Kansas Department of Health & Environment

Kansas Family Medical Assistance

Manual (KFMAM)

Eligibility Policy - 5/18/2022

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02210 Medicaid - The Medicaid program is divided into two segments, the "categorically needy" and the "medically needy."

2211 Categorically Needy - Those persons who are eligible for a cash benefit under the SSI program or who meet Family Medical guidelines comprise a good portion of the categorically needy. Children and pregnant women who have incomes that fall below certain poverty level guidelines also are classified within this group.

The categorically needy receive medical assistance either because their income falls within poverty or Family Medical income guidelines or as a result of SSI eligibility. Within the categorically needy segment are also those persons who are "deemed" to be receiving an SSI cash benefit or Family Medical although ineligible for one due to certain financial or non-financial factors. For Family Medical, this would include persons who become ineligible due to increased earnings or hours of employment. For SSI, this would include persons qualifying based on the Pickle Amendment provisions and persons who qualify for 1619(b) status under the SSI program benefits because they are working but who retain disability.

Coverage of the categorically needy is largely mandated by federal law with some limited options.

2211.01 - The mandatory groups include:

(1) - Persons meeting Caretaker Medical criteria whose countable income does not exceed 38% of the federal poverty level.

(2) - SSI recipients, including those deemed to be receiving SSI.

(3) - Pregnant women and children under the age of 1 whose countable income does not exceed 171% of the federal poverty level.

(4) - Children ages 1 through 5 whose countable income does not exceed 149% of the federal poverty level.

(5) - Children ages 6 through 18 whose countable income does not exceed 133% of the federal poverty level.

(6) - Persons meeting TransMed and Extended Medical criteria.

2212 Medically Needy - The medically needy segment is comprised pregnant women and children who while meeting non-financial criteria do not qualify because their income exceeds the poverty level guidelines of either Medicaid or CHIP. Most persons in the medically needy group are obligated for a share of their medical costs through the "spenddown" process. Coverage of this group is optional under federal law. If a state chooses this option, it must cover pregnant women (including coverage of the 60 day postpartum period) and children. Kansas provides coverage for the following groups:

(1) - Pregnant women

(2) - Children up to age 18 or age 18 and working toward the attainment of a high school diploma or its equivalent

(3) - Persons 65 years of age and older

(4) - Persons who are disabled or blind under SSA standards. Medically needy coverage can also be provided to caretaker relatives of dependent children but Kansas does not currently provide for this.

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