Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 11/21/2024
02000 >>> 02230
02220
02230 Transitional Medical Coverage (TransMed) - Medical coverage is available to caretakers and other individuals under the TransMed program for a period not to exceed 12 months when the provisions in this section are met.
Federal Financial Participation (FFP) is available for the medical coverage of all persons who qualify for TransMed.
2230.01 Eligibility Requirements - General eligibility requirements of act in own behalf (2010), cooperation (02020), not receiving SSI (MKEESM 2630), SSN requirements (2031), citizenship and alienage (2040), citizenship and identity verification (2045), residency (02050), and child in family (02100) must be met. If these requirements are not met, the individual is ineligible for TransMed.
CSS cooperation is not required for TransMed.
Eligibility for TransMed shall be established for twelve months when the following requirements are met:
- the individual meets the definition of a caretaker according to 2110.
- the individual is a recipient of Caretaker Medical coverage in the month prior to the month of the determination.
- the individual has experienced an increase in earnings (includes reported self-employment) resulting from increased hours of employment or monetary increase in the amount paid for hours of work since the last determination.
- the income of the individual's Individual Budget Unit exceeds Caretaker Medical financial standards. This is true even if other changes of income have occurred for either the individual or other IBU members.
If loss of coverage can be directly attributable to the above, TransMed eligibility must be established without regard to other reasons the case may have become ineligible for Caretaker Medical coverage.
2230.02 Establishing TransMed for Other Household Members - At the time of application, or when an individual loses coverage under other medical assistance programs, they shall be assessed for TransMed eligibility.
Household members of an individual approved for TransMed are also eligible for TransMed when the individual is not eligible for any other Medicaid program and the individual's IBU includes the caretaker originally qualifying for TransMed.
If this occurs at the time of the initial TransMed determination, a period of 12 months of coverage is provided.
If the household member is being added to an already established TransMed program, coverage is provided through the end of the already established period. However, such persons shall not be granted coverage for more than three months prior to the month of request and must have been a member of the IBU and residing in the household during the prior three months.
2230.03 Reacting to Changes During TransMed (TMD) - Individuals approved for TMD coverage are continuously eligible according to the 2310 with one exception. When a reduction of income is reported, eligibility shall be assessed to determine if the income is again with the limits of Caretaker Medical (CTM). If the individual meets eligibility requirements for CTM, the coverage shall be changed to CTM.
Individuals who leave the household do not automatically lose their continuous eligibility for TMD. Non-pregnant adults must continue to qualify as a caretaker for eligibility to continue. A new application may be required to reinstate the continuous eligibility. Policies in 2340 apply.
For a child, eligibility ceases when age requirements in 2100 are no longer met.