Eligibility Online Manual
POL M1500: NOTICES
1. Notices Must Contain Specific Information
All notices must contain the following information:
A statement of what action the state intends to take.
The reason for the intended action.
The date the action will occur.
The reason and specific regulation(s) supporting the action.
Explanation of the individual’s right to request an informal conference though the Wyoming Department of Health (WDH) and to request an administrative hearing.
The explanation of the recipient’s obligation and responsibility to report to the Wyoming Department of Health (WDH) or its designee any changes in income, resources, and living situation.
2. Notices of Pending Application
Send a notice to the applicant or client when the application is pending waiting for information. The notice shall include what information is needed to complete the eligibility determination.
Send a notice to the applicant when financially eligible and the application is pending waiting for an approved plan of care.
3. Notice of Approval Or Denial Must Be Mailed Within The Application Time Frame
Applicants/clients must be sent notification of intended action, refer to Section M403 for application processing timeframes.
4. 15-Day Notice of Adverse Action Must Be Provided
The client must be provided a 15-Day Notice of adverse action prior to their benefits being closed or reduced.
Case may close immediately and does not require a 15 day notice under the following circumstances:
Client has been accepted for Medicaid services by another state.
Client requests closure through written statement or electronic signature.
Client is admitted to a public institution.
Defining Requirement: 42 CFR 431.213
42 CFR 435.912
42 CFR 435.913
42 CFR 435.916
42 CFR 431, Subpart E
Social Security Act, Title XIX
1. Mail the assistance unit a notification of approval or denial.
2. Notify the client of the reason if a delay in the eligibility determination occurs and approve or deny the case within the application time frames.
3. Mail the assistance unit a 15-Day notice of adverse action prior to closing or reducing their benefits.
4. Notify the applicant for Medicaid (HCBS) immediately when determined financially eligible and the application is pending waiting for an approved plan of care.