The Medicaid coverage program aims to provide essential health-care services to low income families, children and adults living in Wyoming. Medicaid services are offered to eligible members, enabling them to receive free or low cost quality healthcare.
What is covered by Medicaid in Wyoming? What types ofMedicaid insurance can members apply for? These are some of the questions that many Wyoming residents looking to apply for Medicaid have.
The questions, and others, are discussed under the sections below.
- How much does Medicaid cost in Wyoming?
- What services are covered by Medicaid in Wyoming?
- What does Medicaid not cover in Wyoming?
- Types of Medicaid insurance in Wyoming
How much does Medicaid cost in Wyoming?
WY Medicaid cost estimates vary depending on the income level of a member. Medicaid cost estimates of services offered vary. The State has provided a list of services covered and procedures that members are eligible for. To find out how much is Medicaid, members have to check the codes of the procedures they need. To answer the question, “how much is Medicaid in Wyoming?”, the cost of services and procedure covered from as low as $15 to as high as $5000. The full Wyoming Medicaid fee schedule is available online.
What services are covered by Medicaid in Wyoming?
WY Medicaid coverage caters for the following medical services and items:
- Adult Development Disability Waiver Services
Eligible patients that are 21 years or older and with an intellectual disability get home and community based services. Patients accepted under this program are those that would otherwise need care in an ICF/ID.
- Acquired Brain Injury Waiver Services
Medicaid coverage program provides home and community based services for adults eligible for the program. Applicants have to be 21 years to 64 years, have a brain injury and limited functional ability. Patients accepted under this program are those who would otherwise need care in an Intermediate Care Facility for the Intellectually Disabled (ICF/ID)
- Ambulance Services
Emergency transportation by Air ambulance, Advanced Life Support ambulance, or Basic Life Support ambulance. Sometimes, non-emergency transportation may be provided if other means of transport would put the patient in danger or if the patient needs special attention.
- Ambulatory Surgical Center Services
Patients can be accorded outpatient surgery in a free-standing facility.
- Assisted Living Facility Waiver Services
Medicaid services also covers this community based service that is offered to adults over 19 years that are living in an Assisted Living Facility. These clients would otherwise have to stay in nursing homes. The program does not cover room or boarding costs.
- Care Management Entity
Provision of home and community based services for children and young adults below 21 years. Eligible patients are those with developmental or intellectual disabilities, who would otherwise need care in an ICF/ID.
- Dental Services
Full comprehensive dental services are offered to children and adults below 21 years. Clients eligible for braces are those aged between 12 and 18 years and that have severe problems with their bites such that they get physical functional issues.
- Developmental Center Services
Children aged 5 or younger are provided with developmental assessments and therapy services.
- Durable Medical Equipment
Equipment and supplies ordered by a physician that have to be used at home.
Wyoming Medicaid coverage also caters for the following services and items: End-Stage Renal Disease Services (ERDS), family planning services, home health services, hospital and hospice services, interpretation services, laboratory and x-ray services, and long-term care waiver services.
Other Medicaid services offered include mental health and substance abuse services, nurse practitioner and nurse midwife services, nursing facility services, organ transplant services, physician services, prescription drugs, prosthetics and orthotics, psychiatric hospital services, rehabilitation services, surgical services, transportation services and vision services.
What does Medicaid not cover in Wyoming?
Wyoming Medicaid coverage does not apply for all medical services. Below are some services not covered:
- Services provided without the recipient’s or his/her legal guardian’s consent. The only exception to this rule is if the service was provided due to a medical emergency.
- Experimental procedures. These are procedures that are not generally used or accepted by a physician’s peer group as standard or current practice.
- Reports or examinations required for legal purposes or other non-medical related purposes.
- Medical services offered from outside the US
- Medical services provided when the patient is in custody of the state or is an inmate in a public institution
- Medical services provided to a member who is in emergency detention
- Services that cost more than the service limitations established by the rules of the Department, unless authorization is issued beforehand.
- Services offered due to a court order, if the services are not covered, exceed service limitations, have not been pre-authorized or are offered by a health care practitioner that is not a provider on the date(s) of services
WY Medicaid services program does not cater for the following procedures:
Acupuncture, transsexual surgery, services offered by an independently-practicing speech therapist or social worker, private-duty nursing services, personal comfort items, canceled or missed appointments, infertility services, chronic pain rehabilitation, chiropractic services, biofeedback therapies and equipment and autopsies Medicaid coverage also does not apply to the following services, except in special circumstances: alcohol and chemical rehabilitation, abortions, sterilization, routine physical examinations, hysterectomies and cosmetic procedures.
Types of Medicaid Insurance in Wyoming
There are different types of Medicaid insurance in WY. Wyoming Medicaid coverage members need to enroll for the WHIPP (Wyoming Health Insurance Premium Payment Program).
The types of WY Medicaid insurance that applicants can apply for will depend on how much premiums they can afford and extent of cover they need. To qualify for the WHIPP program, an applicant must be insured through a health plan sponsored by an employer and be qualified for a Medicaid program.