1801
Burial
|
Medical Assistance - W.S. 42-2-103; ARW, Chapt. 8, Burial Rules |
A. Application
process:
1. Require the deceased's authorized
representative to complete a DFS 100 if assets cannot be identified
through records available in the DFS-FO or SSA.
2. Understand an administrative hearing
will be granted if benefits are denied.
3. Direct the request to the DFS-SO
within ten days from the date of the denial of benefits.
B. Eligibility factors:
Require the deceased individual to meet the following to receive burial
assistance:
1. A
2. Eligible for Medicaid; and
3.
Does not have sufficient assets to provide for burial or cremation.
4. Recipients
under the Prescription Drug Assistance, State
Licensed Shelter Care, Specified Low Income
Beneficiaries and Kid Care B programs are not eligible for
burial assistance.
.
C. Income:
1. Consider all income still available
in the month of death to be part of the estate of the
deceased and countable as a asset.
2. DO NOT consider any spousal
maintenance available to the deceased in the case of an institutionalized
individual with a community spouse.
D. Assets:
Determine if there are sufficient assets available to the
deceased to provide for burial or cremation:
1. Consider the following to be available
assets:
a. Whole or term life insurance
policy;
b. Burial contract;
c. Burial fund;
d. Nursing home personal needs account;
e.
Savings and checking account;
f.
Any asset, including funds from other governmental agencies,
which are immediately available without lapse or delay at the time of death;
g. Other assets.
2. Exempt an amount up to or equal to
$1,500 of the corpus of a Medicaid Qualifying Trust.
E. Medicaid Qualifying Trust:
1. DO NOT consider as available funds
an amount up to or equal to $1,500 of a Medicaid Qualifying Trust:
a. That is
irrevocable; and
b. The trustee and trustor retain no
discretion with respect to distributions to the applicant; and
c. The income from the trust shall be
transferred to the applicant at least annually; and
d. The trust corpus shall not exceed $5,000;
and
e. The trust corpus is specifically and
irrevocably designated, assigned or pledged for payment of the applicant’s
burial expenses.
2.
Inform the representative any of the trust corpus remaining after payment of
burial expenses shall be transferred to the WDH to be used in the
medical assistance program.
a. Contact the DFS-SO if there is
money remaining after burial expenses are paid;
b. Understand DFS-SO will coordinate
with the WDH to process the reimbursement.
F. Payment process:
1. Understand the mortician is required to:
a. Submit a yearly itemized general price
list, which shall include all costs for a burial or cremation;
b. Submit an original itemized bill signed
by the authorized representative of the deceased;
c. Itemize cemetery costs separately from
other burial or cremation costs.
2. Understand DFS-SO will:
a. Compare all costs to the general price
list that is current and on file with DFS;
b.
Assure costs submitted are within the general price list.
3.
DO NOT make payment on cemetery costs relating to the opening and closing of
the grave, burial plot, vault, columbarium, crypt, mausoleum, headstone
and perpetual care;
4. Deduct the immediately available assets
of the deceased from the total bill before the payment amount is determined;
5. Inform the authorized representative
the bill must be received within one year from the date of service;
6. Deny the bill under the following
circumstances:
a. The client has sufficient assets
to pay for burial or cremation; or
b. Cemetery charges are not itemized
separately from other burial or cremation costs; or
c. The bill is submitted over one year from
the date of service.
7. Act on the bill within 45 days of
receipt.
G. Benefit processing:
1. Authorize up to $1000;
2. Enter on WOLFS; and
3. Submit the bill to the DFS-SO for
payment.