Worker Responsibilities:

Accessing Waiver System To Determine Eligibility

1. Access the Medicaid Waiver System to determine status of the waiver process and verify the medical necessity requirement has been met.

1A. Log into Waiver System by Clicking on the "Medicaid Waiver System" tab in ECOM or access at https://waivers.health.wyo.gov .

1B. Enter your user name and password. Click on the "Log In" button.

1C. Review the Confidentially Agreement, Check the box indicating that you agree, and Click on the "Continue" button to proceed. This agreement must be completed the first time you log into the system and is required again every 45 days.

2. Complete assigned tasks for applicants who are in the Medicaid Waiver System and meet the eligibility requirements.

2A. Click on the "View" icon next to the Last Name. The system will take you to the next screen and prompt you on what action needs to be completed.

2B. View , under Eligibility, a check mark by Review LT-101 verifies the Medical Necessity requirement has been met.

2C. The system will show Eligibility under Process, complete the determination:

2Ci) Click on Disability requirement has been met when the applicant or client is under 65, and has been determined disabled by SSA or WDH. (This field will only display when the applicant or client is under the age of 65.)

2Cii) Enter the Client ID # from WES.

2Ciii) Click on Has met the income and resource eligibility requirements.

2Civ) Click on "Save" and "Complete." This will complete the task and remove the case from your task list.

2D. The system will communicate the eligibility determination and place the individual on a waiting list.

2E. Pend the case in WES until a Plan Of Care is approved and a start date is provided through the Medicaid Waiver System.

2F. Send a Pending Notice in WES when the individual meets all eligibility requirements.

3. Complete assigned tasks for applicants who are in the Medicaid Waiver System and do not meet the eligibility requirements.

3A. Click on the "View" icon next to the Last Name. The system will take you to the next screen and prompt you to complete the required actions.

3B. The system will show Eligibility under Process, complete the determination:

3Bi) Click on Disability requirement has not been met when the applicant or client is under age 65, and has not been determined disabled by SSA or WDH. (This field will only display when the applicant or client is under the age of 65.) OR

3Bii) Click on Disability requirement has been met when the applicant or client is under age 65, and has been determined disabled by SSA or WDH. (This field will only display when the applicant or client is under the age of 65.) AND

3BiiA) Click on Has been denied financial eligibility .

3Biii) Click on "Save" and "Complete." This will complete the task and remove the case from your task list.

3C. The system will communicate the eligibility determination and notify the waiver program of the denial.

4. Complete a search for an existing waiver client who is being closed or an applicant who is on the waiting list who is being denied.

4A. Click on the "Search Cases" tab.

4B. Fill in any combination of information to find a client.

4C. Click on the "Search" button.

4D. Click on the "View" icon next to the client's name.

4E. Click on the drop down menu to select a reason for accessing this case and Click "Save."

4F. Enter closure or denial reason, the date the client was notified and the effective date of the closure or denial.

4G. Click "Close."

5. Receive notification from the Medicaid Waiver System when an applicant has a funding opportunity.

5A. Redetermine financial eligibility if 60 days has passed since initial application.

5B. Access the Medicaid Waiver System.

5C. View the Process, Funding Opportunity and Status, Confirm Financial, found under your assigned tasks.

5Ci) Click on Disability Requirement has been met. (This field will only display if the applicant or client is under the age of 65.)

5Cii) Click on Has met the income and resource eligibility requirements or

5Ciii) Click on Has been denied financial eligibility .

5Civ) Click on "Save" and "Complete." This will complete the task and remove the case from your task list.

5D. Notification will be sent from the Medicaid Waiver System with the approved Plan Of Care start date.

Authorizing Cases in WES

1. Complete updating resources and income in WES in the month of application and the first month of waiver eligibility forward to maximum benefit month.

Determining Continued Eligibility If Client Loses SSI

1. Require a DHCF-300 Disability Application from the client to determine continued eligibility.

Determining Eligibility For Applicant That Does Not Meet Waiver Eligibility

1. Screen the applicant to see if the individual meets eligibility under another Medicaid group.

2. Deny the application when not eligible.

Applications Received For Applicants Not In The Medicaid Waiver System

1. Email the Waiver Program Manager to determine if an application has been received.

2. Screen the Medicaid application for eligibility under another group when an application has not been received by the Waiver Program Manager.

Closing Cases

1. Finalize eligibility and close benefits in WES when the applicant is no longer eligible

2. Allow 15-day closure notice when an adverse action has occurred.

3. Access the Medicaid Waiver System to communicate the eligibility determination.