Kansas Department of Health & Environment

Kansas Family Medical Assistance

Manual (KFMAM)


Eligibility Policy - 6/29/2022

02000 >>> 02430

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02430 Ineligibility for Medicaid - The family does not have the choice between Medicaid and CHIP benefits. If the child is eligible for Medicaid, including coverage through the poverty level or Family Medical programs, coverage must be provided under that program. This also includes pregnant woman coverage if the child is pregnant. See 2510.

However, a spenddown determination is only required if the family requests such a determination for either the prior or current period.

For a child that would be otherwise eligible for CHIP, if there are expenses in the month of application as well as potentially past due and owing expenses which could be used to meet a current spenddown, the family can also be given the opportunity to qualify under the spenddown program (including both Family Medical Spenddowns and Disability-related Spenddowns). If requested, a full 6 month determination would be applicable. If the family can meet the spenddown and it is to their benefit to do so, Medicaid eligibility would be initially established on the case.

The family will need to be contacted to discern if there is a potential for spenddown coverage and the degree to which it will benefit the children. A final CHIP determination would not be made until the spenddown decision is made.

If spenddown coverage is not established, CHIP coverage shall then be initiated. If spenddown coverage is established for the current period, only one 6-month base should be established with a review set at the end of that period to redetermine CHIP eligibility and establish the 12 month continuous eligibility period. If spenddown can be met for more than 1 base period due to using older unpaid bills or current non-covered expenses, spenddown coverage is to be extended for as long as the family or child can meet the spenddown requirement.

Prior medical eligibility provisions currently in effect are applicable to any family seeking such coverage even though they may only be CHIP eligible in the month of application or are not currently eligible for either Medicaid or CHIP. Eligibility can be established either through a poverty level or spenddown determination for the prior 3 months.

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