(a) Effective Dates of Benefits. Eligibility shall begin on the date on which a qualified entity or qualified hospital determines that an individual is eligible for presumptive eligibility and ends with the earlier of: - (i) The day on which a Medicaid application is given a determination; or
- (ii) The last of day of the month following the month in which the determination of presumptive eligibility was made.
(b) Presumptive Eligibility determinations may be conducted by: - (i) Qualified providers, as specified in Social Security Act § 1920; or
- (ii) Qualified Hospitals, as specified in 42 C.F.R. § 435.1110.
(c) Presumptive Eligibility shall be limited to: - (i) Pregnant women whose family income does not exceed one hundred fifty-four percent (154%) of FPL shall be eligible for temporary outpatient services, as specified in Sections 1902(a)(47) and 1920 of the Social Security Act. A pregnant woman shall be eligible for one (1) presumptive eligibility period per pregnancy.
- (ii) Children under age six (6) whose family income does not exceed one-hundred fifty-four percent (154%) of FPL and children age six (6) through eighteen (18) whose family income does not exceed one-hundred thirty-three percent (133%) of FPL shall be eligible for all services covered under the State Plan, as specified in 42 C.F.R. § 435.1102. A child shall be eligible for one (1) presumptive eligibility period every twelve (12) months.
- (iii) Eligibility groups specified in 42 C.F.R. § 435.1102 and 42 C.F.R. § 435.1103 that are elected in the State Plan.
(d) Status as a qualified provider or qualified hospital may be terminated if staff at a qualified provider or qualified hospital knowingly provides false information to influence a presumptive eligibility determination. Providers may seek corrective action by contacting the Department or requesting an Administrative Hearing pursuant to Chapter 4 of the Medicaid Rules.
(e) Presumptive Eligibility determinations must be made in accordance with Department policy, 42 C.F.R. § 435.1101, 42 C.F.R. § 435.1102, and 42 C.F.R. § 435.1110.
048-18 Wyo. Code R. § 18-7