Overview of Wyoming Medicaid Community Choices Waiver
Wyoming’s Community Choices Waiver (CCW) is a statewide long-term care Medicaid program for seniors and adults with disabilities who are at risk of institutionalization (nursing home admission). Intended to delay and prevent the need for such care, a variety of long-term services and supports (LTSS) are available. LTSS include personal care assistance, adult day care, respite care, personal emergency response systems, and skilled nursing.
Program participants can reside in their own home, the home of a loved one, an assisted living residence, or an adult foster care home.
The services offered under CCW may be provided by licensed agency workers or program participants have the option to self-direct their own care. The participant-directed option allows one to hire, train, manage, and even fire, the caregiver of their choosing. While friends and family, including one’s adult child, can be hired to provide care, spouses and legal guardians are prohibited from being hired. Program participants who cannot self-direct their own care, may choose a representative to do so on their behalf. However, the representative cannot also be the paid caregiver. The financial aspects of being an employer, such as background checks, tax withholding, and issuing caregiver payments, are handled by a Fiscal Management Services Agency.
Wyoming’s Community Choices Waiver is a 1915(c) Home and Community Based Services (HCBS) Medicaid Waiver. Two previous waivers, the Long Term Care Waiver and the Assisted Living Facility Waiver, were merged and formed the Community Choices Waiver. CCW is not an entitlement program; meeting eligibility requirements does not equate to immediate receipt of program benefits. The number of participant enrollment slots are limited, and when these slots are full, a waiting list for program participation forms.
Historically Medicaid only paid for long-term care in nursing homes. 1915(c) HCBS Medicaid Waivers allow states to offer benefits outside of these institutions. “HCBS” stands for Home and Community Based Services. The goal of HCBS is to delay or prevent institutionalization, and to that end, care may be provided in one’s home, the home of a relative, assisted living, or adult foster care / adult family living. Waivers can target specific groups who require a Nursing Home Level of Care and are at risk of institutionalization, such as the elderly, disabled, or persons with Alzheimer’s. Waivers are not entitlements. This means that meeting eligibility criteria does not guarantee receipt of benefits, as there are a limited number of slots for program participants.
Benefits of Wyoming Community Choices Waiver
CCW program participants receive Medicaid state plan services, such as physician services, hospital services, durable medical equipment, and prescription drugs, in addition to home and community based services. Follows is a list of potential HCBS.
– Adult Day Care / Adult Day Health Care
– Assisted Living Facility Services – personal care assistance, supervision, 24/7 on-site response
– Case Management / Transition Intensive Case Management
– Home Meal Delivery
– Home Health Aide – provides personal care assistance
– Home Modifications – i.e., wheelchair ramps, grab bars, widening of doorways
– Homemaker Services – i.e., preparation of meals, grocery shopping, laundry
– Personal Support Services – assistance with daily living activities, such as bathing, eating, light housecleaning, meal preparation, meals
– Personal Emergency Response Systems
– Respite Care – in-home and out-of-home care to relieve a primary caregiver
– Skilled Nursing
– Transition Setup – to help persons transition from a nursing home to community living (i.e., security deposit, utility set-up fees, essential household furnishings)
– Transportation Services (Non-Medical)
Eligibility Requirements for Wyoming Community Choices Waiver
CCW is for Wyoming residents who are seniors (65+ years old) or between 19 and 64 years old and disabled. Persons with disabilities can continue to receive Waiver services as an aged individual upon turning 65. Additional eligibility criteria is as follows.
Financial Criteria: Income, Assets & Home Ownership
The applicant income limit is equivalent to 300% of the Federal Benefit Rate (FBR), which increases each January. In 2023, an applicant, regardless of marital status, can have a monthly income up to $2,742. When both spouses are applicants, each spouse is considered individually, with each spouse allowed income up to $2,742 / month. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of their spouse. Furthermore, in some cases, income can be allocated to the non-applicant spouse from their applicant spouse as a Spousal Income Allowance, also called a Monthly Maintenance Needs Allowance (MMNA).
The maximum amount of income that can be transferred is $3,715.50 / month. This is intended to ensure the non-applicant spouse has a minimum monthly income of this amount. To be clear, this allowance is intended to bring a non-applicant’s monthly income up to $3,715.50. If a non-applicant’s own income is equal to or greater than this amount, they are not entitled to a Spousal Income Allowance.
In 2023, the asset limit is $2,000 for a single applicant. For married couples, with both spouses as applicants, the asset limit is $3,000. When only one spouse is an applicant, the assets of both the applicant and non-applicant spouse are still limited. This is because Medicaid considers the assets of a married couple to be jointly owned. In this case, the applicant spouse can have $2,000 in assets, while the non-applicant spouse is allocated a larger portion of the couple’s assets as a Community Spouse Resource Allowance (CSRA) to prevent spousal impoverishment.
In 2023, the CSRA allows the non-applicant spouse to keep 100% of the couple’s assets, up to $148,620.
Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.
Assets should not be given away or sold under fair market value within 60-months of long-term care Medicaid application. This is because Medicaid has a Look Back Rule and violating it results in a Penalty Period of Medicaid ineligibility.
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. Fortunately, for eligibility purposes, Medicaid in WY considers the home exempt (non-countable) in the following circumstances.
– The applicant lives in the home or has Intent to Return, and in 2023, their home equity interest is no greater than $688,000. Home equity is the current value of the home minus any outstanding mortgage. Equity interest is the portion of the home’s equity value that is owned by the applicant.
– The applicant has a spouse living in the home.
– The applicant has a disabled or blind child of any age living in the home.
– The applicant has a minor child living in the home.
Medical Criteria: Functional Need
An applicant must require a Nursing Facility Level of Care (NFLOC). For the Community Choices Waiver, a trained public health nurse determines one’s functional need utilizing the Long-Term Care 101 (LT101) assessment tool. The amount of assistance required to complete Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) is assessed. These activities include eating, dressing, toileting, grooming, bathing, mobility, meal preparation, and medication management. Deficits in social interaction and cognition (i.e., memory, comprehension, problem solving), which is commonly seen in persons with Alzheimer’s disease or a related dementia, is also considered. To be clear, a diagnosis of dementia in and of itself does not mean one will meet a NFLOC. Based on the LT101, a total score is established, and an applicant must have a specific minimum score in order to meet the NFLOC need.
Qualifying When Over the Limits
Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for WY Medicaid. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.
When persons have income over the limits, Miller Trusts, called Irrevocable Income Trusts in Wyoming, can help. “Excess” income is deposited into the trust, no longer counting as income.
When persons have assets over the limits, trusts are an option. Irrevocable Funeral Trusts (IFTs) are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Medicaid Asset Protection Trusts (MAPTs), which must be implemented well in advance of the need for care, are trusts that protect assets from Medicaid and Medicaid’s Estate Recovery program. Another option, particularly when an applicant does not have a lot of excess assets, is to “spend down assets” on ones that are exempt from Medicaid’s asset limit. Examples include making home modifications, updating home furnishings and appliances, and buying clothing. There are additional planning strategies available when the applicant has assets exceeding the limit.
Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in Wyoming to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Some of the strategies violate Medicaid’s 60-month Look Back Rule, and therefore, should only be implemented with careful planning. However, there are some workarounds, and Medicaid Planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid Planner.
How to Apply for Wyoming Medicaid Community Choices Waiver
Before You Apply
Prior to submitting an application for CCW, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a free Medicaid eligibility test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid Eligibility Test.
As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, bank statements up to 60-months prior to application, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, a common reason applications are delayed is required documentation is missing or not submitted in a timely manner.
Since Wyoming’s Community Choices Waiver is not an entitlement program, there may be a waiting list for program participation. This Waiver is approved for a maximum of approximately 3,464 beneficiaries per year. In the case of a waiting list, an applicant’s access to a participant slot is based on the date they are determined eligible for the program.
To begin the Community Choices Waiver application process, a referral for the program should be made. This can be done by calling the Community Based Services Unit at 855-203-2823.
In addition to submitting a Community Choices Waiver Program Application, persons who are not already enrolled in WY Medicaid must apply. This can be done by submitting a paper Application for Health Coverage & Help Paying Costs, applying online, or by calling the WY Medicaid Customer Service Center at 855-294-2127.
Additional information about the Community Choices Waiver can be found here. Persons can also contact a Benefits and Eligibility Specialist to learn more about program services, eligibility criteria, and to get application assistance. Persons can also call the WY Medicaid Customer Service Center at 855-294-2127 or the WY Medicaid Long Term Care Unit at 855-203-2936.
The Wyoming Department of Health, Division of Healthcare Financing administers the Community Choices Waiver.
Approval Process & Timing
The Wyoming Medicaid application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further. Furthermore, as a waiting list may exist, approved applicants may spend many months waiting to receive benefits.