Programs and Eligibility

Kid Care CHIP provides affordable health coverage for the children of working parents in Wyoming.  The program provides free preventive dental and health care.  Other health services are available for a small co-pay.

Kid Care CHIP is available to the children of parents’ whose income lies below 200% of the federal poverty level and are not eligible for Medicaid.

Wyoming Medicaid children’s programs provide health coverage for eligible children from birth through age 18.

Programs include:

• Child MAGI
• Foster care children in DFS custody
• Former Foster Youth up to the age of 26 who were in DFS custody and on a federally funded Medicaid program at the age of 18
• Children receiving an adoption subsidy
• Newborns born to Medicaid-eligible mothers are automatically eligible for the first year

To qualify a child must be:

• A Wyoming resident
• U.S. citizens or lawful permanent residents who have lived in the U.S. for at least five years
• A child ages 0-18
• Income eligible for Child MAGI
• Children ages 0-5 whose family income is at or below 154% of the Federal Poverty Level (FPL)
• Children ages 6-18 whose family income is at or below 133% of the FPL

What is the Children’s Mental Health Waiver?

The Children’s Mental Health Waiver is a short-term home and community-based program that uses an intensive care coordination model designed to provide a community-based alternative for youth with serious emotional disturbance who might otherwise be hospitalized and whose parents may be required to relinquish custody of their child for them to receive needed mental health treatment and services.

The Children’s Mental Health Waiver seeks to:

(1) prevent custody relinquishment for youth to receive mental health treatment

(2) prevent or reduce the length of costly psychiatric hospital stays

(3) provide a mechanism to offer mental health support services to youth with serious emotional disturbance and their families in identified service areas. The Children’s Mental Health Waiver is not a long-term care waiver.

For Children’s Mental Health Waiver eligibility information please click here.

Presumptive Eligibility (PE) for Pregnant Women is a Medicaid option designed to improve an applicant’s access to temporary Medicaid while their eligibility for full Medicaid benefits is being determined.  Eligible pregnant women are limited to outpatient services through a Medicaid provider for up to 60 days after completing an application for Medicaid.

To qualify a woman must be:

• Pregnant
• A U.S. citizen or lawfully present in the U.S
• A Wyoming resident
• Income eligible at or below 154% of the Federal Poverty Level.

To apply visit your local Public Health Nursing office.

Wyoming Medicaid’s Pregnant Women programs provide health coverage for eligible pregnant women for up to 12 months post-partum. Pregnant women with income below the family care income guidelines must cooperate with Child Support Enforcement once the baby is born to continue eligibility.

To be eligible a woman must be:

• Pregnant
• Income eligible at or below 154% of the FPL
• A U.S. citizen or lawfully present in the U.S
• A Wyoming resident.

The Pregnant by Choice program provides pregnancy planning services to women who have received Medicaid benefits through the Pregnant Women program.

To be eligible a woman must be:

• In the 12 months post-partum period and on Wyoming Medicaid’s Pregnant Women program
• Income eligible at or below 159% of the FPL
• U.S. citizens or lawful permanent residents who have lived in the U.S. for at least five years
• A Wyoming resident.

More information on the Pregnant by Choice program can be found HERE.

The Institutional programs are an option for those individuals who are waiting for or need Long Term Care and are unable to continue to live in the community. This would include Nursing Home Care and Inpatient Hospital Care.

To qualify you must be:

• A U.S. Citizen or a lawful permanent resident who has lived in the U.S. for at least five years
• A Wyoming resident
• Age 65 or older, blind or disabled
• Medically eligible based on needs assessment completed by a public health nurse (nursing home only)
• Hospitalized for 30 days (remain in an institution for at least 30 consecutive days) or verified as SSI eligible
• Income at or below 300% of the Federal Benefit Rate (FBR) Income Standard
• Resources must be within the Maximum Resource Standard

What do Institutional programs cost?
A client is responsible to contribute to the cost of his or her care. This payment, often referred to as a patient contribution, is payable to the facility. The patient contribution is calculated using the individual’s total income less the following allowable deductions:

• $50.00 for personal needs
• Court ordered garnished child support
• Spousal maintenance allowance
• Medical expenses not covered by Medicaid, Medicare, private insurance, or a third party
• Medicare premium may be deducted for the first two months of eligibility
• Health insurance premium

The Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB) are Medicare Savings programs. These programs help income-qualifying Medicare beneficiaries pay Medicare premiums and in some instances Medicare co-insurance and deductibles.

To qualify you must be:

• A U.S. citizen or a lawful permanent resident who has lived in the U.S. for at least five years
• A Wyoming resident
• Entitled to Part A and Part B Medicare Insurance
• Income eligible at or below 135% of the FPL
• Resources must be within the Maximum Resource Standard

Family Care is a Medicaid program that provides health coverage for parents or relatives who are caring for a child under the age of 18.

To qualify you must be:

• A Wyoming resident
• A U.S. citizen or lawful permanent resident who has lived in the U.S. for at least five years
• Income eligible at or below the Family Care income guidelines
• The parent or caretaker relative of a Medicaid eligible child under the age of 18

Wyoming Medicaid’s Emergency Services Program is emergency healthcare for Wyoming’s families and children who are either undocumented immigrants or ineligible immigrants. This is not a full medical assistance program. Only emergency services are covered.

Who is eligible?

Applicants must meet all eligibility factors for a Medicaid program, excluding U.S. citizenship, identity, and social security number requirements.

If you are eligible for SSI, you are automatically eligible for Medicaid.  If you have questions or would like to apply for SSI, visit the Social Security Administration’s website at: https://www.ssa.gov.

The Comprehensive and Support (DD) waivers are Medicaid Home and Community-Based Services (HCBS) waiver programs authorized under Section 1915(c) of the Social Security Act that support individuals with intellectual or developmental disabilities (IDD) as well as individuals with acquired brain injuries. These waiver programs provide individuals access to an array of community-based services. For more information about the DD waivers please visit the Home and Community Based Services page of our website.  For more information, please contact the HCBS Section at (307)777-1531 and/or 1-855-203-2936.

Contact the Long-Term Care Eligibility Unit for more information on financial eligibility criteria at 1-855-203-2936.

The Community Choices Waiver program is a Medicaid Home and Community-Based Services (HCBS) waiver program authorized under Section 1915(c) of the Social Security Act. The Community Choices Waiver (CCW) program provides eligible individuals an alternative to nursing facility care through access to an array of community-based services. For more information about the CCW please visit the Home and Community Based Services page of our website. For more information, please contact the HCBS Section at (307)777-1531 and/or 1-855-203-2936.

Contact the Long-Term Care Eligibility Unit for more information on financial eligibility criteria at 1-855-203-2936.

Breast and Cervical Cancer Treatment (BCCT) program provides medical coverage for treatment for women who have been found eligible under the Breast and Cervical Cancer Early Detection Program (BCCEDP).

A woman must be:

• A U.S. Citizen or a lawful permanent resident who has lived in the U.S. for at least five years
• A Wyoming resident
• Eligible for treatment as identified by the Breast and Cervical Cancer Early Detection Program
• Without medical insurance, including Medicare
• Family income eligible, at or below 250% of the FPL.

The Tuberculosis Assistance program provides coverage for treatment of individuals who have been diagnosed with Tuberculosis and whose income is at or below the Tuberculosis income limit.

Eligibility:

• A U.S. Citizen or lawful permanent resident who has lived in the U.S. for at least five years
• A Wyoming resident
• Diagnosed with Tuberculosis
• Gross monthly income limit is $943 for an individual or $1,415 for a couple
• Resource eligible – limits are:
  • Individual: $2,000
  • Couple: $3,000, when both are applying

The EID program is an option that allows employed individuals who are disabled to receive Medicaid by paying a monthly premium, as long as they are working and meet Social Security Administration (SSA) disability guidelines. The disability determination can be made either through SSA or through the Wyoming Department of Health (using SSA guidelines).

To qualify you must be:

• A Wyoming resident
• A U.S. citizen or lawful permanent resident who has lived in the U.S. for at least five years
• Employed
• Disabled, disability is verified through a Social Security Administration (SSA) disability determination or by the Department or its agent using the SSA criteria.
• Age 16 through 64
• Income eligible
  • Income at or below 300% of the Federal Benefit Rate (FBR) Income Standard
  • Earned income is exempt in eligibility determination
  • Monthly premium is based on earned and unearned income

The Social Security Act (section 1902-1906), allows Wyoming to pay the insurance premiums, co-insurance, and deductibles for Medicaid recipients to keep their health insurance.

Eligibility for the Wyoming Health Insurance Premium Payment Program (WHIPP) is based on a Medicaid client’s medical needs and the cost-effectiveness to the State of Wyoming. The state may pay premiums, deductibles, and co-insurance if:

• You or a family member are a Medicaid client; and
• Have an active employer-sponsored insurance or COBRA policy; and
• It is cost effective

How can WHIPP help you?
By reimbursing the cost of your health insurance premium, WHIPP allows you to keep the following health insurance benefits, at no cost to you:

• Access to a larger network of providers
• Additional health care services that Medicaid may not cover
• Members of your family who are not eligible for Medicaid, but are covered under the health insurance plan may have their premiums paid as well if Medicaid determines that buying a family plan for the Medicaid eligible persons is cost effective.
• If you or a family member qualify for Medicaid due to pregnancy, the State may pay the premiums, deductibles, and co-insurance for you while you are pregnant, provided the health insurance covers the pregnancy, and it is determined to be cost effective.

How to apply?

Send your completed HEALTH INSURANCE VERIFICATION FORM to:
HMS WHIPP Unit
Wyoming Medicaid
Fiscal Agent
5615 High Point Dr.
Mailstop 700
Irving, TX  75038
-OR-
Fax: 1-214-313-1341
-OR-
Email: WHIPP@gainwelltechnologies.com

If you have questions, please call us at 1-844-512-2672