(a) Application Process. - (i) Applicants shall submit an application in the manner and form prescribed by the Department, except when the individual is eligible for Supplemental Security Income (SSI). The application shall be completed, dated, and signed by the applicant or by any person who is assisting the applicant.
- (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 the following time frames:
- (A) Aged, Blind and Disabled programs:
- (I) Forty-five (45) days from the date of application, or
- (II) Sixty (60) days from the date of application when waiting on verification from a third party, or
- (III) Ninety (90) days from the date of application when waiting for a disability determination.
- (B) Family and Children's programs:
- (I) Forty-five (45) days from the date of application.
- (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 specified in 42 C.F.R. §§ 431.206 and 431.210.
- (iv) A record of all action taken shall be documented in the case file, as specified in 42 C.F.R. § 435.914.
- (v) Applicants shall be allowed to receive retroactive Medicaid benefits not to exceed three (3) calendar months prior to the application if the individual received Medicaid covered services at any time during that period, and would have been eligible for Medicaid had they applied, as specified in 42 C.F.R. § 435.915, unless restricted by other federal and state laws and regulations.
(b) Applicant Rights. - (i) Applicants shall be allowed the opportunity to apply for Medicaid without delay, as required by 42 C.F.R. § 435.906.
- (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. § 435.908.
- (iii) Applicants may request assistance completing the applications or obtaining required verification.
- (iv) Applicants shall be informed of the following information in writing and verbally as appropriate:
- (A) The eligibility requirements;
- (B) Available Medicaid services; and
- (C) The rights and responsibilities of applicants and clients.
- (v) Confidentiality. Applications and other personal identifying information are confidential and shall not be disclosed, except as follows:
- (A) To ensure any medical assistance does not duplicate any benefit payment made by another state agency, insurer, group health plan, third party administrator, health maintenance organization or similar entity, upon request of the state agency, insurer or similar entity, the Department may disclose the client's name, social security number, amount of payment, charges for services, dates of services, and services rendered, as provided by Wyoming Statute § 42-4-112.
- (B) To ensure any medical assistance does not duplicate any benefit payment made by another state agency, insurer or similar entity, the Department may request the limited information listed in (A) above from such entities.
- (vi) Administrative Hearing. If an administrative hearing is requested, it shall be conducted in accordance with Wyoming Medicaid Rules, Chapter 4, Medicaid Administrative Hearings.
- (vii) Civil Rights. 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.
(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, income, resources, and trusts.
- (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 Medicaid 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 Dates of Benefits.
- (A) Begin dates. Medicaid eligibility begins the first day of the month in which the individual is eligible, as specified in 42 C.F.R. § 435.915 and the Medicaid State Plan under Title XIX of the Social Security Act, except that eligibility under the Presumptive Programs, eligibility begins the day the application is submitted and approved, as specified in Section 1920 of the Social Security Act.
- (B) Eligibility Period. Individuals under age 19 and women on the Family Planning Waiver are deemed to be continuously eligible for Medicaid for 12 months from the effective date of eligibility or for 12 months from the last periodic review.
- (ii) Redetermination of Eligibility. The Agency shall redetermine an individual's eligibility every 12 months.
048-18 Wyo. Code R. § 18-4