Kansas Department of Health & Environment

Kansas Family Medical Assistance

Manual (KFMAM)

Eligibility Policy - 8/21/2019

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1409 Expedited Medical Service for Pregnant Women Program - All pregnant women who apply for medical assistance, shall be initially assessed for expedited medical eligibility. If eligible based on the criteria listed below the pregnant woman application shall be approved no later than 10 calendar days from the date of application.

In order to qualify for expedited medical eligibility, the pregnant woman must:

1409.01 - Meet the financial requirements of the poverty level program in accordance with 2280; and

1409.02 - Meet all general eligibility requirements as referenced in 2270 except for the completion of an SS-5 for those who do not have or cannot provide a Social Security number.

If all of the above criteria are met, the pregnant woman shall be initially approved for expedited medical assistance only within the 10 day time frame. Only the pregnant woman is eligible for expedited medical assistance. A formal determination of eligibility would then be completed based on the normal processing time guidelines for the pregnant woman. If the pregnant woman is not eligible for expedited medical assistance, the formal determination process shall then be initiated.

For purposes of determining expedited medical eligibility, the simplified eligibility concept of 1320 shall be used to the greatest extent possible. The information on the application/ redetermination form and statements of the pregnant woman shall be accepted as long as eligibility can be determined from that information. If the information provided is inconsistent or incomplete (e.g., estimate of income not provided) so that eligibility cannot be determined, expedited eligibility shall be postponed until sufficient information is provided. All verifications may be postponed in order to meet the 10 day processing time. However, such verifications will need to be provided in order to complete the formal determination process.

Expedited medical eligibility status shall not extend beyond two months following the month of application for assistance. If the pregnant woman were later determined ineligible for assistance, the case would be closed allowing for timely and adequate notice. Any resulting overpayments will be subject to recovery. The continuous eligibility provisions of 2301 would not be applicable if the income used to determined expedited eligibility was incorrect and the revised amount actually exceeded the poverty level standard from the beginning.

If the anticipated category of assistance is apparent based on the initial assessment, the case could be opened using the appropriate program. Otherwise the case should be initially opened on a poverty level program.

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