048-1 Wyo. Code R. §§ 1-5 - Eligibility

(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(3) has withdrawn the application;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.

Notes

048-1 Wyo. Code R. §§ 1-5