Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 11/21/2024
02000 >>> 02310
02300
02310 Continuous Eligibility for MCD Adults and Children - Once financial eligibility is established as of the date the case is processed under a MAGI program, all eligible non-pregnant children and adults shall be eligible for a 12-month period (for pregnant adults and minors, see 2300 and 2301). This 12-month period establishes the review period for the family and the individual continuous eligibility dates for all approved members. However, if there is not eligibility in the application month, but eligibility does exist for one or more months of the prior period, continuous eligibility is established beginning with the first month of eligibility in the prior period.
Children and adults who subsequently enter a household, request assistance and are determined eligible for Medicaid shall also receive continuous eligibility for a 12-month period.
Newborns eligible under the provisions of 2320 and pregnant adults and minors eligible under the provisions of 2301 shall have continuous eligibility periods established independent of other household member's continuous eligibility periods, as the periods established for these groups take precedence for these individual family members.
When a family contains individuals eligible under any combination of Family Medical programs, individual continuous eligibility periods may differ. Continuous eligibility periods will not always align with other household members.
2311 Continuous Eligibility (CE) Period - Continuous eligibility begins with the first month of eligibility (see 2310 above) in the current review period and continues regardless of any changes in income. Such eligibility shall continue unless one of the following circumstances occurs:
2311.02 - an individual no longer meets residency requirements;
2311.04 - a recipient on a MAGI program (Medicaid or CHIP) becomes eligible for a non-MAGI program such as HCBS or SSI (including eligibility under the protected class, see MKEESM 2639), Foster Care Medical (FCM), or Adoption Support Medical (ASM) coverage.
2311.05 - the child no longer lives with a caretaker who meets the criteria of 2110. (Continuous eligibility ends for any non-pregnant adult caretakers in the home).
2311.06 - an individual is found to not have been initially eligible due to agency error or fraud;
2311.07 - a CHIP recipient (unless in a postpartum period) becomes eligible for Medicaid.
2311.08 - there is a voluntary request for case closure;
2311.09 - there is a loss of contact in which the individual and/or family's whereabouts are unknown. Continuous eligibility ends for any non-pregnant adults in the home in accordance with 7230;
2311.10 - there is not at least one child in the home or qualifying under temporary absence provisions of 2110. Continuous eligibility ends for any non-pregnant adults in the home;
2311.11 - a non-pregnant adult caretaker fails to cooperate with Child Support Services (CSS). (Continuous eligibility ends for any non-pregnant adult in the home).
In any of the above situations, coverage shall be terminated with the month the circumstances occur or a following month allowing for timely and adequate notice. Continuous eligibility can be reestablished if there is less than a calendar month break in assistance. Otherwise, the individual would have to reapply and qualify again.
Note: CE does not automatically end for recipients or applicants in an incarcerated status (i.e., individuals who become residents of a jail or prison). For eligibility rules related to incarceration, see 2052.05 for Medicaid minors and 2052.07 for adults.
2312 Changes in Coverage during a Continuous Eligibility Period -
2312.01 Extending Continuous Eligibility - The following situations will allow a change in coverage within the CE period and a new 12-month CE period will be set.
a. TransMed (TMD) to Caretaker Medical (CTM)
b. CHIP (PLT) to any Medicaid program (PLN, PLN/PW, CTM, SSI or LTC/HCBS programs)
c. Any MAGI category to any aid code that is higher in the hierarchy.
2312.02 - The following situations will allow a change in coverage within the CE period but will NOT extend the CE period.
a. Changes within aid code, such as PLT/C4 to PLT/C5
b. CHIP Pregnant Woman (PLT/PW) to PLN/PW (CE should remain 12 months postpartum)
c. SOBRA (PLN or CTM) 18-year-old – CE will only remain in place through the month of the SOBRA individual’s 19th birthday.