Brand name
prescription drugs: $25.00 per prescription.
(iii) Copayments may be adjusted pursuant to
W.S. W.S.
42-4-118.
