Eligibility Online Manual

M406 Defining Client Rights

Purpose: This section will provide information about client rights when applying for Medicaid benefits.

Current Policy Effective Date: August 1, 2016

Date Last Reviewed: August 1, 2016

Previous Policy: January 1, 2014


1. Individuals May Apply For Benefits

Individuals may apply for benefits upon request and without delay. Applications must be made on the prescribed form obtained in person, online, or by mail.

Applications may be submitted by submitted online, emailed, faxed, mailed or delivered to the Wyoming Department of Health(WDH) Customer Service Center or the Medicaid Long Term Care Unit, depending upon the type of case.

2. Applicants May Be Accompanied At Interviews

Applicants have the right to be accompanied by the individual(s) of their choice at interviews.

3. Individuals May Designate Authorized Representative

Individuals have the right to designate an authorized representative when applying for or receiving benefits. An authorized representative is defined as a person acting on behalf of a client or an assistance unit. The authorized representative can be added or modified:

    • In writing by filling out the Appendix C of the Health Coverage Application.

    • Online through the WES client Web Portal.

    • Through the WDH Customer Service Center of Long Term Care Unit via a telephone call.

4. Applicants May An In-Person Or Telephone Interview

Applicants have the right to request an in-person or telephone interview. These interviews can only be conducted in the Cheyenne Medicaid office. Interviews are not required for Family and Children's, Medicare Savings, Employed Individuals with Disabilities, Breast and Cervical or the Tuberculosis programs.

5. Individuals Have Right To Confidentiality

Applicants and clients have the right to have their applications and other personally identifiable information kept confidential, except as necessary to determine eligibility or comply with State or Federal law. Refer to Section M409 for additional information on confidentiality.

6. Individuals Must Receive Certain Information

Applicants and clients must be informed about:

    • Length of time benefits are authorized.

    • Rights and responsibilities of applicants/clients.

7. Individuals May Withdraw Applications At Any Time

8. Clients Must Receive Notice Of Adverse Action

A notice of adverse action must be sent to the client at least fifteen days prior to case closure.

9. Clients May Request Administrative Hearing

Clients have the right to request an Administrative Hearing within 30 days from the date on the Notice of Adverse Action. The WDH may contact clients for a conference prior to an Administrative Hearing.

10. Clients May Continue To Receive Benefits Pending Administrative Hearing

Clients may continue to received benefits when a hearing is requested before the effective date of the adverse action, unless the request for hearing is denied by the WDH.

11. Individuals May Reapply For Benefits

Individuals may reapply for benefits after having an application denied or a case closed.

12. Clients May Request Retroactive Benefits

Clients may request retroactive Medicaid benefits for up to three calendar months prior to the month of application, except for the following programs:.

    • Qualified Medicare Beneficiary Program.

    • Waiver Programs.

    • Hospice Care.

    • Tuberculosis Assistance Program.


Defining Requirement: 42 CFR 435.905 – 912 or 435.610

42 CFR 431.200

Clarifying Information:

Worker Responsibilities:

Withdrawing Applications

1. Document case record when withdrawal is requested in writing or verbally.

2. Withdraw case in WES per withdraw request.

3. Send denial Application Withdrawn notice.