Eligibility Online Manual
M1002C Children's Mental Health Waiver
Purpose: This section will assist in determining eligibility for the Children’s Mental Health Waiver.
Current Policy Effective Date: October 1, 2017
Date Last Reviewed: October 27, 2017
Previous Policy: April 1, 2012
POL M1002C: DETERMINING ELIGIBILITY FOP CHILDREN'S MENTAL HEALTH WAIVER
1. Applicants Must Meet Basic Eligibility
Refer to Section M600 for basic eligibility factors.
2. Applicants Must be Age Four Through Age 20
3. Applicants Must Meet Clinical Eligibility
The Wyoming Department of Health (WDH), Behavioral Health Division determines clinical eligibility.
4. Applicants Must Meet Disability Requirements
Applicants meeting the clinical eligibility fulfill the disability requirement.
5. Applicants Must Meet Income Requirements
Require countable income to be within the maximum income standard per month. Refer to Medicaid Table 1A for income standards. Refer to Section M901 to determine if income is countable. Provide an Income Trust Packet when the countable income is above the maximum income standard.
6. Applicants Must Meet Resource Requirements
Require the countable resources to be within the maximum resource standard. Refer to Medicaid Table 7 for resource standards. Refer to Section M801 to determine if resources are countable.
7. Services Withheld For Resource Transfers
Nonexempt resources cannot be transferred for less than fair market value during the look-back period prior to application or when clients are receiving benefits.
Refer to Section M803 to determine if a resource transfer is exempt and to Section M804 for information on related penalties.
8. Applicants May Have Eligibility For 12 Continuous Months
The eligibility continues for 12 months from the effective date of eligibility, or for 12 months from the last periodic review, for applicants under the age of 19.
9. Benefits Begin First Day Of Month Using Plan Of Care Date
10. Clients Must Be Reviewed
Clients must be periodically reviewed every 12 months to determine continued eligibility. Refer to Section M1403 for information on reviewing eligibility.
A review is not required for SSI clients.
Clients must be reviewed for other Medicaid program eligibility before closing cases.
11. Clients May Lose Benefits
The case will close on the first day of the next month when any of the following occur:
Client does not complete review.
Client dies.
Client determined no longer eligible.
Client enters public institution.
Client moves out of state.
Client’s 12-month period ends and he or she is no longer eligible.
Reference:
Defining Requirement: 42 CFR 435.217
Social Security Act § 1915(c)
Clarifying Information:
1. Clients Pay No Patient Contribution.
2. Clients under age 19, discharged from the Waiver, may have eligibility for the remainder of the 12 continuous months.
Worker Responsibilities:
Determining Best Estimates
1. Refer to Section M903 for information on determining best estimates.
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 Resource Transfer Penalty
1. Refer to Sections M803 and Section M804 for information on 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 Clinical Eligibility requirement has been met.
Log into Medicaid Waiver System by Clicking on the "Waiver System" tab in ECOM or access at https://waivers.health.wyo.gov.
Enter your user name and password. Click on the "Log In" button.
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.
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.
View, under Eligibility, a check mark by the Clinical Eligibility requirement.
The system will show Eligibility under Process and Financial Eligibility as the Status:
Click on Has met the income and resource eligibility requirements.
Click on "Save" and "Complete." This will complete the task and remove the case from your task list.
The system will communicate the eligibility determination and place the individual on a waiting list.
Pend the case in WES until a Plan Of Care is approved and a start date is provided through the Medicaid Waiver System.
Send a Pending Notice in WES when the individual meets all eligibility requirements
3. Complete assigned tasks for applicants who are in the Medicaid Waiver System and do not meet the eligibility requirements.
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.
View the Status, Financial Eligibility or Confirm Financial Eligibility:
Click on Has been denied financial eligibility.
Click on "Save" and "Complete." This will complete the task and remove the case from your task list.
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.
Click on the "Search Cases" tab.
Fill in any combination of information to find a client.
Click on the "Search" button.
Click on the "View" icon next to the client's name.
Click on the drop down menu to select a reason for accessing this case and Click "Save."
Enter closure or denial reason, the date the client was notified and the effective date of the closure or denial.
Click "Close."
5. Receive notification from the Medicaid Waiver System when an applicant has a funding opportunity.
Redetermine financial eligibility if 60 days has passed since initial application.
Access the Medicaid Waiver System.
View the Process, Funding Opportunity and Status, Confirm Financial, found under your assigned tasks.
Click on Has met the income and resource eligibility requirements or
Click on Has been denied financial eligibility.
Click on "Save" and "Complete." This will complete the task and remove the case from your task list.
Notification will be sent from the Medicaid Waiver System with the approved Plan Of Care start date.
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.
3. Access the Medicaid Waiver System to communicate the eligibility determination.