Kansas Department of Health & Environment

Kansas Family Medical Assistance

Manual (KFMAM)


Eligibility Policy - 10/25/2021

02000 >>> 02240

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02240 Four-Month Extended Medical - Persons receiving Family Medical coverage are automatically eligible for medical coverage for a period not to exceed 4 months provided that the following criteria are met.

2240.01 Eligibility Requirements - General eligibility requirements of act in own behalf (2010), cooperation (2021), not receiving SSI (Medical-KEESM 2630), SSN requirements (2031), citizenship and alienage (2040), citizenship and identity verification (2045), residency (2051), and 02100 child in family must be met. If these requirements are not met, the individual is ineligible for Extended Medical.

CSS cooperation is not required for Extended Medical.

Eligibility for Extended Medical shall be established for four months when the following requirements are met:

- the individual meets the definition of a caretaker according to KFMAM 2110.

- the individual is a recipient of Caretaker Medical coverage in the month prior to the month of the determination.

- the individual has experienced an increase in spousal support since the last determination that is the result of a divorce decree or agreement with an effective date prior to December 31, 2018. Spousal support or alimony effected from an agreement made or modified after that date is considered exempt and will have no effect on the MAGI determination.

- the income of the individual's Individual Budget Unit exceeds Caretaker Medical financial standards. This is true even if other changes of income have occurred for either the individual or other IBU members.

If loss of coverage can be directly attributable to the above, Extended Medical eligibility must be established without regard to other reasons the case may have become ineligible for Caretaker Medical coverage.

2240.02 Establishing Extended Medical for Other Household Members - At the time of application, or when an individual loses coverage under other medical assistance programs, they shall be assessed for Extended Medical eligibility.

Household members of an individual approved for Extended Medical are also eligible for Extended Medical when the individual is not eligible for any other Medicaid program and the individual's IBU includes the caretaker originally qualifying for Extended Medical.

If this occurs at the time of the initial Extended Medical determination, a period of 4 months of coverage is provided. If the household member is being added to an already established Extended Medical program, coverage is provided through the end of the already established period. However, such persons shall not be granted coverage for more than three months prior to the month of request and must have been a member of the IBU and residing in the household during the prior three months.

2240.03 Reacting to Changes During Extended Medical - Individuals approved for Extended Medical coverage are continuously eligible according to the KFMAM 2310 with one exception. When a reduction of income is reported, eligibility shall be assessed to determine if the income is again with the limits of Caretaker Medical. If the individual meets eligibility requirements for Caretaker Medical, the coverage shall be changed to Caretaker Medical for the remainder of the existing eligibility period. A new eligibility period does not apply in this situation.

Individuals who leave the household do not automatic lose their continuous eligibility for Extended Medical. Non-pregnant adults must continue to qualify as a caretaker for eligibility to continue. A new application may be required to reinstate the continuous eligibility. Policies in KFMAM 2340 apply.

For a child, eligibility ceases when age requirements in 2100 are no longer met.

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