048-46 Wyo. Code R. §§ 46-4 - Eligibility Requirements

(a) Eligibility under this Chapter is limited to persons who complete the application process and who meet the requirements for clinical and financial eligibility established under this Section. An individual is not eligible for the Wyoming Medicaid Supports Waiver unless the individual meets the following criteria:

(i) The individual satisfies the citizenship, residency, and financial eligibility requirements established in Chapter 18 of the Department of Health's Medicaid Rules;

(ii) The individual qualifies for the relevant institutional level of care pursuant to Section 6 of this Chapter;

(iii) The individual has received a clinical eligibility diagnosis pursuant to Section 7 of this Chapter; and

(iv) The individual has received a qualifying Inventory for Client and Agency Planning (ICAP) score pursuant to Section 8 of this Chapter.

(b) An individual is not eligible for the Wyoming Medicaid Comprehensive Waiver unless the individual meets the following criteria:

(i) The individual meets the eligibility criteria pursuant to subsection (a) of this Section;

(ii) The individual has assessed service needs in excess of the established cost limit on the Supports Waiver; and

(iii) The individual meets one of the following:

(A) The emergency criteria as approved by the Extraordinary Care Committee (ECC); or

(B) The criteria for reserved capacity as specified in Section 13(f) or (g) of this Chapter.

(c) Diagnoses and assessments used to meet initial clinical eligibility shall be accurate and shall be completed within the past five (5) years. Any assessment or reassessment for eligibility is subject to review by the Division before acceptance, and may require additional evidence or verification.

(d) Case managers shall complete all eligibility paperwork within thirty (30) calendar days of being selected. Submitted paperwork shall be reviewed by the Division within thirty (30) calendar days of receipt.

Notes

048-46 Wyo. Code R. §§ 46-4

Adopted, Eff. 6/21/2017. Amended, Eff. 7/26/2018. Amended, Eff. 12/20/2019.