Wyoming Medicaid Community Choices Waiver: Eligibility & Benefits

Program Description

The Community Choices Waiver (CCW) is a Home and Community Based Services Waiver that provides long-term care services for individuals who require a nursing home level of care but choose to remain living in their community (their home, the home of a family member, or an assisted living residence) rather than in a nursing home. Services include personal care assistance, meal delivery, adult day care, respite care, and more.

One particularly attractive benefit of the CWW is the Participant Direction option (more commonly called self-directed or consumer-directed care). This benefit allows eligible participants to choose who will be their paid caregiver. Individuals using the Participant Direction option must have the ability to, and must want to, direct their own care. This role includes all aspects of being an employer, including the hiring, training, and firing of their direct service worker. For those unable to manage these activities, a family member with power of attorney for health care may be able to do so on their behalf.

Another attractive component of the Participant Direction option is that family members, such as an adult child, can be hired as the direct service worker. Make note, spouses, legal guardians, and power of attorneys cannot be hired to provide care. Direct service workers earn an hourly wage and cannot work in excess of 40 hours a week.

The Community Choices Waiver is not an entitlement program, which means there are limited slots available for enrollment. Said another way, just because one is eligible for the program does not guarantee that they will be accepted into the program. CCW is administered by the Wyoming Department of Health’s Division of Healthcare Financing (DHCF).

Eligibility Guidelines

The Community Choices Waiver is a Medicaid program, and as such, the participant must be eligible for Wyoming Medicaid. The following eligibility criteria are specifically for seniors applying for this waiver.

General Requirements

Residency – Applicants must be residents of the state of Wyoming.

Age – Applicants must be 65 years of age or older or between 19 and 64 years old and be declared blind or disabled.

Functional Ability – Applicants must require a level of care that is equivalent to that of nursing home care.

Financial Requirements

Income Limits
As of 2024, a single applicant cannot have income in excess of $2,829 a month. This figure is 300% of the Federal Benefit Rate (FBR). For couples when both spouses are applying, each spouse is allowed $2,829 in income.

When only one spouse is applying, the applicant spouse is able to transfer up to $3,853.50 a month in income to their non-applicant (community) spouse. This monthly maintenance needs allowance not only helps to lower the applicant’s income, but also is intended to prevent the community spouse from becoming impoverished. If the non-applicant spouse already has monthly income equal to or above this figure, a transfer of income is not permitted.

Assets Limits
In 2024, a single applicant can have resources (assets) up to $2,000. That being said, certain resources are considered exempt items, such as one vehicle and an individual’s primary home, given the applicant’s equity value interest in the home is not more than $713,000, and the applicant, or their spouse, lives in the home. When both spouses are applying, the asset limit is $3,000.

In the case of a married applicant whose spouse is not also applying for Medicaid services, there are spousal impoverishment rules in place to prevent the non-applicant (community) spouse from having too little on which to live. As of 2024, the community spouse is able to retain a resource allowance of up to $154,140 of the couple’s assets. This is in addition to the $2,000 the applicant spouse is able to retain.

Over the Financial Limits?

Wyoming residents who exceed these income and/or asset limits but still cannot afford their care costs might still qualify for this program by working with a Medicaid planning professional. They are trained to assist applicants who find themselves in this very situation and are well versed in reallocating income and assets so that it isn’t counted toward the limits. For instance, extra income can be deposited into a Miller Trust, also referred to as a Qualified Income Trust, and an Irrevocable Funeral Trust can be used to lower one’s countable assets.

Benefits and Services

A variety of services are available via this waiver, including both in-home services and services provided in assisted living. (This waiver does not cover room and board for assisted living; only services to help delay nursing home placement.) Make note, not all services may be available in all areas.

• Adult Day Care
• Assisted Living Services – homemaker, personal care, medication management, and supervision
• Case Management
• Fiscal Management Services – for the participant directed option 
• Home Delivered Meals – up to two meals a day
• Participant Direction Option / Direct Service Worker
• Non-Medical Transportation
• Personal Care Attendant – assistance with bathing, grooming, oral hygiene, toiletry, grocery shopping, meal preparation, etc. 
• Personal Emergency Response System – installation and monthly service
• Respite Care – 30 day limit per year
• Skilled Nursing – must be prescribed by a physician

How to Apply / Learn More

Additional information about the Community Choices Waiver can be found on the Wyoming Department of Health website. And this downloadable handbook has further details on the program.

When applying, it is recommended that applicants first select a case manager in their area. An application can be found here, which should be either mailed, emailed, faxed or delivered in person. To get help applying, one can contact the Home and Community-Based Services (HCBS) Section of the Wyoming Department of Health at 800-510-0280.