Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 11/21/2024
2051
2052 Institutionalization - For medical assistance, the following criteria apply to persons who are institutionalized:
2052.01 - An individual who is placed by a state agency into an out-of-state institution retains residence in the state making the placement. Thus, individuals who are placed in care facilities outside of Kansas by DCF retain their Kansas residence.
Providing basic information to individuals about another state's Medicaid program or about the availability of health care services and facilities in another state does not constitute a placement action. This would also include assisting an individual in locating an institution in another state provided the individual was capable of intent and independently decided to move.
2052.02 - For individuals who become incapable of intent before the age of 21 or who are under the age of 21, the state of residence is the state in which their parents or legal guardian reside for applicants or in which they did reside at the time of institutional placement for recipients. If the parents live in different states, the state of residence of the parent making application shall be applicable.
Individuals are considered incapable of intent if: their IQ is 49 or less; or they have a mental age of 7 or less based on reliable tests; or they are judged legally incompetent; or there is medical and social documentation to support a finding that they are incapable of intent.
2052.03 - For individuals who become incapable of intent on or after age 21, the state of residence is the state in which they are physically residing.
2052.04 - For all other institutionalized individuals, the state of residence is the state in which the individual is living with the intention to remain there permanently or for an indefinite period.
NOTE: In addition, Kansas has entered into interstate residence agreements with the following states: California, Florida, Kentucky, New Mexico, Ohio, Pennsylvania, South Dakota, Tennessee, Texas, and Wisconsin. The agreement states that individuals residing in a Medicaid approved institution for long term care in one of the above-named states who would be Kansas residents under (2) or (3) shall be deemed residents of that state for purposes of medical assistance unless the person was placed there by Kansas state or local government personnel. The reciprocal situation is also covered in the agreement. Refer to MKEESM 8112 for definition of a Medicaid approved institution.
2052.05 Incarcerated Minors (Medicaid) - Federal regulations prohibit states from fully terminating Medicaid coverage for children under the age of 21 and Aged Out Foster Care (AGO) recipients who become inmates of public institutions, i.e., correctional facilities, on or after October 24, 2019. When a Medicaid recipient in this category becomes institutionalized in this manner, coverage is suspended vs. terminated, meaning that while coverage is inaccessible while they are in a detained/incarcerated status, it will be reinstated upon their release without a new application being required as long as they remain eligible based on current circumstances. Likewise, applications received on behalf of individuals in this category who are currently in a detention placement must be accepted and determined for Medicaid eligibility; if determined eligible while incarcerated, a new application will not be required for redetermination upon release.
2052.06 Incarcerated Minors (CHIP) - - A new CHIP eligible applicant cannot be enrolled while in an incarcerated setting. When an application is received requesting coverage for an incarcerated child, and the child is found to be otherwise CHIP eligible, the application must be denied due to incarcerated status. The exception to this rule is when a child is currently receiving coverage on the CHIP program and enters a correctional facility during a CE period. Incarceration is not an exception to CE, so in this case, coverage may not be terminated on the basis of incarceration; rather, coverage will temporarily end (i.e., be suspended) until the agency is notified of the child’s release at which point the child would be reinstated for the remainder of the existing CE period.
NOTE: If the child was not released prior to the expiration of the CE/review period, coverage would not be reinstated without a new application or review form.
2052.07 Incarcerated Adults - Medicaid funds are excluded from the payment of medical claims for individuals residing in a correctional facility except for certain emergency qualifying events under the Inmate Program. For this reason, when a Medicaid recipient enters a correctional facility (i.e., prison, jail, or other non-Medicaid eligible public institution) coverage must be deactivated or suspended upon entry. Likewise, when an application is received on behalf of a Medicaid-eligible incarcerated individual, coverage must be delayed until the release date.
While incarceration disallows Medicaid payment of medical claims, it does not impact a person’s eligibility. This means a person will maintain eligibility for Medicaid while residing in a correctional facility and upon release may have benefits reinstated without a new application as long as they continue to meet categorical program requirements (age, residency, etc.). This also means that an application may not be denied solely due to a person’s incarceration status. An incarcerated individual must be determined based on eligibility related factors, and if eligible, coverage will begin upon release. If the person is in a current continuous eligibility (CE) or review period, they may be reinstated for the remainder of that period, or a new CE period may begin, depending on program eligibility. If ineligible for another program, they may be reinstated or approved for MediKan Reintegration (MKN/RI) when criteria is met.
Note: See MKEESM 2640 for information related to MediKan.