Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 1/8/2026
2051
2052 Institutionalization - For medical assistance, the following criteria apply to persons who are institutionalized:
2052.01 - An individual who is placed by a state agency into an out-of-state institution retains residence in the state making the placement. Thus, individuals who are placed in care facilities outside of Kansas by DCF retain their Kansas residence.
Providing basic information to individuals about another state's Medicaid program or about the availability of health care services and facilities in another state does not constitute a placement action. This would also include assisting an individual in locating an institution in another state provided the individual was capable of intent and independently decided to move.
2052.02 - For individuals who become incapable of intent before the age of 21 or who are under the age of 21, the state of residence is the state in which their parents or legal guardian reside for applicants or in which they did reside at the time of institutional placement for recipients. If the parents live in different states, the state of residence of the parent making application shall be applicable.
Individuals are considered incapable of intent if: their IQ is 49 or less; or they have a mental age of 7 or less based on reliable tests; or they are judged legally incompetent; or there is medical and social documentation to support a finding that they are incapable of intent.
2052.03 - For individuals who become incapable of intent on or after age 21, the state of residence is the state in which they are physically residing.
2052.04 - For all other institutionalized individuals, the state of residence is the state in which the individual is living with the intention to remain there permanently or for an indefinite period.
NOTE: In addition, Kansas has entered into interstate residence agreements with the following states: California, Florida, Kentucky, New Mexico, Ohio, Pennsylvania, South Dakota, Tennessee, Texas, and Wisconsin. The agreement states that individuals residing in a Medicaid approved institution for long term care in one of the above-named states who would be Kansas residents under (2) or (3) shall be deemed residents of that state for purposes of medical assistance unless the person was placed there by Kansas state or local government personnel. The reciprocal situation is also covered in the agreement. Refer to MKEESM 8112 for definition of a Medicaid approved institution.
2052.05 Incarcerated Minors (Medicaid & CHIP) - Federal regulations prohibit states from fully terminating Medicaid or CHIP eligibility for children under the age of 21 and Aged Out Foster Care (AGO) recipients who become inmates of public institutions, i.e., correctional facilities, on or after October 24, 2019. When a Medicaid or CHIP recipient in this category becomes institutionalized in this manner, coverage is suspended vs. terminated, meaning that while coverage is inaccessible while they are in a detained/incarcerated status, it will be reinstated upon their release without a new application being required as long as they remain eligible based on current circumstances. Likewise, applications received on behalf of individuals in this category who are currently in a detention placement must be accepted and determined for pre-release Medicaid or CHIP eligibility; if determined eligible while incarcerated, a new application will not be required for redetermination upon release. If the individual is considered a qualifying youth under the CAA 2023 reentry requirements, they will be eligible for a limited pre-release benefit program which covers specific services for the 30 days prior to release. Upon release they will remain eligible and continue on the appropriate full-benefit plan.
Note: If the child was not released prior to the expiration of the CE/review period, coverage would not be reinstated without a new application or review form.
See 2052.06 for additional considerations for incarcerated minors on CHIP. See 2052.08 regarding qualifying youth under the CAA and limited services provided under Medicaid/CHIP in the 30 days prior to release.
2052.06 Incarcerated Minors (CHIP) - A new CHIP eligible applicant cannot generally be enrolled while in an incarcerated setting. When an application is received requesting coverage for an incarcerated child, and the child is found to be otherwise CHIP eligible, the application must be denied due to incarcerated status, unless they are within 30 days of release (2052.08). The other exception to this rule is when a child is currently receiving coverage on the CHIP program and enters a correctional facility during a CE period. Incarceration is not an exception to CE, so in this case, coverage may not be terminated on the basis of incarceration; rather, coverage will temporarily end (i.e., be suspended) until the agency is notified of the child’s release at which point the child would be reinstated for the remainder of the existing CE period.
NOTE: If the child was not released prior to the expiration of the CE/review period, coverage would not be reinstated without a new application or review form.
2052.07 Incarcerated Adults - Medicaid funds are excluded from the payment of medical claims for individuals residing in a correctional facility except for certain emergency qualifying events under the Inmate Program. For this reason, when a Medicaid recipient enters a correctional facility (i.e., prison, jail, or other non-Medicaid eligible public institution) coverage must be deactivated or suspended upon entry. Likewise, when an application is received on behalf of a Medicaid-eligible incarcerated individual, coverage must be delayed until the release date.
While incarceration disallows Medicaid payment of medical claims (referred to as the Medicaid inmate payment exclusion), it does not impact a person’s eligibility. This means a person will maintain eligibility for Medicaid while residing in a correctional facility and upon release may have benefits reinstated without a new application as long as they continue to meet categorical program requirements (age, residency, etc.). This also means that an application may not be denied solely due to a person’s incarceration status. An incarcerated individual must be determined based on eligibility related factors, and if eligible, coverage will begin upon release (or 30 days prior to release if they qualify for the limited benefit plan, see 2052.08). If the person is in a current continuous eligibility (CE) or review period, they may be reinstated for the remainder of that period, or a new CE period may begin, depending on program eligibility. If ineligible for another program, they may be reinstated or approved for MediKan Reintegration (MKN/RI) when criteria is met.
Note: See MKEESM 2640 for information related to MediKan.
2052.08 Limited Pre-release Benefit Plan for Certain Incarcerated Youth and Adults - While the Medicaid inmate payment exclusion applies to incarcerated individuals in most cases, federal legislation under the Consolidated Appropriations Act (CAA) of 2023 requires that certain services must be covered by Medicaid and CHIP for incarcerated youth and adults up to 21 who are post-adjudication (or sentencing) and within 30 days of their release date if they qualify for Medicaid and CHIP programs. This means that when a Medicaid/CHIP recipient or an individual who qualifies for Medicaid/CHIP under the age of 21, or AGO under age 26, becomes incarcerated, the facility must ensure certain services are provided for the required timeframe and that the Medicaid/CHIP agency is billed for these services.
The population qualifying for special services under this policy are defined as eligible juveniles and consist of children or young adults who meet the following criteria:
a. Eligible for Medicaid (either currently in a CE period or determined eligible based on an application)
b. Eligible for CHIP (either currently in a CE period or determined eligible within 30 days prior to release. Prior to that timeframe, they would be denied due to incarcerated status.)
c. Under 21 years of age or between 18 and 26 if aged out of the foster care system, including the Kansas Department of Corrections Juvenile Services (KDOC-JS)
d. Are being held in a carceral/correctional facility after being convicted.
e. Received specific services (see below) during the 30 days prior to their official release
The special services referred to above consist of screening and diagnostic services (also referred to as EPSD) and targeted case management (TCM), or case management only for CHIP.