Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 9/18/2025
02440
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.