Kansas Department of Health & Environment

Kansas Family Medical Assistance

Manual (KFMAM)

Eligibility Policy - 5/30/2023

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2411 Uninsured Status - Each child must not be covered by comprehensive health insurance which includes coverage of at least doctor visits and hospitalization. This is regardless of the extent of coverage for these benefits, the cost of the insurance, the amount of any deductibles or co-insurance, or whether the maximum level of benefits for a particular coverage year has been reached. Health insurance coverage shall be deemed not to exist if the lifetime maximum of benefits for the policy has been reached.

Health insurance providing only single types of coverage would be excluded from this definition. Examples of health insurance which would not disqualify a child include:

2411.01 - Dental or vision only coverage.

2411.02 - Prescription only coverage.

2411.03 Long term care insurance - In addition, comprehensive health insurance that is not reasonably accessible to a child because of the distance involved in traveling to participating providers shall also be excluded from this definition. These situations generally involve insurance coverage through an insurance plan that pays for services performed by a limited group of contracted providers. For example, a child is covered under a policy provided by an absent parent who lives in Florida. Although mail order prescription drugs are available and accessible to the child under the plan, the only participating doctors and hospitals are located in the state of Florida. Therefore, comprehensive coverage is not accessible and CHIP coverage would not be denied for this child due to insurance coverage. These situations shall be evaluated on a case-by-case basis however, any situation where routine travel exceeding 50 miles one-way may be evaluated for exclusion under this provision.

If health coverage is obtained while an application for CHIP is still pending, the insurance would be considered for eligibility purposes. If this is obtained after CHIP benefits have been approved, eligibility shall continue for the entire continuous eligibility period (see 2450 below) and then terminated at the time of review if health insurance is still in effect and the individuals remain eligible for CHIP. The same is true if the insurance was present at the time the CHIP benefits are approved but due to a waiting period, the private coverage had not yet begun.

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