Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 4/19/2024
2460.01 Removing a Child From an Existing Plan - When an eligible child in a current continuous eligibility period leaves the household, the continuous eligibility period shall not be broken as long as the new family is cooperating with the agency in adding the child to the new plan (see 2460.02). To facilitate the process, the child shall remain a participating member of the plan through the end of the month following the month the change is reported. This is not necessary if action is being taken immediately to add the child to the new case so no break in assistance results. Follow the provisions of 2452 when removing a child if the continuous eligibility period for a child is broken.
2460.02 Adding a Child to a Plan - A child meeting the general eligibility requirements of 2272 and 2273 or 2402 and 2403 may be added to a plan effective the month the request is made for coverage. If needed, eligibility may also be determined for three months prior to the month of request. (See also 3100 - MAGI Budgeting Units and 2010 - Act in Own Behalf). The following guidelines shall be used when making such changes:
(1) - Adding a Child to an Existing Plan - A new or recipient child may be added to an existing plan without a formal review. This includes children new to the household as well as children previously excluded from the plan because coverage was not requested (see 3100) and children previously ineligible due to nonfinancial criteria. A verbal request is sufficient to prompt such action.
(a) If a child is already a recipient under a MAGI program and a request is made to add the child to another existing MAGI program, the child shall be added to the new program effective the month following termination on the previous program. A new determination of eligibility shall be completed based on the new family's circumstances to determine the type of coverage the child will have. Income in the amount already budgeted on the new case shall be used along with income of the individual being added and any new IBU members added to the plan because of the addition of this child. If the family cooperates with the application process and the individual is determined eligible using the new IBU income and circumstances, they will be approved for a new continuous eligibility period. No changes will be made to the family’s existing review period. Changes in the type of coverage (Medicaid or CHIP) may result. However, if the family does not cooperate (e.g., fails to provide information) or if the child is no longer eligible, the child remains eligible through the end of his/her initial continuous eligibility period under the type of coverage initially provided.
(b) If the child is not a current MAGI, the child is added effective the month of request. Income currently budgeted for individuals already included in the IBU shall be used to determine eligibility along with the income of the individual being added and any new IBU members added due to the addition of the child. If the child falls into the CHIP income range, the additional CHIP requirements of Health Insurance Coverage (2411) must also be met. If retroactive coverage is requested, a child may be added to a plan up to three months prior to the month of request.
In either situation, if the family reports a change in income at the time of the addition of the individual, that new income will be budgeted in the month of application. Any changes that may occur for other individuals or to a premium obligation will be made effective the month after the month the request is made for the new individual.
(2) - Adding a Child to a New Plan - If a request for coverage is made by a new caretaker for a child who is a current recipient under a MAGI program, and the family unit does not have an active case, a review application shall be obtained. See 2460.01 for requirements to remove a child from the previous case. If the family cooperates with the application process and the child remains eligible, a new twelve month continuous eligibility period is established. However, if the family does not cooperate (e.g., fails to provide income information) or if the child is no longer eligible, the child remains eligible through the end of his/her initial continuous eligibility period under the same coverage initially provided. When processing such changes, it is imperative that action be taken as expeditiously as possible to ensure uninterrupted medical coverage.
Determinations for children impacted when two households combine because of the request for assistance of a mutual child shall also be treated according to these provisions.