Detailed Answer

Understanding Wyoming Medicaid Estate Recovery

Under both federal and Wyoming law, Medicaid may seek reimbursement from the estate of a deceased beneficiary who was age 55 or older when receiving long-term care. Federal law (42 U.S.C. § 1396p(link)) authorizes this recovery. In Wyoming, see Wyo. Stat. § 25-4-105(link), which requires the Department of Health to file a claim in probate when funds exist in the estate.

Who Can Request Claim Documentation?

The personal representative of the estate (executor or administrator) has the legal right to request all Medicaid claim records. If you are not the personal representative, you must obtain a court order or authorization from the representative. You will need:

• Letters of appointment or letters testamentary.
• A certified copy of the death certificate.

How to Obtain the Records

1. Contact the Wyoming Department of Health, Division of Healthcare Financing: submit a written request specifying the deceased beneficiary’s name, date of birth, Medicaid ID, and date of death. Include a copy of your personal representative documentation.

2. Request an itemized statement of services, payments, and recovery attempts. Ask for the explanation of benefits, payment schedules, and any liens placed on estate property.

3. If needed, invoke Wyoming’s open records rules under Wyo. Stat. § 16-4-202(link). While medical records may be exempt, Medicaid claim files held by the state agency are subject to inspection by the estate’s representative.

Reviewing and Verifying the Claim

Once you receive the documentation:

• Compare service dates and provider charges against medical records from care facilities.
• Verify that the rates billed match Wyoming’s Medicaid fee schedule (Wyo. Admin. Code, Chapter 15).
• Check for duplicate claims or services not rendered.

Challenging or Appealing the Claim

If you identify errors, you may:

• File an appeal with the Medicaid Fair Hearings Office within 30 days of the claim notice (Wyo. Stat. § 42-2-108(link)).
• Submit corrected documentation or provider statements to the estate recovery unit.
• Consult a probate attorney for assistance with complex disputes.

Disclaimer: This article is for educational purposes only and is not legal advice.

Helpful Hints

• Gather all estate and medical records before requesting claim files.
• Keep copies of all correspondence with the Medicaid agency.
• Note deadlines for appeals and documentation requests.
• Review the probate court docket to track the state’s claim filing.
• Consider consulting a probate or Medicaid attorney if you face complex issues.