Ch. 18, § 4. Application Process, Applicant/Client Rights and Responsibilities

(a) Application Process. (i) Applicants shall submit an application in the manner and form prescribed by the Department. The application shall be completed, dated, and signed by the applicant or by any person who is assisting the applicant. (ii) Applications shall be processed 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 documentation from a third party for use in determining eligibility, or (III) Ninety (90) days from the date of application when waiting for a disability determination to be completed by the Department or designee. If future medical evidence is required to assess the applicant's duration of disability, a medical deferment of up to ninety (90) additional days for processing is authorized. (B) Family and Children's programs: (I) Forty-five (45) days from the date of application, or (II) Sixty (60) days from the date of application when waiting on documentation from a third party for use in determining eligibility. (iii) Applicants shall be notified in writing of the reasons for the approval, denial or closure, the specific regulation supporting the action, and an explanation of the right to request a hearing, as specified in 42 C.F.R. § 431.210 and Wyo. Stat. § 42-4-108. (iv) Any individual who has been determined eligible by the Social Security Administration (SSA) for Supplemental Security Income (SSI) is not required to complete an application. (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, 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. (ii) Applicants may be accompanied, assisted, or represented by an individual or individuals of their choice during the application process. (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 individuals. (v) If an administrative hearing is requested, it shall be conducted in accordance with Wyoming Medicaid Rules Chapter 4, Medicaid Administrative Hearings. (c) Applicant/Client Responsibilities. (i) Applicants shall cooperate in the eligibility process by providing all information and documentation requested by the Department, including, but not limited to, income, resources, and trusts. (ii) Applicants who fail to cooperate or provide the information requested by the Department shall be denied eligibility. (iii) Applicants, clients, and their representatives shall report changes in any of the following circumstances to the Department within ten (10) days: (A) Income; (B) Resources, if applicable to their program; (C) Household composition; (D) Health insurance coverage; and (E) Address. (d) Eligibility Period and Redeterminations. (i) Medicaid eligibility begins the first day of the month in which the individual is eligible, except for eligibility under the Presumptive Programs, when eligibility begins the day the application is submitted and approved. (ii) Individuals under age nineteen (19) and women on the Family Planning waiver are deemed to be continuously eligible for Medicaid for twelve (12) months from the effective date of eligibility or for twelve (12) months from the last review. (iii) The Department shall redetermine client's eligibility every twelve (12) months.