Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0064 - Kid Care CHIP
Chapter 5 - Rules and Regulations for Kid Care CHIP ("Children's Health Insurance Program")
Section 5-4 - Application Process, Application Rights and Responsibilities
Universal Citation: WY Code of Rules 5-4
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 as specified in
42
CFR §
435.907(b).
(A) Any individual who knowingly makes a
false statement or misrepresentation or knowingly fails to disclose a material
fact in obtaining benefits may be guilty of a misdemeanor or felony, as
specified in Wyoming Statute §
42-4-111.
(ii) Applications shall be acted on within
forty-five (45) days from the date of the application, as required by
42
C.F.R. §
457.340(d).
(iii) Applicants shall be notified in writing
of the reasons for the action, the specific regulation supporting the action,
and an explanation of the right to request a hearing, as required by
42
C.F.R. §
457.340(e).
(b) Applicant Rights.
(i) Applicants shall be allowed the
opportunity to apply for Kid Care CHIP without delay, as required by
42
C.F.R. §
457.340(a).
(ii) Applicants may be accompanied, assisted,
or represented by an individual or individuals of their choice during the
application process, as required by
42
C.F.R. §
457.340(a).
(iii) Applicants may request assistance
completing the applications or obtaining required verification, as required by
42
C.F.R. §
457.340(a).
(iv) Applicants shall be informed of the
following information in writing and verbally as appropriate, as required by
42
C.F.R. §
457.340(a):
(A) The eligibility requirements;
(B) Available Kid Care CHIP services;
and
(C) The rights and
responsibilities of applicants and clients.
(v) Applications and other personal
identifying information are confidential and shall not be disclosed, except as
allowed by state and federal regulation, as required by
42 C.F.R. §
438.224.
(vi) Applicants shall not be excluded, denied
benefits, or otherwise discriminated against on the grounds of race, color,
sex, religion, political belief, national origin, age, or disability, as
required by
42 C.F.R. §
438.100(d).
(c) Applicant Responsibilities.
(i) Applicants shall cooperate in the process
of determining eligibility by providing all information and documentation
requested by the Department, including, but not limited to documents listed in
Sections 5 and
6.
(ii) Applicants shall assign to the
Department any right to medical support and to payment for medical care from a
third party to the extent that Kid Care CHIP has paid for medical
services.
(iii) Applicants who fail
to cooperate or provide the information requested by the Department shall be
denied eligibility.
(d) Eligibility Period and Redeterminations.
(i)
Effective Date of Benefits.
(A) Kid Care CHIP
eligibility begins the first day of the month following the application date if
the application date is on or before the twenty-fifth (25th) day of the month;
or the first day of the month after the following month if the application date
is after the twenty-fifth (25th) day of the month.
(B) Individuals are deemed to be continuously
eligible for twelve (12) months from the effective date of eligibility or for
12 months from the last periodic review, as required by
42 C.F.R.
§
457.342, unless the child turns age
nineteen (19), enters a public institution, moves out of state, becomes
eligible for Medicaid, or requests that the Kid Care CHIP policy be
closed.
(ii) The
Department shall re-determine an individual's eligibility every 12 months, as
required by
42 CFR
§
457.343
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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