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Public notice
What is an "1115 Waiver" under Medicaid?
The word “waiver” refers to “waiving” certain statutory provisions of the Social Security Act, which governs the Medicaid program.
Some waivers have expanded services and populations covered. For example, people with intellectual and developmental disabilities used to only be eligible for nursing home or institutional care. Wyoming's Comprehensive and Supports Waivers allow them to receive care in home- and community-based alternatives.
Others are focused on alternative service delivery as a way of containing costs.
Section 1115 allows States to test out ideas that will improve the Medicaid program.
What is the purpose of this waiver?
The purpose of this waiver application is to prevent or delay Medicaid-paid nursing home stays by ‘intercepting’ people who may later qualify for Medicaid only after spending down assets in an institutional setting.
What will the waiver do?
The waiver would expand a limited menu of Medicaid home- and community-based services to adults over 65 years who meet the following criteria:
Meet a lower threshold of 11 points on Medicaid's level-of- care assessment, the LT-101. The current qualifying threshold is 13 points.
Have a monthly income that is less than 400% of the SSI standard, or ~$3,656 per month. The current limit is 300% of SSI, which works out to ~$2,742 per month.
Have countable non-house assets less than $10,000. The current limit is $2,000.
No Medicaid medical services would be provided.
The waiver would also eliminate, for this population only, the requirement for the State to pursue the recovery of assets and estates of people after death.
Additionally, with a proposed total budget of $5,000,000, we anticipate being able to serve only 350 people at any given time. This will necessitate a waitlist. We would select individuals off the waitlist on a randomized basis, so everyone has an equal chance of receiving a slot as they open up.
Why is the Department of Health doing this?
Footnote 17 from our supplemental budget directs us to do so. The footnote reads:
17. The director of the department of health, with the consent of the governor, shall enter into negotiations with the United States department of health and human services regarding the operation of a narrowly tailored, long-term care waiver under Section 1315 of Title XI, Part A of the federal Social Security Act, as amended, with the intent of expanding long-term home care and community-based services to individuals who may not currently qualify for such services under Medicaid as reported by the department of health to the joint labor, health and social services interim committee and the joint appropriations committee in accordance with footnote 6 of this section.
Where can I read more?
This is only the abbreviated public notice; the full public notice is available at this link. The full 1115 waiver application is available here in its entirety, and a brief summarizing the waiver is shown on this site, below. In addition, we have a primer on aging in Wyoming and how it affects Medicaid here.
All of these documents are also in the public Google Drive folder visible below.
Can I submit public comment?
Yes. The official State public notice period for the Long Term Care - Eligibility Expansion waiver is from August 21, 2023 to September 22nd, 2023, but we will take comments before then.
To submit public comments, please fill out the Google Form at the bottom of this site.
Can I go to a public meeting to talk about this?
Yes. We will hold two public meetings to receive public comment. The locations, times, and URLs/numbers to join remotely are:
On Thursday, August 24th, 2023, from 12:00 to 3:00pm, in Cheyenne, at the Laramie County Library - Willow Room.
Video call link: https://meet.google.com/kxz-qkvg-sqe
Or dial: (US) +1 413-752-2834 PIN: 128 849 639#
On Friday, August 25th, 2023, from 12:00 to 3:00pm in Casper, at the Thyra Thomson State Office Building - Turntable Room (3017).
Video call link: https://meet.google.com/zgd-czvq-zfs
Or dial: (US) +1 662-767-4040 PIN: 730 449 093#
Can I register on an email list for updates?
Sure! Just submit a public comment that you'd like your email on a mailing list, and we can send you updates.
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