Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 12/26/2024
2222
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.