Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 7/15/2025
02000 >>> 02440
02430
02440 Premium Requirement for CHIP - A monthly family premium will be charged for CHIP coverage beginning at 167% of federal poverty. If the total countable income is less than this amount, there is no premium charge. If income is equal to or greater than 167% of poverty but less than 192% of poverty, a $20 monthly premium is charged. If income is greater than or equal to 192% of poverty but less than 218%, a $30 monthly premium is charged. If income is equal to or greater than 219% of poverty but less than 255% of poverty, a $50 monthly premium is charged.
Only one premium per family is charged regardless of the number of CHIP eligible children. The amount of premium shall be based on the highest poverty level percentage determined for the family.
Families that include participating American Indian/Alaska Native (AI/AN) children are not subject to the premium requirements. The classification of AI/AN is based on client statement and will require no further verification. The premium will be eliminated for the family unit in these situations. These families shall never be subject to a premium delinquency or closure for failing to pay premiums.
The premium obligation is determined through the eligibility process in KEES and is communicated to the premium billing vendor through an automated interface with the Premium Billing and Collection system which is operated by the premium billing vendor.
The Eligibility Specialist is responsible for providing notification to the family of their obligation, see 1423.
The premium billing vendor is responsible for premium billing, collection, and monitoring. Monthly premium notices will be sent to all families subject to a premium obligation. The initial premium statement will be mailed on either the 1st or 15th of the month, depending on when coverage is authorized. Subsequent monthly premiums will be mailed on the 1st business day of each month.
All premium payments are due on the last day of the month in which they are billed. Premium payments are sent to the following address: KanCare Premium Billing, P.O. Box 842195, Dallas, TX 75284-2195. Payments can also be made by phone by calling 1-866-688-5009. Information regarding premium status is available to staff in KEES and by accessing the premium billing system.
2441 Premium Deliquency - Payment of CHIP premiums is a requirement for CHIP eligibility with the exception of pregnant CHIP minors, see 02510.
An account meets the definition of delinquent when there are two invoices that have not been paid and have not previously been used to penalize the household. These invoices do not have to be consecutive and may occur from two different eligibility periods. An account remains delinquent until the payment is made for the delinquent amount, or a consumer previously terminated at review for premium delinquency reapplies and qualifies for CHIP. The Premium Billing and Collection (PB&C) system is responsible for determining when an account is delinquent and transmitting that information to KEES so it may be used in the eligibility determination.
Failure to pay delinquent premiums at review results in discontinuance. When delinquent premiums are paid, or when a consumer previously closed for premium delinquency reapplies and qualifies for CHIP, the previously penalized delinquent premiums cannot be used again to terminate or deny CHIP coverage.
A denial or discontinuance for delinquent premiums shall only be applied to individuals who are otherwise eligible for CHIP at the time of their review. For example, if an individual has existing health insurance, they shall be denied or discontinued for that reason. They are not considered otherwise eligible for CHIP, so the delinquency is not relevant to their denial or discontinuance
Penalties are applied at the case level, not the individual level. However, a child may not be denied or discontinued for premium delinquency until their annual review. If there is a request to add a child to a CHIP program where there is a premium delinquency on the case, the child may be determined eligible for CHIP benefits despite the delinquency, provided they are otherwise eligible for CHIP. The new applicant child may not be adversely impacted by the premium delinquency until their next review.
2442 Impact on Current Recipients - When an ongoing CHIP recipient fails to pay their premium obligation for two invoices and the account becomes delinquent, if the case remains delinquent at review and the child(ren) are otherwise CHIP eligible, coverage is discontinued. Discontinuance may only occur at the point of the CHIP recipient’s review as premium delinquency does not impact a child’s Continuous Eligibility (CE) period.
2442.01 Impact of Payments on Premium Deliquency - If a payment is made of the delinquent amount before the end of the review period, the delinquency is resolved. CHIP eligibility may be reinstated without a new request for coverage being required.
If payment of the delinquent amount is made after the review period has ended following closure at review, a new request for coverage is required and a new determination is made. If the request is received during the Reactivation period, a verbal request is allowed. After that time, a new application is required, which would include a verbal request for coverage as allowed per 1402. As this would be considered a new determination and not a reinstatement, coverage will not backdate and should begin the date of approval.
2443 Impact on Eligibility for New Applicants (Including Former Residents) - When processing a new request for CHIP, whether a new application or adding a person to an existing program, and there are delinquent premiums, this will have no impact on new CHIP eligibility. This includes both new applicants and former recipients who lost coverage and are now reapplying.
2444 Collection of Past Due Premiums - Following closure at review for premium delinquency, the same delinquent premiums may not be used to negatively impact eligibility for the individual. However, the past due obligation is not forgiven until payment is made. The obligation remains on the consumer’s account, maintained by the fiscal agent.
The premium billing vendor applies a special payment methodology to the accounts in such a way that will prevent the case from going into a delinquent status, solely on the basis of how the payments are applied.
2444.01 Fees and Collections of Unpaid Premiums - If the agency incurs a fee associated with the collection of a premium obligation, such as a returned check fee, this fee will be assigned to the consumer and included as a past due amount.
Cases that have become six months past due may be referred to State Debt Set-Off for collection. Any fee charged for collections through State Debt Set-Off and will be assigned to the consumer.
2445 Premium Changes - If a change occurs during the 12-month continuous eligibility period that decreases the family's poverty level percentage (such as a change in countable income or household composition), action is to be taken to reduce or eliminate the premium as necessary.
- A premium reduction or removal is processed in the month after the month of report of the change when it is unrelated to a request for coverage for a household member.
- A premium reduction or removal is processed in the month of report when also processing a request for coverage for a household member.
- A premium shall not be increased for an individual during their continuous eligibility period, unless adding CHIP coverage for a new household member who requires a premium obligation.
A premium change notice is required.
2446 Premium Refunds and Adjustments -
Overstated Premiums - When the agency determines a premium has been overstated for a prior period, immediate action to correct future premiums shall be taken. In addition, a premium is adjusted for a prior period in the following situations:
- An agency error resulted in the incorrect premium; or
- A timely reported change was not acted upon timely and resulted in the incorrect premium.
Failure on the part of the client to report a change timely shall not result in an adjusted premium for a prior period.
To adjust the premium amount for the prior period, the Eligibility Specialist must reprocess eligibility in KEES for each month affected.
Understated Premiums - When the agency determines a premium has been understated for a current or prior period, immediate action to correct future premiums shall be taken. Only adequate notice is required when notifying of the new premium amount. If the client was initially given notice of the correct premium amount, a retroactive adjustment shall be made in KEES. If the client did not initially receive the correct notification, an overpayment shall be established for the prior period.