2650 Continuous Eligibility for Medicaid Children

2650 Continuous Eligibility for Medicaid Children

Once financial eligibility is established as of the date the case is processed under a MAGI program, all eligible non-pregnant children shall be eligible for a 12-month period.  This 12-month period establishes the review period for the family and the individual continuous eligibility dates for all approved members.  However, if there is not eligibility in the application month, but eligibility does exist for one or more months of the prior period, continuous eligibility is established beginning with the first month of eligibility in the prior period.

Children who subsequently enter a household, request assistance, and are determined eligible for Medicaid shall also receive continuous eligible for a 12-month period.

When a family contains individuals eligible under different assistance plans, individual continuous eligibility periods may differ.  Continuous eligibility periods will not always align with other household members.

Once continuous eligibility is established for individuals under the age of 19, coverage shall not switch between medical aid codes, except as noted in 2652.

2651 Continuous Eligibility (CE) Period

Continuous Eligibility begins with the first month of eligibility (see 2650 above) in the current review period and continues regardless of any changes in income or income.  Such eligibility shall continue unless one of the following circumstances occurs:

1. The child turns age 19;
2. An individual no longer meets residency requirements;
3. The child dies;
4. There is a voluntary request for case closure (i.e., voluntary withdrawal);
5. The child is later found to have not been initially eligible due to agency error or fraud.
6. A recipient on a MAGI program (Medicaid or CHIP) becomes eligible for a non-MAGI program such as HCBS or SSI (including eligibility under the protected class, see MKEESM 2639), Foster Care Medical (FCM), or Adoption Support Medical (ASM) coverage.

In any of the above situations, coverage shall be terminated with the month the circumstances occur or a following month allowing for timely and adequate notice. Continuous eligibility can be reestablished if there is less than a calendar month break in assistance. Otherwise, a new application would be required for the child to qualify again.

NOTE: CE does not automatically end for recipients or applicants in an incarcerated status (i.e., individuals who become residents of a jail or prison).  For eligibility rules related to incarceration, see 8111.1 (3) and KFMAM 2052.05 for Medicaid minors.

2652 Changes in non-MAGI Coverage during a CE Period

As stated in 2650, aid code changes are not permissible during a CE period, with exception to situations listed below where Poverty Level Medical (PLN) coverage shall be determined (unless the child is eligible to be transitioned back to the family’s active MAGI coverage program for the duration of the CE period).

1. Child loses SSI recipient status;
2. Child is terminated from HCBS waiver services;
3. Child is discharged from a Medicaid approved facility.

2653 Extending Continuous Eligibility

The following situations will allow a change in coverage within the CE period and a new 12-month CE period will be set.

1. CHIP to SI Medical Program;
2. CHIP to Long Term Care (LTC) Coverage (applies to both HCBS and NF coverage);
3. Poverty Level Medical (PLN) to SI Medical Program;
4. Poverty Level Medical (PLN) to Long Term Care (LTC)
5. Caretaker Medical (CTM) to SI Medical Program;
6. Caretaker Medical (CTM) to Long Term Care (LTC)