Ch. 34, § 5. Waiver Program Eligibility

(a) The Department shall offer CCW enrollment only to those individuals determined by the Department to meet all applicable eligibility requirements of Wyoming Medicaid Rules Chapter 18 and of this Chapter. (i) The individual shall be a member of one (1) of the following CCW target groups: (A) The individual is aged sixty-five (65) years or older; or (B) The individual is between the ages of nineteen (19) and sixty-four (64) years and has been determined disabled by the Social Security Administration or by the Department pursuant to Wyoming Medicaid Rules Chapter 18. (ii) The individual shall need services that qualify for a nursing facility level of care as measured by the level of care assessment approved by the Department and conducted pursuant to Wyoming Medicaid Rules Chapter 22. (A) The individual's need for nursing facility level of care must have been evaluated no more than three hundred sixty-five (365) days prior to enrollment in CCW and re-evaluated at least annually thereafter. (B) An individual who has lost eligibility based on not meeting a nursing facility level of care, upon new application may be re-evaluated within three hundred sixty-five (365) days of their last assessment if the individual documents a change in condition sufficient to warrant a new evaluation. (b) The individual shall be eligible, and maintain continuous eligibility, for the Wyoming Medicaid program pursuant to Wyoming Medicaid Rules Chapter 18. (c) Individuals who reside in a nursing facility, hospital, intermediate care facility for individuals with intellectual disabilities, or other institutional setting shall be ineligible to receive CCW services. (i) During a declared emergency this ineligibility may not apply to certain temporary services available to support the individual's transition from an institutional setting, for which services are limited to thirty (30) consecutive days. (ii) Participants admitted to an institutional setting for a period greater than thirty (30) consecutive days shall be terminated from the CCW. (iii) Individuals residing in an institutional setting may receive transitional services for a period of six (6) months prior to transitioning to HCBS in accordance with the Department's standards and requirements. (d) Individuals denied enrollment or continued participation in the CCW pursuant to the provisions of this Section shall be issued a written notice of adverse action and informed of their right to request an administrative hearing in accordance with Wyoming Medicaid Rules Chapter 4.