Kansas Department of Health & Environment

Kansas Family Medical Assistance

Manual (KFMAM)


Eligibility Policy - 10/16/2021

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2052 Institutionalization - For medical assistance, the following criteria apply to persons who are institutionalized:

2052.01 - An individual who is placed by a state agency into an out-of-state institution retains residence in the state making the placement. Thus, individuals who are placed in care facilities outside of Kansas by DCF retain their Kansas residence.

Providing basic information to individuals about another state's Medicaid program or about the availability of health care services and facilities in another state does not constitute a placement action. This would also include assisting an individual in locating an institution in another state provided the individual was capable of intent and independently decided to move.

2052.02 - For individuals who become incapable of intent before the age of 21 or who are under the age of 21, the state of residence is the state in which their parents or legal guardian reside for applicants or in which they did reside at the time of institutional placement for recipients. If the parents live in different states, the state of residence of the parent making application shall be applicable.

Individuals are considered incapable of intent if: their IQ is 49 or less; or they have a mental age of 7 or less based on reliable tests; or they are judged legally incompetent; or there is medical and social documentation to support a finding that they are incapable of intent.

2052.03 - For individuals who become incapable of intent on or after age 21, the state of residence is the state in which they are physically residing.

2052.04 - For all other institutionalized individuals, the state of residence is the state in which the individual is living with the intention to remain there permanently or for an indefinite period.

NOTE: In addition Kansas has entered into interstate residence agreements with the following states: California, Florida, Kentucky, New Mexico, Ohio, Pennsylvania, South Dakota, Tennessee, Texas, and Wisconsin. The agreement states that individuals residing in a Medicaid approved institution for long term care in one of the above-named states who would be Kansas residents under (2) or (3) shall be deemed residents of that state for purposes of medical assistance unless the person was placed there by Kansas state or local government personnel. The reciprocal situation is also covered in the agreement. Refer to Medical-KEESM 8112 for definition of a Medicaid approved institution.

2052.05 Incarcerated Minors - Federal regulations prohibit states from fully terminating Medicaid coverage for children under the age of 21 and Aged Out Foster Care (AGO) recipients who become inmates of public institutions, i.e. correctional facilities, on or after October 24, 2019. When an Medicaid recipient in this category becomes institutionalized in this manner, coverage is suspended vs. terminated, meaning that while coverage is inaccessible while they are in a detained/incarcerated status, it will be reinstated upon their release without a new application being required as long as they remain eligible based on current circumstances. Likewise, applications received on behalf of individuals in this category who are currently in a detention placement must be accepted and determined for Medicaid eligibility; if determined eligible while incarcerated, a new application will not be required for redetermination upon release.

Note: At this time, this policy only applies to Medicaid individuals (PLN or M-CHIP) and not to CHIP.

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