§ 35-25-108 — 35-25-103. Child health insurance program eligibility; services by department or private health insurance

Wyoming § 35-25-108

• Jurisdiction: Wyoming
• Title 35: Public Health and Safety
• Ch. 25: PUBLIC PROGRAMS
• Art. 1: CHILD HEALTH INSURANCE PROGRAM

Text

(a) Subject to approval of the state plan by the United
States secretary of health and human services, and subject to
available state and federal funding the department shall provide
a health insurance plan for an eligible child whose monthly
gross family income is not more than two hundred percent (200%)
of the federal poverty level. A child who is determined
eligible to receive benefits under this section shall remain
eligible for twelve (12) months as long as the child resides in
the state of Wyoming and has not yet attained nineteen (19)
years of age. A child's eligibility to receive benefits under
this act shall be redetermined on an annual basis. A simplified
application process, which includes minimum eligibility
requirements, shall be provided throughout the state at various
public and private establishments approved by the department of
health. To be determined eligible to receive benefits under this
section, a child shall not be eligible under the Wyoming Medical
Assistance and Services Act, shall not have been covered under
another health insurance plan for a minimum of one (1) month
prior to application for coverage under this act or, upon birth,
the child would not otherwise be covered by a public or private
health insurance plan. Eligibility under this section shall be
determined by the department of health or its designee.
(b) The child health insurance plan required by subsection
(a) of this section shall be provided either through a private
health insurance company licensed by the insurance commissioner
to write insurance in Wyoming or by the department of health's
division responsible for administering the Medicaid program.
The department's division shall be used to provide the insurance
plan only if it can provide the plan at a lower cost than can a
qualified private insurance company or if use of the division
will otherwise accrue more benefits to the state than will use
of a private insurance company. If the child health insurance
plan required by subsection (a) of this section is provided
through the department's division, the department shall
competitively procure the contract at least once every five (5)
years. In awarding the contract the department shall compare
the cost of operating the program through a private insurance
company to a forecasted state administered alternative.
(c) A medical provider who accepts payment for services
provided under this section shall not charge or attempt to
collect payments in excess of a rate schedule established by the
department or in excess of rates negotiated with a private
health insurance company who is offering child health insurance
pursuant to this act.