Who Is Eligible for Medicaid?

Eligibility is generally based on family income and family structure and sometimes resources and/or healthcare needs.   Federal regulations define more than fifty groups of individuals that may qualify for Medicaid coverage.  If you fit into any of the groups below, you may qualify for Medicaid coverage.

 

Families and Children's Programs

 

Children

  • Children ages 0-18
  • Newborns born to Medicaid eligible mothers
  • Children with an eligible caretaker relative
  • Children in foster care (through Department of Family Services) and children in subsidized adoptions 

Pregnant Women

  • Pregnant women
  • Presumptively eligible pregnant women (allows coverage of outpatient services from the date of application through the last day of the following month)

Family Care Adult

  • Adults who are caretaker relatives of an eligible dependent child who is under age 19 living in the home and who meet certain other guidelines 

 

Aged, Blind or Disabled Programs

 

 SSI (Supplemental Security Income) and SSI Related

  • SSI – A individual eligible for SSI automatically receives Medicaid
  • SSI Related – An individual no longer receiving SSI payments may be eligible for Medicaid using SSI criteria 

Institution - Individuals in any of the following types of institutions may be eligible, if they meet other guidelines

  • Nursing Home
  • Hospital Inpatient
  • Hospice
  • Wyoming Life Resource Center
  • Wyoming State Hospital – age 65 and older  

Home and Community Based Waiver - Individuals may qualify for the following programs if they need assistance to stay in the community and meet other guidelines

  • Long Term Care Waiver
  • Assisted Living Facilities Waiver
  • Acquired Brain Injury Waiver
  • Children’s Mental Health Waiver 
  • Developmental Disabilities Waiver
  • Program of All-Inclusive Care for the Elderly (PACE)

 

Additional categories of eligibility include:

 

Breast and Cervical Cancer Treatment Program

  • Women who have been diagnosed with breast and/or cervical cancer, are uninsured, and meet other guidelines

Tuberculosis Assistance Program

  • Individuals diagnosed with Tuberculosis who meet other guidelines                                                                                                                                       

Employed Individuals with Disabilities

  • Individuals who have a disability (based on Social Security guidelines), are working and meet other guidelines 

 Medicare Savings Programs

  • Individuals with limited income who are entitled to or receiving Medicare
    • Qualified Medicare Beneficiaries (QMB) program can help pay for Medicare premiums, deductibles and co-payments
    • Specified Low Income Beneficiaries (SLMB) program can help pay Medicare Part B premiums

Non Citizens with Medical Emergencies

  • Individuals who are non citizens and meet all eligibility requirements under a Medicaid group, except for citizenship, identity and social security number, may be eligible for Emergency Services

 

Financial Guidelines

Financial eligibility is based upon the Federal Poverty Level (FPL) or the Supplemental Security Income (SSI) standard. Not all programs use the same FPL percentage when determining eligibility.