Eligibility Online Manual

M103 Eligible Persons


Purpose: This section will outline persons that are potentially eligible for Medical Assistance.


Current Policy Effective Date: February 1, 2021

Date Last Reviewed: March 25, 2022

Previous Policy: September 1, 2017

POL M103: ELIGIBLE PERSONS

1. Consider the following persons potentially eligible for medical assistance:

  • Individuals who meet all Family MAGI requirements (42 CFR 435.110).

  • Individuals who meet all Family MAGI eligibility requirements except for an increase in earned income or child support (42 CFR 435.112, 42 CFR 435.115).

    • Individuals referred by the Wyoming Breast and Cervical Cancer Early Detection Program requiring treatment for breast or cervical cancer whose income is less than or equal to 100% FPL (Social Security Act§ 1902(a)(10)(A)(ii)(xviii).

  • Individuals in a medical institution who would be eligible for Family MAGI if not in the institution (42 CFR 435.211).

  • Individuals in a medical institution who would be eligible for Family MAGI if not in the institution (42 CFR 435.211).

  • Pregnant women (42 CFR 435.201, 42 CFR 435.116).

  • Children zero through the age of five whose family income is less than or equal to 154% of the FPL (42 CFR 435.118).

  • Children age six through the age of 18 whose family income is less than or equal to 133% FPL (42 CFR 435.118).

  • Children zero through the age of 18 who are covered by Medicare but meet the criteria of Child Zero through the age of five or Child Age six through the age of 18 (42 CFR 435.116).

  • Newborns (42 CFR 435.117):

    • Born to a woman who is receiving medical assistance in the month of the birth, including Emergency Services for Aliens.

    • OR

    • Born to a woman who applies after the birth of the baby and in determining retroactive eligibility the mother is found to be eligible for medical assistance, including Emergency Services for Aliens.

  • Children in foster care (42 CFR 435.145).

  • Adopted children under a Title IV-E or State Subsidized Adoption agreement with DFS (42 CFR 435.145).

  • Elderly/disabled persons who reside in a Medicaid approved medical institution/hospital (Nursing Home) (42 CFR 435.236).

  • Individuals placed in the Geriatric Hall at the State Hospital in Evanston.

  • Individuals who meet 30 consecutive days of Inpatient Hospital Care (42 CFR 435.236).

  • Individuals age 19 or older who require Home and Community Based Services (HCBS), (Community Choices Home & Community Based Waiver) under a federal waiver (42 CFR 435.217).

  • Individuals who require Home and Community Based Services (HCBS )(Comprehensive, Support, Acquired Brain Injury, and Children's Mental Health) under a federal waiver (42 CFR 435.217).

  • Individuals who are terminally ill and elect Hospice Care (42 CFR 435.236).

  • Individuals entitled to Medicare who have income of less than or equal to 135% FPL.

  • Individuals who have been exposed to tuberculosis. (42 CFR 435.215).

  • Individuals who incurred medical bills prior to the month of application may be eligible for retroactive medical assistance.

  • Employed individuals, age 16 through age 64, who are in receipt of Social Security disability payments, or have been determined disabled by the Social Security Administration, and whose income is less than or equal to 300% CAP (W.S. 42-4-115, -116). (Employed Individuals with Disabilities)

  • Children who received SSI on 8/22/96 and who lost eligibility due to the new definition of disability in P.L. 104-193, as amended.

  • Individuals who lose SSI benefits due to the entitlement of SSA Widow/Widower benefits (42 CFR 435.137 - .138).

  • Individuals who were entitled to RSDI and eligible for and received SSI benefits concurrently but have lost SSI (PICKLE Program) (42 CFR 435.135).

  • Individuals age 18 or older and disabled prior to age 22 (Disabled Adult Child).

  • Individuals who are disabled or blind and are SSI eligible except for earned income (1619).

  • Individuals who are SSI eligible but do not receive a payment because they are in a licensed medical institution (EO1).

Reference:

Defining Requirement: See Above

Clarifying Information:

Worker Responsibilities: