Kansas Department of Health & Environment

Kansas Family Medical Assistance

Manual (KFMAM)

Eligibility Policy - 8/16/2022

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02220 Medical Coverage for Families -

2221 Medical Coverage for Families - Medical coverage is available to families with children under the Family Medical program if the requirements specified below are met. This includes those who lose eligibility under the Family Medical program and qualify under the extended medical provisions (TransMed and 4-Month Extended Medical.)

2222 Family Medical Coverage - Persons meeting the following criteria are eligible for medical coverage under the Family Medical program:

2222.01 General Eligibility Requirements - General eligibility requirements of act in own behalf (2010), cooperation (2021), not receiving SSI (Medical-KEESM 2630), SSN (2031), citizenship and alienage (2040), citizenship and identity verification (2045), and residency (2051) must be met. In addition, the age and caretaker requirements of 2100 and 2110 must be met. The MAGI budgeting unit provisions of 3100 are also applicable.

2222.02 Financial Eligibility - Financial eligibility shall be determined based solely on income using the provisions of 5000 and subsections. Resources shall not be considered.

To be eligible, the total countable income must not exceed the monthly poverty level standards referenced in the KDHE Eligibility Policy Appendix F-8.

A one month base period shall be used in accordance with 6311.

2222.03 Coverage Limitation - Coverage shall not be provided under the Family Medical program to the following:

(1) - Persons convicted of medical fraud per 8420.

(2) - Persons who have a special spenddown per 8362.03.

(3) - Non-pregnant adult caretakers who fail to cooperate with child support enforcement per 2061 and subsections. A period of ineligibility shall be imposed on such persons as per 2067. Medical coverage is not available to penalized individuals under the Family Medical program until the failure or refusal ceases. However, the possibility of medical eligibility under other determined medical programs shall be considered at the point the penalty is applied, based on ex parte guidelines and before medical coverage is terminated.

Note: See Policy Memo 2014-11-01 for information about a temporary suspension of the application of penalties for failing to cooperate with Child Support Services (CSS).

2222.04 Continuation of Coverage - Family medical coverage shall continue through the end of the established review period as outlined in 2310. The person must continue to meet nonfinancial criteria.

The Family Medical household is required to report applicable changes within ten days.

Once financial eligibility is established in the Family Medical program, the continuous eligibility provisions of 2301, 2310, 2311 and 2320 are applicable to all assistance plan members. Eligibility will continue to be provided to those individuals under the Family Medical program until the end of the individual's continuous eligibility period as established in these sections even if the household no longer meets financial criteria.

All Family Medical cases shall be reviewed once every twelve months (see 7441).

2223 Family Medical Programs Hierarchy - As the various medical programs have different rules and benefits, eligibility should be determined following the medical program hierarchy. This hierarchy is embedded in the eligibility system and is controlled by system rules.

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