Wyoming Medicaid Definition
Medicaid in Wyoming is administered by the Wyoming Department of Health.
Medicaid is a wide-ranging health insurance program for low-income individuals of all ages. Jointly funded by the state and federal government, it provides health coverage for various groups of Wyoming residents, including pregnant women, parents and caretaker relatives, adults with no dependent children, employed and unemployed individuals with disabilities, and seniors. However, the focus of this webpage is strictly on Medicaid eligibility for Wyoming elders, aged 65 and over, and specifically for long term care, whether that be at home, in a nursing home, or in an assisted living facility.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Wyoming seniors may be eligible. These programs have slightly different financial and medical (functional) eligibility requirements, as well as varying benefits. Further complicating eligibility are the facts that the requirements vary with marital status and that Wyoming offers several pathways towards Medicaid eligibility.
1) Institutional / Nursing Home Medicaid – this is an entitlement program. This means anyone who meets the requirements will receive assistance, which is provided only in nursing home facilities.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – with these programs, there are a limited number of participant enrollment slots. Therefore, wait lists may exist. Benefits are provided at home, adult day care, or in assisted living.
3) Regular Medicaid / Aged, Blind, and Disabled – this is an entitlement program, which means all eligible applicants are able to receive services. Benefits are provided at home or adult day care.
The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from a Wyoming Medicaid program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible for Wyoming Medicaid. More.
|2020 Wyoming Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||$2,349 / month||$2,000||Nursing Home||$4,698 / month (Each spouse is allowed up to $2,349)||$3,000||Nursing Home||$2,349 / month for applicant||$2,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,349 / month||$2,000||Nursing Home||$4,698 / month (Each spouse is allowed up to $2,349)||$3,000||Nursing Home||$2,349 / month for applicant||$2,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$783 / month||$2,000||None||$1,175 / month||$3,000||None||$1,175 / month||$3,000||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, this income can come from any source. Examples include employment wages, alimony payments, Veteran’s benefits, pension payments, Social Security Disability Income, Social Security Income, Supplemental Security Income, IRA withdrawals, and stock dividends.
When only one spouse of a married couple is applying for nursing home Medicaid or a HCBS Medicaid waiver, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded and does not affect the applicant spouse’s eligibility. However, this is not the case for a married couple with one spouse applying for Aged Blind and Disabled Medicaid. Rather, the income of both the applicant spouse and non-applicant spouse is counted towards the applicant’s eligibility. For more information on how Medicaid counts income, click here.
For married couples with one spouse applying for institutional Medicaid or a Medicaid waiver, there is a Minimum Monthly Maintenance Needs Allowance (MMMNA) for non-applicant spouses that have insufficient income from which to live. Put another way, the MMMNA is intended to prevent impoverishment of non-applicant spouses. In simple terms, if the non-applicant spouse, also called the community spouse or well spouse, has income under $3,216 / month (this figure is effective January 2020 and changes in January of each year), he or she is entitled to a portion of the applicant spouse’s income, bringing his or her income level to $3,216 / month. Please note, this spousal impoverishment rule is not relevant for married couples with one spouse applying for regular Medicaid.
What Defines “Assets”
Countable assets, also referred to as resources, include cash, stocks, bonds, investments, promissory notes, certificates of deposit, credit union, savings, checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility purposes, there are many assets that are not counted. In other words, they are exempt from the asset limit. Exemptions include personal belongings, such as clothing and wedding rings, household furnishings and appliances, an automobile, a burial plot, burial funds (up to $1,500), life insurance policies (up to $1,500 in cash surrender value) and one’s primary home, given the Medicaid applicant or his or her spouse lives in the home and the equity value is under $595,000 (in 2020).
For married couples, as of 2020, the community spouse can retain half of the couple’s joint assets, up to a maximum of $128,640, as the chart indicates above. This spousal impoverishment rule is referred to as the Community Spouse Resource Allowance (CSRA) and is intended to prevent the non-applicant spouse from having too little from which to live. As with the MMMNNA, this rule is intended for non-applicant spouses of spouses who live in a nursing home facility or receive services via a HCBS Medicaid Waiver. The CSRA does not apply to non-applicant spouses of regular Medicaid applicants.
Please note, it is vital that one does not give away assets or sell them for less than fair market value in an attempt to meet Medicaid’s asset limit. This is because Wyoming has a Medicaid Look-Back Period, which is a period of 60 months (5 years) that dates back from one’s Medicaid application date. During this time frame, Medicaid checks all past transfers to ensure no assets were sold or given away for less than they are worth. This also includes past asset transfers one’s non-applicant spouse has made. If one is found to be in violation of the look-back period, one will be penalized with a period of Medicaid ineligibility.
Qualifying When Over the Limits
For elderly Wyoming residents (aged 65 and over) who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Qualified Income Trusts (QIT’s) – QIT’s, also referred to as Miller Trusts, are special trusts for Medicaid applicants who are over the income limit, yet still cannot afford the cost of their long-term care. This type of trust, also called an Irrevocable Income Trust in Wyoming, offers a way for individuals over the Medicaid income limit to still qualify for long-term care Medicaid, as money deposited into a QIT does not count towards Medicaid’s income limit. In simple terms, one’s excess income (over the Medicaid income limit) is directly deposited into a trust, in which a trustee is named, giving that individual legal control of the money. The account must be irreversible, meaning once it has been established, it cannot be changed or canceled, and must have the state of Wyoming listed as the remainder beneficiary. In addition, the money in the account can only be used for very specific purposes, such as paying long term care services / medical expenses accrued by the Medicaid enrollee. As previously stated, the income in this account is exempt from Medicaid’s income limit.
Unfortunately, Irrevocable Income Trusts do not assist one in qualifying for Medicaid if their assets are over the eligibility limit. Said another way, no assets can be used to establish or supplement the QIT. If one meets the income requirements for Medicaid eligibility, but not the asset requirement, the above option cannot assist one in “spending down” their excess assets. However, one can “spend down” assets by spending assets over the asset limit on non-countable ones. Examples include home modifications and additions (wheelchair ramps, roll-in showers, stair lifts, and adding first floor bedrooms), home improvements (replacing faulty electrical wiring, updating plumbing, and replacing old water heaters), vehicle modifications (wheelchair lifts, adaptive control devices, and floor modifications to allow one to drive from a wheelchair), prepaying funeral and burial expenses, and paying off debt.
2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.
Specific Wyoming Medicaid Programs
Community Choices Waiver (CCW) – this HCBS Medicaid Waiver provides assistance for those who require a nursing home level of care, but choose to remain living at home, the home of a family member, or in an assisted living facility. Benefits include adult day care, meal delivery, personal emergency response systems, respite care, skilled nursing, and non-medical transportation. Personal care attendants are also an available benefit, and via the In-Home Participant Directed Option, program participants are able to hire the caregiver of their choosing, including select relatives.
How to Apply for Wyoming Medicaid
Senior Medicaid applicants can apply for benefits online at WES (Wyoming Eligibility System), fill out and submit the paper application, “Application for Health Coverage & Help Paying Costs”, or apply via phone by calling the Customer Service Center at 1-855-294-2127. Elderly applicants may find their local Area Agency on Aging office helpful in answering questions or for assistance with the application process. Please note that it can take as many as 45 days for a Medicaid determination to be made.
When submitting an application for long-term care Medicaid in Wyoming, it is vital that applicants are certain that they have satisfied all eligibility criteria (in detail above). Elderly applicants who have income and / or assets over the limit(s) should consider Medicaid planning for the best chance of acceptance into a Medicaid program. While the application process can be confusing and lengthy, seniors can learn more about the process here.