Kansas Department of Health & Environment

Kansas Family Medical Assistance

Manual (KFMAM)

Eligibility Policy - 5/18/2022

06000 >>> 06300 >>> 6311 >>> 6311.02

previous section6311.01


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6311.02 Prior Medical Eligibility (Not Applicable to CHIP) - An applicant for medical assistance may request a determination of medical eligibility for a 3 month period prior to the month of application. The month of application establishes this prior medical period. A request for prior medical must be made in the month of application or the two following months. When a request for coverage is not processed within the applicable case disposition timeline as defined in 1407, the period to request prior medical is extended to 12 days following the date of the determination. Requests made after this time shall be denied. See 2340.02and 2460.02 regarding prior coverage determinations for children being added to an existing PLN program.

Prior eligibility can be established even though there is no eligibility for the current base period. However, there is no eligibility in any prior month for an individual who does not qualify for Medicaid.

NOTE: Prior CHIP coverage is only available for certain CHIP eligible newborns. (See 2500)

A 3 month eligibility base shall be used unless one of the following conditions exist:

(1) - Part or all of the prior base period falls into a previously established medical base period.

(2) - Part or all of the base period falls within any month in which the client was a Medicaid recipient.

(3) - The individual is not categorically eligible for any medical program in one or more months of the base period (i.e., is not a child, a pregnant woman, or a caretaker).

(4) - The individual was not part of the current family group in one or more months of the base period.

If, in the above instances, the assistance request includes other individuals in the family group, only the individual would be excluded for the applicable months. If the assistance request is only for the individual, the prior base period shall be shortened to exclude those months.

A one month base period shall be used in accordance with 6311.01 for each month of the prior period. Eligibility can be determined for any one or all of the 3 prior months.
Financial factors of eligibility apply to the entire base period. Eligibility factors other than the income shall affect eligibility for each of the months separately. Eligibility shall be effective only for the months in which the client meets both the financial and nonfinancial factors of eligibility.

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