Kansas Department of Health & Environment

Kansas Family Medical Assistance

Manual (KFMAM)


Eligibility Policy - 12/9/2022

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02300 Continuous Eligibility for Pregnant Women and Minors - Once eligibility for Medicaid or CHIP is established as of the date the case is processed, including Foster Care Medical (FCM), Adoption Support Medical (ASM), SSI Medical, Caretaker Medical (CTM), TransMed (TMD), Extended Medical (EXT), Breast and Cervical Cancer Medical (BCC), PLN or any Poverty Level Program (including prior medical), the pregnant woman or minor shall be automatically eligible throughout the pregnancy term and the postpartum period despite any changes in income. All general eligibility factors must be met during the continuous eligibility period. This includes pursuit of third party resources per 2020.03, SSN requirements of 2031, citizenship and alienage requirements of 2040, and residence requirements of 2051. It does not include cooperation regarding countable income as changes in income do not affect continuous eligibility, loss of contact per 7230, or cooperation with reviews during the continuous eligibility period per 2020.02.

A pregnant woman or minor who initially qualifies for Medicaid or CHIP under another category shall continue to be eligible through the postpartum period even if she loses categorical eligibility under the program she was initially established under. When this occurs, eligibility shall be established under the Medicaid Poverty Level or CHIP program for the remainder of the continuous eligibility period. This would include pregnant persons turning 19 who are no longer eligible for child's poverty level coverage and SSI recipients who lose disability status.

When eligibility ends under one of the above-mentioned programs, and it is later discovered that a pregnancy existed during the CHIP or Medicaid eligibility period, the pregnant woman/minor shall be reinstated and provided with continuous eligibility through the postpartum period. The pregnancy must have existed within the eligibility period and must be reported within one calendar month following closure.

Continuous eligibility shall be provided if eligibility is established for any of the months in the prior medical period (Medicaid only). However, if there is a break in assistance of one or more months during the continuous eligibility period due to residency requirements or voluntary withdrawal, continuous eligibility shall end and the woman would have to qualify under the poverty level program again or another medical program.

Only one continuous eligibility period is applicable per pregnancy. Thus, if one pregnancy ends during the continuous period and another begins shortly thereafter, the woman must requalify for regular poverty level eligibility for the second pregnancy before having access again to the continuous eligibility provisions. If coverage is approved for a new pregnancy during a previously-established postpartum period, a new continuous eligibility period will be set based on the new pregnancy/postpartum dates. If the pregnant woman is not eligible for new pregnancy coverage, she will remain on the existing coverage for the previous pregnancy through the postpartum period at which time she will be reviewed for ongoing benefits.

For persons under the age of 19 eligible under these guidelines, a continuous eligibility period applies beginning the first month of determination and continuing through 12-months postpartum regardless of changes in circumstance.

Once continuous eligibility is established for a pregnant woman, she shall not switch between medical aid codes during her continuous eligibility period, with the exception of a change from Poverty Level Pregnant Woman to a Caretaker Medical Pregnant Woman category.

2033 Good Cause for Participation Without a Social Security Number (SSN) - The client who establishes good cause for failure to apply for an SSN shall be allowed to receive assistance for 1 month in addition to the month of application. For benefits to continue past these 2 months, good cause for failure to apply must be shown and documented on a monthly basis.

In determining if good cause exists for failure to comply with the requirement to apply for or provide an SSN, the specialist shall consider information from the individual, SSA, and any other appropriate sources. Documentary evidence or collateral information that the individual has applied for an SSN or made every effort to supply the necessary documents to complete an application for an SSN shall be considered good cause for not complying timely with this requirement. Good cause does not include delays due to illness, lack of transportation, or temporary absences because SSA makes provisions for mailing applications in lieu of applying in person. If the individual can show good cause why an application for an SSN has not been completed in a timely manner, that person shall be eligible for assistance for 1 month in addition to the month of application. Good cause for failure to apply must be shown monthly after the initial 2 months for such an individual to continue to participate. Good cause must be documented to support the decision to allow the individual to receive assistance pending application for an SSN.
Non-citizen applicants who qualify for a non-work SSN (see those under 2043) only are not required to apply for or provide an SSN to the agency as a condition of eligibility. They may be approved without an SSN under the good cause provision.

2301 Postpartum Period for Pregnant Women - Eligibility for pregnant adults/minors shall continue through the 12th calendar month following the month of birth of the child(ren) or termination of pregnancy provided the individual is or will be a Medicaid or CHIP recipient for the month of birth or pregnancy termination (including prior medical eligibility).

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