Kansas Department of Health & Environment

Kansas Family Medical Assistance

Manual (KFMAM)


Eligibility Policy - 8/16/2022

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02310 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 non-pregnant children and adults shall be eligible for a 12-month period (for pregnant adults and minors, see 02300 and 2301). 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 adults and minors 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.

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 non-pregnant children and adults shall be eligible for a 12-month period (for pregnant adults and minors, see 02300 and 2301). 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 adults and minors 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 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 (unless pregnant or in a postpartum period, see 02300);

2311.02 - an individual no longer meets residency requirements;

2311.03 - an individual dies;

2311.04 - an individual enters an institution or jail (see 2052.05 for information relating to minors);

2311.05 - the 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 due to agency error or fraud;

2311.07 - an individual becomes eligible for HCBS or for SSI (including eligibility under the protected class see Medical-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.

2312.02 - The following situations will allow a change in coverage within the CE period but will NOT extend the CE period. In some situations, the CE period may even be shortened if the new coverage type has a shorter CE period than the one that was initially established.

a. CHIP Newborn to CHIP Deemed Newborn - This situation will cause the CE period to be shortened because a Deemed CHIP Newborn's CE period is set to match the end of their mother's CE period.
b. CHIP to Medicaid when processing an income change or a household change.
c. CHIP to Medicaid when a prior medical request is received/processed after CHIP eligibility was established and Medicaid eligibility is overlaying the previously established CHIP coverage.

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