Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 11/21/2024
02000 >>> 02340
02330
02340 Changes in MCD Family Unit - The following provisions apply in determining the continuous eligibility period for children and adults when household composition changes. These policies are applicable to all family medical programs.
2340.01 Removing an Individual from an Existing Plan - When an eligible individual in a current continuous eligibility period leaves the household, the continuous eligibility period shall not be broken as long as a new request for coverage is received in the month following the month of closure (see 2311). To facilitate the process, the individual 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 individual to a new case so no break in assistance results. Follow the provisions of 2312 when removing an individual if the continuous eligibility period is broken.
2340.02 Adding an Individual to a Plan - An individual meeting the general eligibility requirements of the Medicaid Poverty Level program (2271, 2272 and 2273), the CHIP program (2401, 2402 and 2403), or Family Medical program (2221 and 2222) 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. The addition of an individual to the plan will not affect the coverage of any family member that is continuously eligible. See also 3100 - Assistance Planning, 2010 - Act in Own Behalf, 2310 - Continuous Eligibility and 2100 - Child in family. The following guidelines shall be used when making such changes:
(1) - Adding an Individual to an Existing Plan - A new or recipient individual may be added to an existing family medical plan without a formal review. This includes individuals new to the household as well as those previously excluded from the plan because coverage was not requested (see 3120) and those previously ineligible due to nonfinancial criteria (e.g., non-cooperation penalty). A verbal request is sufficient to prompt such action as long as the individual was not previously discontinued due to failure to complete a review. See 1402.
(a) If the individual is already a recipient under a MAGI program and a request is made to add the individual to another existing MAGI program, the individual 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 group's circumstances to determine the type of coverage the individual 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 the individual. If the family group cooperates with the application process and the individual is determined eligible using the new family group's 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 individual is no longer eligible, the individual remains eligible through the end of his/her initial continuous eligibility period under the type of coverage initially provided.
(b) If the individual is not a current MAGI recipient, they are added effective the month of request. Income currently being 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 to the IBU due to the addition of the individual. This includes eligibility for months prior to the month of request. If retroactive coverage is requested, the individual 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 the application. Any positive changes that may occur for other individuals or to a premium obligation will be made effective the month the request is made for the new individual.
(2) - Adding an Individual to a New Plan - If a new request for coverage is received from a new caretaker or family group for an individual who is a current recipient under a MAGI program, and the family unit does not have an active case, an application shall be obtained. See 2460.01 for requirements to remove an individual from the previous case. If the family cooperates with the application process and the individual 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 individual is no longer eligible, the individual remains eligible through the end of his/her initial continuous eligibility period under the type of 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 shall also be treated according to these provisions.