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 quality 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 for 45 days pending Medicaid eligibility determination

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 2008        Family Care Standard - 1996

Family Size   100% FPL    133% FPL           Family Size

1                    $    867          $  1153               1         $    362

2                    $   1167         $  1552               2         $    512

3                    $   1467         $  1951               3         $    590

4                    $   1767         $  2350               4         $    659

SSI Standard – revised January each year.       Current:  $637/ mo Single                                                                                            $956/mo Couple              Eligibility Unit 04/01/08