Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 12/26/2024
02000 >>> 02220
02210
02220 Medical Coverage for Families -
2221 Medical Coverage for Families - Medical coverage is available to families with children under the Family Medical program if the requirements specified below are met. This includes those who lose eligibility under the Family Medical program and qualify under the extended medical provisions (TransMed and 4-Month Extended Medical.)
2222 Family Medical Coverage - Persons meeting the following criteria are eligible for medical coverage under the Family Medical program:
2222.01 General Eligibility Requirements - General eligibility requirements of act in own behalf (2010), cooperation (02020), not receiving SSI (MKEESM 2630), SSN (2031), citizenship and alienage (2040), citizenship and identity verification (2045), and residency (02050) must be met. In addition, the age and caretaker requirements of 2100 and 2110 must be met. The MAGI budgeting unit provisions of 3100 are also applicable.
2222.02 Financial Eligibility - Financial eligibility shall be determined based solely on income using the provisions of 5000 and subsections. Resources shall not be considered.
To be eligible, the total countable income must not exceed the monthly poverty level standards referenced in the KDHE Eligibility Policy Appendix F-8.
A one month base period shall be used in accordance with 6311.
2222.03 Coverage Limitation - Coverage shall not be provided under the Family Medical program to the following:
(1) - Persons convicted of medical fraud per 8420.
(2) - Persons who have a special spenddown per 8362.03.
(3) - Non-pregnant adult caretakers who fail to cooperate with child support services per 2061 and subsections. A period of ineligibility shall be imposed on such persons as per 2067. Medical coverage is not available to penalized individuals under the Family Medical program until the failure or refusal ceases. However, the possibility of medical eligibility under other determined medical programs shall be considered at the point the penalty is applied, based on ex parte guidelines and before medical coverage is terminated.
2222.04 Continuation of Coverage - Family medical coverage shall continue through the end of the established review period as outlined in 2310. The person must continue to meet nonfinancial criteria.
The Family Medical household is required to report applicable changes within ten days.
Once financial eligibility is established in the Family Medical program, the continuous eligibility provisions of 2301, 2310, 2311 and 2320 are applicable to all assistance plan members. Eligibility will continue to be provided to those individuals under the Family Medical program until the end of the individual's continuous eligibility period as established in these sections even if the household no longer meets financial criteria.
All Family Medical cases shall be reviewed once every twelve months (see 7441).
2223 Family Medical Programs Hierarchy - As the various medical programs have different rules and benefits, eligibility should be determined following the medical program hierarchy. This hierarchy is embedded in the eligibility system and is controlled by system rules. If the request for coverage is for children only, the hierarchy shall be applied beginning with level 5 unless eligible for SSI or AGO.
1) SSI – Eligibility for caretakers and children who are receiving SSI payments should first be determined for SSI.
2) AGO – If an individual is not otherwise eligible for SSI but reports being in foster-care in the month of their 18th birthday, eligibility should be determined for AGO.
3) CTM – If caretakers are not eligible for SSI or AGO, eligibility should be determined for CTM, as eligibility for this program can lead to TMD or EXT coverage.
4) TMD/EXT – If caretakers are not eligible for CTM, determine eligibility for TMD or EXT if 2230/2240 are met.
5) PLN – If pregnant women or children are not eligible for CTM, determine eligibility for PLN.
6) CHIP – If children are not eligible for PLN, determine eligibility for CHIP. For families with unpaid medical bills who are likely to meet a spenddown, eligibility should be determined for MDN prior to authorization of CHIP coverage due to CHIP authorization the date of approval.
7) MDN – A spenddown should be determined for pregnant women or children who exceed eligibility for the above medical programs. In addition, children eligible for CHIP might be better served by the MDN program if their medical bills occur prior to enrollment in a managed care plan.