Wyoming Medicaid Long Term Care Programs, Benefits & Eligibility Requirements

Summary
Medicaid’s rules, benefits and name can all vary by state. This article focuses on Wyoming Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers or Aged, Blind and Disabled (ABD) Medicaid. This is different than regular Medicaid, which is for financially limited people of all ages.

 

Wyoming Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

Wyoming Nursing Home Medicaid will cover the cost of long-term care in a nursing home for financially limited Wyoming seniors who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

  • Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
  • Skilled nursing care
  • Physician’s visits
  • Prescription medication
  • Medication management
  • Mental health counseling
  • Social activities

Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.

Wyoming Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover care expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $50/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.

Wyoming Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.

 

Home and Community Based Services (HCBS) Waivers

Wyoming Home and Community Based Service (HCBS) Waivers will pay for long-term care services and supports that help Wyoming Medicaid recipients who require a Nursing Facility Level of Care remain living in the community instead of residing in a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long-term care services for Wyoming residents who live in their home, the home of a loved one, an assisted living residence or an adult foster care home. While Wyoming’s HCBS Waivers may cover long-term care benefits in those settings, it will not pay for room and board costs.

The HCBS Waiver relevant to Wyoming seniors is the Community Choices Waiver.

Community Choices Waiver (CCW)
Wyoming’s Community Choices Waiver (CCW) covers long-term care services and supports to Wyoming Medicaid recipients who require a Nursing Facility Level of Care and live in their own home, the home of a loved one, an assisted living residence or an adult foster care home. CCW benefits can include adult day care, skilled nursing services, meal delivery, transportation and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). These benefits will be made available depending on the needs and circumstances of each program participant. Wyoming Medicaid also covers physician services, prescription drugs, hospital services and durable medical equipment for CCW beneficiaries.

Unlike Nursing Home Medicaid, the CCW is not an entitlement. Instead, it has a limited number of enrollment spots (3,464 per year as of 2023). Once those spots are full additional applicants are placed on a waitlist.

 

Aged, Blind, and Disabled Medicaid

Wyoming’s Aged, Blind, and Disabled (ABD) Medicaid provides healthcare coverage and long-term care services and supports to financially limited Wyoming residents who are aged (65 and over), blind or disabled and live in the community. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for financially limited people of all ages. ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without wait. Access to long-term care benefits via ABD Medicaid depends on the availability of funds, programs and caregivers in the area where the beneficiary lives.

ABD Long Term Care Benefits
Eligible Wyoming seniors who show a medical need for long-term care services can receive those services through ABD Medicaid. These benefits can include in-home personal care, adult day care, meal delivery, home modifications and Personal Emergency Response Systems (PERS). ABD Medicaid recipients qualify for these benefits one at a time. This is different from Nursing Home Medicaid, which makes all of its benefits immediately available for anyone who qualifies. Instead, Wyoming seniors will be evaluated by the state to determine what kind of long-term care benefits they need and will receive.

Program of All-Inclusive Care for the Elderly (PACE)
PACE coordinates medical, social service and long-term care coverages into one comprehensive plan and delivery system for ABD Medicaid recipients, including Medicare benefits for those who are “dual eligible.” PACE also administers vision and dental care, and PACE day centers provide adult day care, meals, social activities and regular health checkups. PACE program participants are required to need a Nursing Facility Level of Care, but they must live in their home or somewhere else in the community. Although Wyoming does not have a PACE program of its own as of Jan. 1, 2024, there are programs in neighboring Colorado and Nebraska. While seniors can not use PACE programs (or receive any kind of Medicaid benefits) in other states, or transfer their Medicaid coverage from state to state, they can re-apply for Medicaid in a new state without any waiting period if they relocate. To learn more about PACE, click here.

 

Eligibility Criteria For Wyoming Medicaid Long Term Care Programs

To be eligible for Wyoming Medicaid, a person has to meet certain financial and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

  Just For You: The easiest way to find the most current Wyoming Medicaid eligibility criteria for your specific situation is to use our Medicaid Eligibility Requirements Finder tool.

Wyoming Nursing Home Medicaid Eligibility Criteria

Financial Requirements
Wyoming residents have to meet an asset limit and an income limit in order to be financially eligible for nursing home coverage through Wyoming Medicaid. For a single applicant in 2023, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for Wyoming Nursing Home Medicaid for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, Wyoming Medicaid beneficiaries who reside in nursing homes must give most of their income to the state to help pay for the cost of care. They are only allowed to keep $45/month of their income as a “personal needs allowance,” and they are allowed to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.

For married applicants with both spouses applying, the 2024 asset limit for Wyoming Nursing Home Medicaid is a combined $3,000, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

  Plan Ahead: There are alternative pathways to eligibility for Wyoming Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Wyoming has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for nursing home coverage through Wyoming Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is usually associated with a nursing home. To determine level of care need for Medicaid purposes, Wyoming uses the Long Term Care 101 assessment tool. A trained public health nurse will use this tool to conduct a functional assessment which takes into account the applicant’s ability to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and laundry), as well as their cognitive abilities and any social interaction issues.

 

Wyoming Home and Community Based Services (HCBS) Waivers Eligibility Criteria

Financial Requirements
Wyoming residents have to meet an asset limit and an income limit in order to be financially eligible for Home and Community Based Services (HCBS) Waivers. For a single applicant in 2024, the asset limit for HCBS Waivers in Wyoming is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for Wyoming HCBS Waivers for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants with both spouses applying, the 2024 asset limit for HCBS Waivers in Wyoming is a combined $3,000, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

  Plan Ahead: There are alternative pathways to eligibility for Wyoming HCBS Waivers applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Wyoming has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for Wyoming Home and Community Based Services (HCBS) is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is usually associated with a nursing home. To determine if they require that level of care, a trained public health nurse will conduct a functional assessment of Wyoming HCBS Waivers applicants using the Long Term Care 101 assessment tool. This takes into account the applicant’s ability to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and laundry), as well as their cognitive abilities and social interaction issues.

 

Wyoming Aged, Blind, and Disabled Medicaid Eligibility Criteria

Financial Requirements
Wyoming residents have to meet an asset limit and an income limit in order to be financially eligible for Aged, Blind, and Disabled (ABD) Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for a single applicant is $943/month. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments.

For married applicants, the 2024 asset limit for Wyoming ABD Medicaid is a combined $3,000 combined, and the income limit is a combined $1,415/month. This applies to married couples with both spouses applying or with just one spouse applying.

  Plan Ahead: There are alternative pathways to eligibility for ABD Medicaid applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While Wyoming has a Look-Back Period of five years for Nursing Home Medicaid and HCBS Waivers applicants to make sure they don’t give away their assets to get under the limit, the Look-Back Period does not apply to ABD Medicaid applicants. However, ABD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid or HCBS Waivers, and those programs will deny or penalize the applicant for giving away assets.

Functional Requirements
The only functional requirement for receiving basic healthcare coverage through Aged, Blind, and Disabled (ABD) Medicaid in Wyoming is being age 65 or over, blind or disabled. For ABD Medicaid applicants who require long-term care services and supports, Wyoming will conduct an assessment of their ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and laundry), as well as their cognitive abilities and social interaction issues, to determine the kind of long-term care the state will cover.

 

How Wyoming Medicaid Treats the Home for Eligibility Purposes

One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:

  • If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $713,000 (as of 2024) then the home is exempt.
  • If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
  • If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $713,000.

These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.

Wyoming Medicaid applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Wyoming and how you can protect your home from it, click here.

 

Applying For Wyoming Medicaid Long Term Care Programs

The first step in applying for Wyoming Medicaid Long Term Care coverage is deciding which of the three Medicaid programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that program. Applying for Wyoming Medicaid when not financially eligible will result in the application, and benefits, being denied.

During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Wyoming Medicaid applicant. These documents will be needed for the official Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.

After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Wyoming residents can apply for Wyoming Medicaid online at this Department of Health webpage. They can also apply over the phone by calling 855-294-2127. Or, they can download, complete and submit the Application for Health Coverage & Health Paying Costs.

For a comprehensive guide that will take you through the application process for all three types of Medicaid Long Term Care, click on the program you want: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.

  Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney. 

 

Choosing a Wyoming Medicaid Nursing Home

After being approved for nursing home coverage through Wyoming Medicaid, you or your loved one has to choose which Medicaid-accepting nursing home best meets your needs. Even though Nursing Home Medicaid is an entitlement, not all nursing homes accept Medicaid, and those that do may not have space when you need it. Finding the right facility can be a chore, especially if you’re looking in a specific location.

Wyoming has roughly 35 nursing homes, and all of them accept Medicaid. The facilities are spread throughout the state, with only a few communities have more than one nursing home. There are three facilities that accept Medicaid within 25 miles of Cheyenne. There are also three nursing homes around both Casper and Sheridan, and there are two facilities near Rock Springs.

Residents in some Wyoming communities may regularly cross state lines for personal and business reasons, including healthcare. But Medicaid coverage does not cross state lines. So, someone with Wyoming Medicaid would not be covered for nursing homes in South Dakota or Utah, even if facilities in those places are convenient or well-suited for the Wyoming resident.

 TOOLS: To find and compare nursing homes, Wyoming residents can use Nursing Home Compare, which is a search tool administered by the Centers for Medicare & Medicaid Services (CMS) that has information on more than 15,000 nursing homes across the country.

When you’ve found nursing homes that meet your needs and accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can be a good place to start. The healthcare professionals who work with you are another great source of information. You can also contact the Wyoming Department of Health Aging Division to find more information about nursing homes in Wisconsin.

After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: How does the facility handle dental and vision care? Does it offer social activities? What is the food like? Who are the staff doctors? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.

CMS data shows the nursing homes in Wyoming fare well in terms of health standards. Wyoming nursing homes averaged 20 health deficiencies per facility from 2019-2022, while the national average during that same time frame was 25.7.