Ch. 18, § 7. Presumptive Eligibility

(a) Eligibility shall begin on the date on which a qualified provider or qualified hospital determines that an individual is eligible for presumptive eligibility and ends with the earlier of: (i) The day on which Medicaid eligibility is determined; or (ii) The last day of the month following the month in which the determination of presumptive eligibility was made if no full Medicaid application is received. (b) Presumptive eligibility determinations may be conducted by a: (i) Qualified provider; or (ii) Qualified hospital (c) Presumptive eligibility shall be limited to the following categories: (i) Pregnant women whose family income does not exceed one hundred fifty-four percent (154%) of FPL shall be eligible for temporary outpatient services. 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 Wyoming Medicaid State Plan. A child shall be eligible for one (1) presumptive eligibility period every twelve (12) months. (iii) Parents and other caretaker relatives of a dependent child, whose family income does not exceed the income eligibility levels specified in the Medicaid State Plan shall be eligible for all services covered under the Wyoming Medicaid State Plan for this group. The individual shall be eligible for one (1) presumptive eligibility period every twelve (12) months. (iv) Certain individuals needing treatment for breast or cervical cancer whose household income does not exceed two hundred fifty percent (250%) of FPL shall be eligible for all services covered under the Wyoming Medicaid State Plan for this group. The individual shall be eligible for one (1) presumptive eligibility period every twelve (12) months. (v) Children who were in any State's or Tribal custody under a Federally Funded Foster Care Medicaid program at the time of their eighteenth (18th) birthday and are released from custody at that time or later, are eligible for Medicaid until age twenty-six (26). The individual shall be eligible for one (1) presumptive eligibility period every twelve (12) months. (d) Status as a qualified provider or qualified hospital may be terminated if a staff member of the provider or hospital knowingly provides false information to influence a presumptive eligibility determination. Providers may request reconsideration of the disqualification in accordance with Wyoming Medicaid Rules Chapter 4.