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Medical Assistance Law In Wyoming

Wyoming Medical Assistance and Services Act

Medicaid is funded jointly by the state and federal governments. Before a state can receive federal appropriations for Medicaid, a state plan must be approved by the federal Health Care Financing Administration. 42 U.S.C. § 1396; 42 C.F.R. § 430.

Under federal law, the state plan must include provisions for collecting payments from liable third parties and reimbursement of those payments to Medicaid.

States must require recipients to assign to the state any rights to recovery of payment of medical care from a liable third party. This assignment is a condition of eligibility to receive Medicaid benefits. 42 U.S.C. § 1396(k).

Wyoming's compliance with this federal mandate is found at Wyo. Stat. §§ 42-4-201-- 42-4-208.... Wyo. Stat. § 42-4-201(a) clearly and succinctly reiterates federal law and states the intent of the Wyoming legislature:



If a recipient covered by this chapter receives an injury under circumstances creating a legal liability in some third party, the recipient shall not be deprived of any medical assistance for which he is entitled under this chapter.

He may also pursue his remedy at law against the third party.

If the recipient recovers from the third party in any manner, including judgment, compromise, settlement or release, the state is entitled to be reimbursed for all payments made, or to be made, on behalf of the recipient under this chapter.

There can be no clearer statement that Wyoming's legislature intended the Department be fully reimbursed for Medicaid payments made on behalf of a recipient who recovers those payments from a liable third party.Cargill, 967 P.2d at 1001-02.

"Upon signing an application for medical assistance . . ., an applicant assigns to the department any right to medical support or payment for medical expenses . . . . The assignment is effective upon a determination of eligibility . . . ." Wyo. Stat. Ann. § 42-4-106 (b) (Michie 1994).

When a recipient of Medicaid benefits recovers from a third party as specified by statute, the State is entitled to be reimbursed for payments made or to be made. Wyo. Stat. Ann. § 42-4-201(a) (Michie 1994).

"Recipient" is defined as "any person receiving benefits under programs provided pursuant to this title." Wyo. Stat. Ann. § 42-1-101(a)(v) (Michie 1994).

The statutes give the Department three methods for achieving reimbursement. Wyo. Stat. § 42-4-202 provides for a lien against the recipient's recovery.

Wyo. Stat. § 42-4-204 makes the Department subrogated to the recipient's right of recovery and also grants the Department an assignment of "any entitlements from a claim or action against any responsible third party for medical services, not to exceed the amount expended by the department, Cargill, 967 P.2d at 1002.

The obligation and method of providing notice is provided for in Wyo. Stat. Ann. § 42-4-202(d) (Michie 1994), which states:

(d) The department shall be given notice of monetary claims against a person, firm or corporation that may be liable to pay part or all of the cost of medical care when the department has paid or become liable for the cost of that care. Notice shall be given as follows:

(i) Applicants for medical assistance shall notify the state or local agency of any possible claims when they submit the application. Recipients of medical assistance shall notify the department of any possible claims when those claims arise. A recipient's noncooperation in providing information to the department to assist in pursuing liable third parties shall result in denial or termination of eligibility per federal law;

(ii) An enrolled medicaid provider shall notify the department when the person has reason to believe that a third party may be liable for payment of the cost of medical care. If the person providing medical care services fails to notify the department when a third party is liable for payment of the cost of medical care and the department, because of lack of notice from the provider, does not receive reimbursement for the cost of medical care, the department may adjust the value of those claims from future payments to that provider;

(iii) An attorney representing a recipient of medical assistance in a claim upon which the department may be entitled to a lien under this section shall notify the department of its potential lien claim before filing a claim, commencing an action, or negotiating a settlement. Any attorney who knowingly fails to notify the department of any settlement or knowingly fails to ensure the state is reimbursed, to the extent of the lien, from the proceeds of any settlement or judgment under this section shall be reported to the state board of professional responsibility for the Wyoming state bar.

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