EqualityCare (Medicaid) Eligibility

Who is Eligible for Wyoming Medicaid?

 

Eligibility is generally based on family income and sometimes assets and/or healthcare needs.   Federal statutes define more than fifty groups of individuals that may qualify for Medicaid coverage.   There are four broad categories of Medicaid eligibility in Wyoming:

·         Children

·         Pregnant Women

·         Family Care Adults

·         Aged, Blind and Disabled

·         Childless adults who do not fit into one of these categories are not covered regardless of income or assets.

 

·         Children

·         Newborns are automatically eligible if the mother is Medicaid eligible at the time of the birth.

·         Low Income Children are eligible if family income is below 100% FPL or 133% FPL (federal poverty level),      dependent on age of the child

·         Family Care Children are eligible when a caretaker is determined eligible based on family income below  the 1996 Family Care Standard

·         Foster Care Children in DFS (Department of Family Services) custody are eligible in different income levels including some who enter subsidized adoption or who age out of foster care until they are age 21

 

·         Pregnant Women

·         Pregnant Women are eligible if family income is below 133% FPL and women with income below the 1996   Family Care Standard must cooperate with child support

·         Presumptive Eligibility allows coverage of outpatient services from the date of application until the last day of the following month.

 

·         Family Care Adult

·         Family Care Adults (caretaker relatives with a dependent child) are eligible if family income is below the 1996 Family Care Standard

 

Aged, Blind and Disabled

 

SSI (Supplemental Security Income) and SSI Related

·         SSI – A person receiving SSI automatically qualifies for Medicaid

·         SSI Related – A person no longer receiving SSI payment may be eligible using SSI criteria

 

·         Institution - All categories are income eligible up to 300% SSI Standard

·         Nursing Home

·         Hospital

·         Hospice

·         ICF MR – State Training School

·         IMD – WY State Hospital – age 65 and older

 

·         Home and Community Based Waiver – All waiver groups are income eligible up to 300% SSI Standard

·         Developmental Disabilities Child

·         Developmental Disabilities Adult

·         Acquired Brain Injury

·         Assisted Living Facilities

·         Long Term Care

·         Children’s Mental Health waiver

 

 

Additional categories of eligibility include:

 

Special Groups

·         Breast and Cervical Cancer Treatment Program – Uninsured women diagnosed with breast or cervical cancer are income eligible below 250% FPL

·         Tuberculosis Program – Individuals diagnosed with tuberculosis are eligible based on the TB standard

 

Employed Individuals with Disabilities

·         Employed Individuals with Disabilities are income eligible under 300% SSI using unearned income and must pay a premium

 

Medicare Savings Programs

·      Qualified Medicare Beneficiaries are income eligible under 100% FPL, benefits include payment of Medicare premiums, deductibles and cost sharing

·       Specified Low Income Beneficiaries are income eligible under 135% FPL, benefits include payment of Medicare premiums only

 

Non Citizens with Medical Emergencies

·         A non citizen who meets all eligibility factors under a Medicaid group except for citizenship and social security number is eligible for emergency services

 

 

 

FPL – Monthly Income April 2009         Family Care Standard - 1996

Family Size   100% FPL    133% FPL           Family Size

1                    $    903         $  1200               1         $    362

2                    $   1214        $  1615               2         $    512

3                    $   1526        $  2029               3         $    590

4                    $   1838        $  2444               4         $    659

 

SSI Standard – revised January each year.       Current:  $674/ mo Single   

                                                                                                     $1011/mo Couple        

     Eligibility Unit 01/01/09

  

How to apply

 

To find out if you qualify for EqualityCare Health Insurance, contact your local Department of Family Services for an application.

 

Persons applying for Children, Pregnant Women and/or Family Care Adult programs may complete the Application for Wyoming’s Healthcare Coverage Programs, which is also used for the Kid Care CHIP program. The application may be mailed to Kid Care CHIP or to a local DFS office.

 

Pregnant women may also apply through a qualified provider for the Pregnant Woman Program. If determined presumptively eligible, they will have up to sixty (60) days of coverage for outpatient services.

 

Persons applying for all other EqualityCare programs or who want to appl for other programs offered through the Department of Family Services (DFS), such as food stamps or child care, need to apply in person at the local DFS office. Persons applying for Supplemental Security Income (SSI) need to apply at the Social Security District Office.

 

To apply, print the Healthcare application from our website, then fill it out, sign it, and mail it or take it in to your local DFS office. You cannot fill out the application on the computer, because it must be signed.

 

 

Healthcare Coverage Application

 

Healthcare Coverage Application SPANISH

 

Links to Presumptive Eligibility materials for Qualified Providers for the Policy Change effective July 1, 2008.