Committee told Wyoming's Medicaid relies on tight categorical rules and a $2,000 resource test for long-term care

Director Stefan Johansen and eligibility staff outlined the checks Wyoming uses to determine Medicaid eligibility and described how asset rules can delay access to long-term care.

"Having low income does not qualify you for Medicaid in Wyoming," Director Stefan Johansen told the Appropriations Subcommittee, noting Wyoming is a nonexpansion state and requires both financial and categorical eligibility. Johansen said children, very low-income seniors, family caretakers, SSI recipients, waiver populations and pregnant women are the primary enrollment groups.

Jesse Springer, the department's interim state Medicaid agent, described the application process and the data matches used to verify applicants. "We have a trusted interface that tells us exactly who is on SSI in Wyoming," Springer said, and the department also matches with the Department of Labor, Homeland Security, the Social Security Administration, the IRS and vital records.

Springer told lawmakers the department begins with self-declared assets and requires supporting documents such as bank statements; the state subscribes to a commercial data service that covers most banks and is expanding its checks to include property and vehicle records. "We're checking what's self declared against what we find through other assets," he said.

Officials emphasized the federal and program rules that affect long-term care eligibility. The department repeatedly cited a long-standing cash/resource limit that effectively requires many long-term-care applicants to have less than $2,000 in countable assets. Johansen noted federal guidance sets a baseline home-value allowance (cited here at $730,000) and, per the department's presentation, "the Big Beautiful Bill set a maximum of a million dollars," leaving Wyoming without a single state statute specifying which home-value standard to apply.

Committee members asked how changing the $2,000 standard might affect enrollment. Springer said raising the limit would not change income rules and estimated modest near-term effects: "Just remember that it's not changing the income standard. So the individual still have to meet the income standard, and the income standard is really what's driving most of eligibility," he said, adding scenarios modeled at lower increases (e.g., $4,000 or $5,000) suggested perhaps about 100 people would enroll earlier in long-term-care programs.

Officials also described medical necessity and functional assessments for waiver programs and nursing-home level of care. For many waiver applicants, even after meeting income and asset tests, individuals must qualify medically and may be placed on wait lists before services begin. Springer said eligibility is generally backdated to the first day of the application month once screening is complete.

The department gave the committee preliminary PERM information and eligibility-error figures during the same presentation. Johansen said the department's 2024 claims error-rate estimate is under 1% for Medicaid and CHIP (federal audit finalization pending) and that the Medicaid eligibility error rate for the last audited cycle is about 3.64%, slightly above the federal 3% benchmark. "We're trying to get below that 3% threshold," Jesse Springer said, explaining many errors are administrative (for example, missing phone signatures or absent documentation) rather than deliberate fraud.

Ending: Lawmakers pressed on possible statutory changes and additional modeling of asset-test scenarios. The committee scheduled further discussion and a public meeting in Casper on Nov. 7 so residents can weigh in on related budget and policy decisions.