Many Medicare beneficiaries who struggle to afford the cost of Medicare coverage are eligible for help through a Medicare Savings Program (MSP). In Wyoming, these programs pay for Medicare Part B premiums, Medicare Part A and B cost-sharing, and – in some cases – Part A premiums.

• Qualified Medicare Beneficiary (QMB): The income limit is $1,235 a month if single and $1,663 a month if married. QMB pays for Part A and B cost sharing, Part B premiums, and – if a beneficiary owes them – it also pays their Part A premiums.
• Specified Low Income Medicare Beneficiary (SLMB): The income limit is from QMB levels up to $1,478 a month if single and $1,992 a month if married. SLMB pays for Part B premiums.
• Qualified Individuals (QI): The income limit is from SLMB levels up to $1,660 a month if single and $2,239 a month if married. QI pays for Part B premiums.

Medicare covers most medically necessary services – including hospitalization, physician services, and prescription drugs – but Original Medicare doesn’t cover important services like vision and dental benefits, and Original Medicare beneficiaries can also rack up fairly significant out-of-pocket costs (deductibles and coinsurance) if they don’t have supplemental coverage.

Some Medicare beneficiaries – those whose incomes make them eligible for Medicaid – can receive coverage for additional services and out-of-pocket costs if they’re simultaneously enrolled in Medicaid for the aged, blind and disabled (ABD).

In Wyoming, Medicaid ABD covers 2 preventive visits and 2 emergency dental visits each year. It also pays for extractions and repair or restoration of existing dentures, but does not cover new dentures.

Medicaid ABD does not pay for routine vision care. Vision exams and lenses are only covered for the treatment of eye disease or injury.

Income eligibility: The income limit is $783 a month if single and $1,175 a month if married.

Asset limits: The asset limit is $2,000 if single and $3,000 if married.

Wyoming does not have a Medicaid spend-down. Residents with income too high to qualify for Medicaid ABD are not able to access those benefits.

Medicare beneficiaries who receive Medicaid, an MSP, or Supplemental Security Income (SSI) also receive Extra Help – a federal program that reduces their out-of-pocket prescription drug costs under Medicare Part D. Individuals can also apply for Extra Help through the Social Security Administration if they don’t receive it automatically.

The income limit for this program is $1,615 a month for singles and $2,175 a month for couples, and the asset limit is $14,610 for individuals and $29,160 for spouses.

Medicare beneficiaries increasingly rely on long-term services and supports (LTSS) – or long-term care – which is mostly not covered by Medicare. It’s common to think of long-term care as being provided in a nursing home, but more than a third of Medicare beneficiaries who lived at home received some assistance with LTSS in 2015, and the number of Medicare beneficiaries who need some level of long-term care assistance will continue increasing as the population ages.

Unlike Medicare, Medicaid does cover long-term care, including nursing home care and in-home custodial care. But eligibility rules are complex and they differ from state to state, making it challenging for beneficiaries to understand what assistance might be available to them.

Medicaid nursing home coverage in Wyoming

Income limits: The income limit is $2,349 a month if single and $4,698 a month if married (and both spouses are applying).

When only one spouse needs Medicaid, the income limit for single applicants is used – and only the applicant’s income is counted.

But if a person meets the income limits for Medicaid nursing home coverage, most of that income has to be contributed to the cost of the nursing home care. In Wyoming, nursing home residents with Medicaid coverage must pay nearly their entire income toward their care, with the exception of a small personal needs allowance (of $50 a month) and the cost of health insurance premiums (such as Medicare Part B and Medigap).

Assets limits: The effective asset limit is $2,000 per applicant. If only one spouse needs Medicaid, federal spousal impoverishment rules allow the other spouse to keep up to $126,800.

(Note: the asset limit for HCBS is actually $3,000 for a married couple when both spouses are applying, but eligibility workers are instructed to use the asset limit for single applicants when this would be beneficial to them.)

Certain assets are not counted when determining whether a person’s assets are within the required range. These include many household items, family heirlooms, certain prepaid burial arrangements, and one car. A first home does not disqualify an applicant from receiving Medicaid coverage for nursing home care if the applicant’s equity in the home is no more than $595,000.

Home and Community Based Services (HCBS) waivers

Medicaid programs in each state pay for community-based LTSS. These are called Home and Community-Based Waiver (HCBS) services because recipients continue living in the community, rather than entering a nursing home.

Income limits: The income limit is $2,349 a month if single and $4,698 a month if married (and both spouses are applying).

When only one spouse needs Medicaid, the income limit for single applicants is used – and only the applicant’s income is counted.

Assets limits: The effective asset limit is $2,000 per applicant. If only one spouse needs Medicaid, the other spouse is allowed to keep up to $126,800.

An applicant’s first home will not disqualify them from receiving Medicaid HCBS if their equity in the home isn’t more than $595,000.

Qualifying for Medicaid LTSS with income above the eligibility limit in Wyoming

Wyoming limits Medicaid nursing home benefits and HCBS to applicants with incomes below the eligibility limit of $2,349 a month (if single). Applicants with incomes above this limit can qualify for LTSS services if they deposit income into a Qualified Income Trust, which is also called a “Miller Trust.”

Nearly all of the person’s income – including income placed into the Miller Trust – must be contributed towards the cost of their care once they enter a nursing home. However, some withdrawals are permitted, including an allowance for dependent children under 18, a spousal allowance, Medicare Part B premiums for the first two months the person is eligible for nursing home coverage, and certain banking or trust fees.

Spousal impoverishment protections in Wyoming

Eligibility rules for Medicaid LTSS programs differ from other Medicaid benefits when only one spouse is applying. If only one spouse is applying for Medicaid LTSS, only that person’s income is counted. (Normally with Medicaid benefits, the income of both spouses is counted – regardless of whether the application is for one or both spouses.)

Spousal impoverishment rules allow community spouses (ie, a non-institutionalized spouse) of Medicaid LTSS recipients to keep a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their Medicaid spouse’s monthly income. This is sometimes known as a “spousal allowance.”

In Wyoming in 2020, these spousal impoverishment rules allow community spouses to keep:

• An MMMNA of between $2,155 and $3,216 per month.
• A Community Spouse Resource Allowance (CSRA) that is $128,640.
• A monthly housing allowance of up to $646.50.

Medicaid home equity limit in Wyoming

Federal law requires states to limit eligibility for Medicaid nursing home and HCBS to applicants with a home equity interest below a specific dollar amount. In 2020, states set this home equity level based on a federal minimum of $595,000 and maximum of $893,000.

Wyoming uses the federal minimum home equity limit – meaning applicants with more than $595,000 in home equity are not eligible for Medicaid nursing home care or HCBS.

Penalties for transferring assets in Wyoming

Because long-term care is prohibitively expensive, there is an incentive to give away or transfer assets to family members, friends, or organizations in order to meet the meager asset limits required in order to be eligible for Medicaid nursing home or HCBS benefits. To curb these asset transfers, federal law requires states to implement a penalty period for Medicaid nursing home applicants who give away or transfer assets below market value. States can also have a penalty period for HCBS.

Wyoming has an asset transfer penalty for both nursing home care and HCBS. This penalty is based on a 60-month look-back period, so it considers any asset transfers that the person made during the five years prior to applying for Medicaid LTSS. The penalty period is calculated by dividing the value of asset transfers and gifts during made the look-back period by the cost of nursing home care (which is $7,803 in Wyoming in 2020).

Estate recovery in Wyoming

A state’s Medicaid agency is required to recover what it paid for LTSS and related medical costs beginning at the age of 55. States also have the option of recovering costs for enrollees in this age group who did not receive LTSS, and for enrollees younger than 55 who were permanently institutionalized.

Wyoming has chosen to recover what it paid for all Medicaid benefits beginning when an enrollee was 55. This means that estate recovery is not limited to payments for LTSS.

Wyoming may grant an exemption to estate recovery in cases where recovering from an estate would cause undue hardship. The state will also delay its estate recovery if a Medicaid enrollee is survived by a spouse or a child who is under 21, blind or disabled. Estate recovery will occur once the spouse dies or when the child turns 21 or is no longer considered disabled.

Congress exempted Medicare premiums and cost sharing from Medicaid estate recovery starting with benefits paid after December 31, 2009, but Medicaid would recover those costs for benefits paid through that date.

Wyoming Senior Citizens Inc. (WSCI)

Free volunteer Medicare counseling is available by contacting Wyoming Senior Citizens Inc. (WSCI) at 1-800-856-4398.

WSCI offers a variety of services for Wyoming Medicare beneficiaries, including operating the State Health Insurance Assistance Program (SHIP). SHIPs can help beneficiaries enroll in Medicare, compare and change Medicare Advantage and Part D plans, and answer questions about state Medigap protections. Counselors may also be able to provide referrals for home care agencies or long-term care services. WSCI also offers the following services and programs:

• National Family Caregiver Support Program
• Senior Companion Program
• Long-Term Care Ombudsman
• Senior Medicare Patrol
• Foster Grandparent Program
• Wyoming Home Services Program

The WSCI website has more information about each of these.

Elder law attorneys

Elder law attorneys can help individuals plan for Medicaid long-term care benefits. Use this search feature from the National Academy of Elder Law Attorneys (NAELA) to find an elder attorney locally.

Wyoming’s Medicaid program is overseen by the Wyoming Department of Health. You can apply for Medicaid ABD or an MSP using this website or by calling 1-855-294-2127.

An in-person interview is always required when applying for long-term care benefits, and many states also require one for Medicaid ABD. However, interviews are no longer required for the MSP.