048-35 Wyo. Code R. § 35-5

Current through April 27, 2019

Section 35-5 - Assignment of Benefits and Third Party Liability

(a) Assignment of Benefits, Third Party Liability, and Estate Recovery.

• (i) By signing an application, an applicant shall be deemed to have made an assignment to the Department [the right to medical support or payment of medical expenses] on the applicant's behalf and on behalf of any relative, ward, or legal dependent for whom application is made.

• (ii) The assignment of benefits is effective upon a determination of eligibility and remains in effect with respect to services provided during the period of eligibility for Medicaid, including any period of retroactive eligibility.

(b) Payer of last resort. Medicaid will pay for services only after payment of all other third party payers has been exhausted, except as provided by 42 U.S.C. § 1396d(b) and Title V of the Social Security Act.

(c) Recovery of payments from third party payers. If the Department pays or becomes obligated to pay Medicaid funds on behalf of an applicant or a client because of an injury, illness, or disability for which a third party is legally liable or obligated to pay, the Department may recover the full amount of such Medicaid funds from the third party to the extent of such party's liability up to the amount of medical assistance paid, as provided by law.

(d) Estate recoveries. If the Department pays or becomes obligated to pay Medicaid funds on behalf of a client who is fifty-five (55) years of age or older, or who was an inpatient in a nursing facility, intermediate care facility for people with intellectual disability or other medical institution, the Department may recover the full amount of such Medicaid funds from the estate of the deceased client or from the estate of a spouse.

(e) The Department, Division of Healthcare Financing, or its successor shall be named payee on all payments for Medicaid benefit recovery.

048-35 Wyo. Code R. § 35-5

Amended, Eff. 2/19/2019.