Frequently Asked Questions
What is the difference between Medicare and Medicaid? The federal government administers Medicare. Medicare is not based on financial need but is generally linked to receiving Social Security benefits based on being age 65 or older or having a disability.
Medicaid is an assistance program administered on a state-by-state basis. Medicaid eligibility is based mainly on financial need.
What is Medicaid? Medicaid pays for a variety of medical services for children and adults with limited income and resources. Medicaid is supported by federal and state taxes. You can apply for Medicaid benefits regardless of sex, race, religion, color, national origin, sexual orientation, marital status, age, disability, or veteran status. If you are found (or determined) eligible, you can receive Medicaid as long as you continue to meet the eligibility requirements. Your local Department of Family Services or the Department of Health Long Term Care Unit determines eligibility for Medicaid programs.
How can Medicaid help you? The Medicaid program assists Wyoming residents in various medical situations. When you apply, the information you provide on your Medicaid application and any required verification (proof) will be used to determine which program(s) you qualify for and which program is best for you and your family.
Do I have to live in Wyoming to get Medicaid? Yes, you must be a resident of Wyoming to get Wyoming Medicaid. To be considered a Wyoming resident, you must live here or plan to live here within 45 days of applying.
How do I know if I am eligible for Medicaid? After applying for Medicaid, your local Department of Family Services or the Department of Health Long Term Care Unit will send you a notice to let you know if you are eligible.
What are the different eligibility categories? Medicaid is for people in two broad categories, “Families and Children” or “Aged, Blind or Disabled.”
Families and Children is for children under 19 years of age and pregnant women. Parents and other relatives who are providing care for unmarried children living with them may also qualify in this category, but the income limits are very low.
Where do I apply for Medicaid? You may apply for Medicaid at your local Department of Family Services (DFS) office or the Wyoming Department of Health Long Term Care Unit. You may also fill out an application and mail it in to your local DFS office or to the Wyoming Department of Health Long Term Care Unit . There is also an online application that you can complete and submit electronically.
How long does it take to find out if my children or I are eligible for Family and Children's programs? The Department of Family Services has 45 days to approve or deny an application. This is extended to 60 days if more information is needed from you. You will receive a letter in the mail letting you know if you qualify.
Are there special programs for parents who lose Family Care Medicaid because of full-time employment or receipt of child support payments? Yes. Twelve and Four Month Extended Medical are transitional programs that can help individuals in these circumstances.
If I have other insurance, would I still be eligible for these programs? Yes. Medicaid pays amounts that are still owed after your primary insurance pays.
I was on Medicaid in another state, can I transfer my Medicaid? No. You cannot transfer Medicaid from one state to another. Each state’s Medicaid program is different. You must submit a new application in Wyoming and provide proof that your case has been closed in your old state of residence.
What is a household? A “household” is made up of children under age 19, their parent(s), guardian(s), and/or caretaker realtive(s) who all live in the home.
What if I don’t have a Social Security Number? If you do not have a Social Security Number, leave the field blank. You will need to apply for a Social Security Number through the Social Security Administration.
What if I already have medical bills? If you have medical bills in the 3 months before you submit an application for Medicaid, you may be eligible for Medicaid to pay those bills. Your income from those months must have been within the Medicaid income limits and the medical services received must have been Medicaid covered services and must have been provided by an Medicaid enrolled provider.
How long will my children or I be covered by these programs? Under most programs, you will be approved for one year from the date your eligibility is determined. You will be sent a “renewal” notice prior to the one year anniversary, and you will need to complete and return the renewal to the Department of Family Services or the Department of Health Long Term Care Unit where they will re-determine eligibility for you and/or your children. If it is determined that you are no longer eligible for that program, you will be notifed by mail.
Is there a special program for children and pregnant women? Yes. Pregnant women and children below the age of six may have more income and still qualify for no-cost Medicaid services. The income guidelines are different for children birth to age 6 and children 6 to 19.
Do I have to pay for Medicaid? If your are eligible for Medicaid, you will receive Medicaid services at no cost to you, with these exceptions:
- Adults over the age of 21 who are not pregnant may have a small co-payment for medical services or treatment not related to the pregnancy.
- The Employed Individuals with Disabilities (EID) program requires a monthly premium.
- If you are in a Long Term Care facility, you will be responsible to contribute to the cost of your care
- If you are in an Assisted Living Facility, you will be responsible to pay for room and board
What if I'm disabled? If you feel you are disabled, tell us on your application. There are certain criteria you must meet to receive Medicaid on the basis of disability. You must qualify for disability programs using Social Security guidelines. Proof may involve obtaining medical records, tests, and other medical findings.
How long does it take to find out if I am eligible for Aged, Blind or Disabled programs? The Department of Family Services or Department of Health Long Term Care Unit has 45 days to approve or deny an application. This is extended to 60 days if more information is needed from you and 90 days if disability is being determined. You will receive a letter in the mail letting you know if you qualify.
What documents will I need to turn in along with my application? You will need to turn in copies of original documents when applying for healthcare coverage or bring originals in to your local Department of Family Services office to have copies made. Documents are listed in each program section of this website.
How much money can I have and be eligible for Medicaid Aged, Blind or Disabled programs? After the eligibility worker determines that you meet the medical necessity requirements, the value of all your resources will be added up. Resources are cash gifts, money in checking or savings accounts, credit union accounts, stocks, savings bonds, trusts, annuities, or any other money that you have saved or invested. Resources also include things like boats, trailers, real estate, and life insurance policies or other items of value that you may own. Medicaid does not count as resources the home you live in (if the value is under $536,000), one vehicle or personal property (e.g., clothing, furnishings). The amount of resources you may have depends on the size of your family and the eligibility group for which you are applying. This will be determined at the time of application.
How much income can I get and be eligible for Medicaid? Income is money that you get from working, or money that someone gives you, or checks that you get, like Social Security, unemployment or disability benefits, child support, retirement benefits, or sick pay. The amount of income you may have depends on the size of your family and the eligibility group for which you are applying.
Can I get help from Medicaid with Medicare costs? Yes. Medicaid can assist with your Medicare expenses.
- The Qualified Medicare Beneficiary program pays for the Medicare Part A and B premiums, co-insurance and deductibles. To be eligible you must have income at or below 100% of the FPL.
- The Specified Low-Income Beneficiary pays for the Medicare Part "B" premium. To be eligible you must have income below 135% of the FPL.
I am disabled and working: Can Medicaid help me? Yes. If you have a disability as determined by the Social Security Administration or the Wyoming Department of Health using Social Security guidelines, you may qualify for the Employed Individuals with Disabilities (EID) program.
Are there special programs for individuals with breast and cervical cancer? Yes. Breast and Cervical Cancer Treatment Program (BCCTP) provides needed cancer treatment to eligible individuals diagnosed with breast and/or cervical cancer and who are in need of treatment. In order to be eligible for this program, you must first be eligible for Wyoming Breast and Cervical Cancer Early Detection Program. For more information on this program, go to: http://wdh.state.wy.us/phsd/bccedp/index.html.
Can a person with Tuberculosis (TB) get Medicaid? Yes. There is a special program for individuals with Tuberculosis.
I lost my Medicaid card. How do I get another one? Contact Xerox (ACS) at 1-800-251-1269 or log into the ACS/Medicaid web Portal at: http://wyequalitycare.acs-inc.com to order another one.
How do I change my information or report the birth of my child? Contact your local Deparment of Family Services to make these changes to your record.
Is the Medicaid Eligibility Manual available online? Yes. To view the Medicaid Eligibility Manual, click here.
I am an adult with no income, can I qualify for Medicaid? There is limited coverage through Medicaid for parents or qualified relatives of an eligible child under age 19 and aged, blind and disabled individuals. We would recommend you contact your local Department of Family Services for more information.
The Social Security administration determines eligibility for individuals with disabilties through the Supplemental Security Income (SSI) program.
What are my rights after I apply for Medicaid? Link to Rights and Responsibilities document
Can I still keep part of my income if I am in a nursing home? A client is responsible for paying the nursing home for part of the cost of his or her care. This is called the Patient Contribution. This is figured by subtracting allowable deductions from the amount of income a client receives each month. Click on the Nursing Home and Inpatient Hospital link in the left hand menu for more information.
What are resources as defined by Medicaid? A resource is real or personal property that has economic value. Resources can include, but are not limited to, cash savings, investments, houses, land, vehicles, etc. The applicant's resources are evaluated for ownership, accessibility, and equity value. All resources are countable unless specifically excluded by regulation.
What resources are excluded when determining eligibility for Medicaid? Many resources are excluded including your place of residence, if the equity value is at or below $536,000. Vehicles may be excluded including one vehicle with the highest equity value and income-producing vehicles.
If I think I am eligible for Medicaid, should I cancel any other health insurance I might already have? No. You can qualify for Medicaid and keep your current health insurance policy.
How do I file a Medicaid complaint? If you do not understand or if you disagree with an Medicaid decision, contact your local Department of Family Services office or the Wyoming Department of Health Long Term Care Unit . If you feel that policy was incorrectly followed, you may ask for an Administrative Hearing. You must request this hearing within 30 days of being notified in writing of a decision regarding your Medicaid benefits. If you do not request a hearing within 30 days, no hearing will be granted.
What if I go to an out-of-state nursing home or other long-term care facility? In order for Medicaid to cover the costs of an out-of-state provider, they must be an enrolled Wyoming Medicaid provider.
If I am getting Social Security benefits, am I automatically eligible for Medicaid? You are only automatically eligible for Medicaid if you are SSI medically eligible.