Kansas Department of Health & Environment

Kansas Family Medical Assistance

Manual (KFMAM)


Eligibility Policy - 8/21/2019

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02300 Continuous Eligibility for Pregnant Women - Once financial eligibility for Title 19 is established as of the date the case is processed under Foster Care Medical, Adoption Support Medical, SI Medical, Caretaker Medical, TransMed, Extended Medical, Breast and Cervical Cancer Medical, or any Medicaid Poverty Level (including prior medical), the pregnant woman 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. This provision does not apply to women for whom expedited eligibility is established per 1407 but who are later determined to be ineligible because the information used to establish such eligibility was incorrect.

A pregnant woman who initially qualifies for Medicaid 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 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 Title 19 eligibility period, the pregnant woman shall be reinstated and provided with continuous eligibility. 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. However, if there is a break in assistance of one or more months during the continuous eligibility period, continuous eligibility shall end and the woman would have to qualify under the poverty level program again or another medical program. In addition, if continuous eligibility is not established for the month following the month regular eligibility is lost, it cannot be provided and the woman would once again have to qualify for the poverty level program 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.

For persons under the age of 19 eligible under these guidelines, a 12 month continuous eligibility period applies (see 2311 for establishing the 12 month period). If the 12 month period ends prior to the last day of the postpartum period, continuous eligibility also continues.

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.

2301 Postpartum Period for Pregnant Women - Eligibility for pregnant women shall continue through the 2nd calendar month following the month of birth of the child or termination of pregnancy provided the woman is or will be a Medicaid recipient for the month of birth or pregnancy termination (including prior eligibility). This provision applies not only to pregnant women who were MP recipients in that month but also to pregnant women who were eligible under another FFP medical program and lost that eligibility in the month of birth or pregnancy termination due to a change in circumstances (e.g., loss of cash eligibility). All general eligibility factors must continue to be met during the postpartum period.

2310 Continuous Eligibility for MCD Adults and Children - Once financial eligibility is established as of the date the case is processed under a MAGI program, all eligible children and non-pregnant adults shall be eligible for a 12-month period. This 12-month period establishes the review period for the family and the individual continuous eligibility dates for all approved members. However, if there is not eligibility in the application month, but eligibility does exist for one or more months of the prior period, continuous eligibility is established beginning with the first month of eligibility in the prior period.

Children and adults who subsequently enter a household, request assistance and are determined eligible for Medicaid shall also receive continuous eligibility for a 12-month period.

Newborns eligible under the provisions of 2320 and pregnant women eligible under the provisions of 2301 shall have continuous eligibility periods established independent of other household member's continuous eligibility periods, as the periods established for these groups take precedence for these individual family members.

When a family contains individuals eligible under any combination of poverty level children, CHIP, Family Medical, newborn or pregnant women categories, individual continuous eligibility periods may differ. Continuous eligibility periods will not always align with other household members.

2311 Continuous Eligibility Period - Continuous eligibility begins with the first full month of eligibility (see 2310 above) in the current review period and continues regardless of any changes in income. Such eligibility shall continue unless one of the following circumstances occurs:

2311.01 - a child turns age 19;

2311.02 - an individual no longer meets residency requirements;

2311.03 - an individual dies;

2311.04 - an individual enters an institution or jail;

2311.05 - a child no longer lives with a caretaker who meets the criteria of 2110;

2311.06 - an individual is found to not have been initially eligible;

2311.07 - an individual becomes eligible for HCBS or for SSI (including eligibility under the protected class see KEESM 2639), foster care, or adoption support assistance;

2311.08 - there is a voluntary request for case closure.

2311.09 - there is a loss of contact in which the individual and/or family's whereabouts are unknown. Continuous eligibility ends for any non-pregnant adults in the home in accordance with 7230.

2311.10 - there is not at least one child in the home or qualifying under temporary absence provisions of 2110. Continuous eligibility ends for any non-pregnant adults in the home.

2311.11 - a non-pregnant adult caretaker fails to cooperate with Child Support Services (CSS).
In any of the above situations, coverage shall be terminated with the month the circumstances occur or a following month allowing for timely and adequate notice. Continuous eligibility can be reestablished if there is less than a calendar month break in assistance. Otherwise, the individual would have to submit a new application and qualify again.

2312 Changes in Coverage during a Continuous Eligibility Period -

2312.01 Extending Continuous Eligibility - The following situations will allow a change in coverage within the CE period and the CE period will be extended if the new eligibility sets a longer CE period then what has been previously established.

a. TransMed to Caretaker Medical
b. Extended Medical to Caretaker Medical
c. Poverty Level Pregnant Woman to Caretaker Medical Pregnant Woman
d. Poverty Level Pregnant Woman to Caretaker Medical Parent
e. Poverty Level Medicaid Newborn to Poverty Level Medicaid Deemed Newborn
f. Poverty Level Medicaid or CHIP Child to Caretaker Medical Child
g. CHIP Pregnant Woman to Poverty Level Pregnant Woman
h. CHIP Pregnant Woman to Caretaker Pregnant Woman
i. Changes within the Aid code, such as changes within PLT, PLN, or CTM.

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