Worker Responsibilities:

Determining Best Estimates

1. Refer to Section M903 for information on determining best estimates.

Determining Premium Payments

1. Enter all gross earned and unearned income in WES.

2. WES will calculate the premium amount using the income entered on the system. The EID premium amount will display on the Medical Eligibility Determination Results screen on the Income Test tab.

3. Monthly premiums are due as follows:

3A. Require no premium for first and second months; however, require premium to be prepaid for the third month and received by the 10th of the month.

Example: Application received in June, no premium for June or July; however, August premium is due by August 10th.

3B. Require a premium for all retroactive months to be received before authorizing each benefit.

Mail premiums to the Fiscal Agent:

State of Wyoming - EID Premiums

P.O. Box 200120

Dallas, TX 75320-0120

3C. Fiscal Agent provides payment coupons to remind clients of the monthly premium amounts and the due date of premium payment.

4. Finalize eligibility and authorize benefits. WES will automatically generate an approval notice, including monthly premium amount.

5. Enter any change in income on the appropriate screens in WES when there is an increase or decrease in income.

5A. WES will re-calculate the premium amount using the new income entered.

Acting On Non-Receipt Of Premium Payments

1. Receive notification of non-payment from Fiscal Agent.

2. Review for eligibility under other Medicaid programs.

3. Ineligible for other programs and under age 19, eligibility continues for 12 months from the effective date of eligibility or for 12 months from the last periodic review.

4. Ineligible for other programs and over age 19, finalize eligibility and close for non-payment of premium.

Reinstating Benefits

1. If there is a 60-day break in Medicaid assistance, require completion of a new Medicaid application.

1A. Refer to program policies to determine eligibility.

1B. Eligible , finalize and authorize benefits for the first month of eligibility. Applicants must pay all delinquent premium payments before reopening the EID case.

1Bi. Case file should include a copy of the email from the Fiscal Agent stating delinquent premiums have been paid in full.

1C. Ineligible , finalize eligibility and deny benefits in WES.

2. If there is less than a 60-day break in Medicaid assistance, accept the premium.

2A. Reinstate benefits for the month of closure.

2B. Recalculate premium amount when change in income is reported and verified. WES will recalculate the premium using the new income entered.

3. Finalize eligibility and authorize benefits.

4. WES will automatically generate an approval notice, including monthly premium amount.

Reviewing Cases

1. Refer to Section M1403 for information on reviewing cases.

Approving Cases For Remainder Of The 12 Continuous Months Period

1. Change coverage group in WES to the 12 Month Continuous Waiver group, beginning the month the child under the age of 19 is found ineligible.

2. Finalize eligibility and authorize benefits.

3. WES will automatically generate a closure notice for the waiver services and an approval for the 12 Month Continuous Waiver group.

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.