Reference:

Defining Group:    42 CFR 435.217

                          Social Security Act §1902(a)(10)(A)(ii)(xv)

                          Social Security Act § 1902(e)(12)

Income:               42 CFR 435 Subpart K

Resources:          42 CFR 435 Subpart L

Clarifying Information:

The Medicaid Waiver System will send notification.

Clients Pay No Patient Contribution.

Clients under age 19, discharged from the Waiver, may have eligibility for the remainder of the 12 continuous months.

Worker Responsibilities:

Determining Countable Income

1. Refer to Section M901 to determine if income is countable.

Determining Countable Resources

1. Refer to Section M801 to determine if resources are countable.

Calculating Nonexempt Resource Transfer Penalty

1. Refer to Sections M803 and M804 for information on transferring nonexempt resources and related penalties.

Accessing Waiver System to Determine Eligibility

1. Access the Medicaid Waiver System to determine status of the waiver process and verify the ICF-MR level of care requirement has been met.

1A. Log into Medicaid Waiver System by Clicking on the "Waiver System" tab in ECOM or access at https://waivers.health.wyo.gov.

1B. Enter your user name and password. Click on the "Log In" button.

1C. Review the Confidentially Agreement, Check the box indicating that you agree, and Click on the "Continue" button to proceed. This agreement must be completed the first time you log into the system and is required again every 45 days.

2. Complete assigned tasks for applicants who are in the Medicaid Waiver System and meet the eligibility requirements.

2A. Click on the "View" icon next to the Last Name. The system will take you to the next screen and prompt you on what action needs to be completed.

2B. View, under Eligibility, a check mark by Complete LT-104 verifies the ICF-MR level of care requirement.

2C. The system will show Eligibility under Process and Financial Eligibility as the Status:

2Ci) Click on Has met the income and resource eligibility requirements.

2Cii) Click on "Save" and "Complete." This will complete the task and remove the case from your task list.

2D. The system will communicate the eligibility determination and place the individual on a waiting list.

2E. Enter the Waiver Type and Pending Date in WES on the Waiver Information screen until a Plan of Care is approved and a start date is provided through the Medicaid Waiver System.

2F. Finalize on the Preliminary Determination Summary screen as eligible when the individual meets all eligibility requirements. WES will pend the case and generate a notice.

3. Complete assigned tasks for applicants who are in the Medicaid Waiver System and do not meet the eligibility requirements.

3A. Click on the "View" icon next to the Last Name. The system will take you to the next screen and prompt you to complete the required actions.

3B. View the Status, Financial Eligibility or Confirm Financial Eligibility:

3Bi) Click on Has been denied financial eligibility.

3Bii) Click on "Save" and "Complete." This will complete the task and remove the case from your task list.

3C. The System will communicate the eligibility determination and notify the waiver program of the denial.

4. Complete a search for an existing waiver client who is being closed or an applicant who is on the waiting list who is being denied.

4A. Click on the "Search Cases" tab.

4B. Fill in any combination of information to find a client.

4C. Click on the "Search" button.

4D. Click on the "View" icon next to the client's name.

4E. Click on the drop down menu to select a reason for accessing this case and Click "Save."

4F. Enter closure or denial reason, the date the client was notified and the effective date of the closure or denial.

4G. Click "Close."

5. Receive notification from the Medicaid Waiver System when an applicant has a funding opportunity.

5A. Redetermine financial eligibility if 60 days has passed since initial application.

5B. Access the Medicaid Waiver System.

5C. View the Process, Funding Opportunity and Status, Confirm Financial, found under your assigned tasks.

5Ci) Click on Has met the income and resource eligibility requirements or

5Cii) Click on Has been denied financial eligibility.

5Ciii) Click on "Save" and "Complete." This will complete the task and remove the case from your task list.

5D. Notification will be sent from the Medicaid Waiver System with the approved Plan Of Care start date. 

Determining Continued Eligibility If Client Loses SSI

1. Require application.

2. Determine continued eligibility.

3. Finalize the new program type in WES and authorize benefits when the client meets all eligibility requirements.

4. WES will automatically generate an approval notice.

Approving Benefits

1. Update the Waiver Information screen in WES with the Plan of Care Date.

2. Finalize eligibility and authorize benefits when the client meets all eligibility requirements.

3. WES will automatically generate an approval notice.

4. Access the Medicaid Waiver system to communicate the eligibility determination.

Denying Benefits

1. Finalize eligibility and deny benefits in WES when the applicant is not eligible.

2. WES will automatically generate an approval notice.

3. Access the Medicaid Waiver System to communicate the eligibility determination.

Reviewing Cases

1. Refer to Section M1403 for information on reviewing cases.

Approving Cases For Remainder Of The 12 Continuous Months Period

1. Finalize the 12 Month Continuous Waiver program in WES and authorize benefits, beginning in the month after a child under the age of 19 is found ineligible.

2. WES will automatically generate a closure notice for the waiver services and approval for the 12 Month Continuous Waiver group.

Closing Cases

1. Finalize eligibility and close benefits in WES when the applicant is no longer eligible.

2. Allow 15-Day closure notice when an adverse action has occurred. WES will automatically generate the closure notice.

3. Access the Medicaid Waiver System to communicate the eligibility determination.