Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 11/21/2024
02000 >>> 02400
02360
02400 General Program Information for the Childrens Health Insurance Program (CHIP) - The CHIP program is designed to cover children up to age 19 who are not financially eligible for Medicaid and whose countable income does not exceed the maximum amount of the federal poverty level. The child must not be covered under current health insurance. If family income is equal to or greater than 167% of the federal poverty level, a monthly family premium is charged for coverage. See the F-8 Kansas Medical Assistance Standards.
CHIP is based on a federal block grant authorized under Title XXI of the Social Security Act. For the most part it is state controlled but is subject to federal funding allotments as well as state funding provided by the Kansas State Legislature.
The CHIP program provides health coverage through KanCare. A capitated payment rate is established by KDHE-DHCF on a per enrollee basis. The overall scope of services covered in the program is similar to those services provided in the Medicaid program. The KanCare Clearinghouse has the responsibility for establishing eligibility based on policies established within the limits set forth in state and federal statutes, the Code of Federal Regulations, and the Kansas Administrative Regulations.
Children who are eligible for Medicaid (SI, poverty level eligible, etc.) do not qualify for CHIP and thus a determination of Medicaid eligibility must be done prior to establishing coverage under CHIP. This includes a spenddown determination if beneficial to the child.
Coverage under the CHIP program is not effective until the day of authorization. See 2470. CHIP is not an entitlement program like Medicaid and coverage availability is subject to federal funding authorized for the program.
The following additional requirements and issues affect the CHIP program.
2401 General Eligibility Requirements - The general eligibility requirements of acting in own behalf 2010 (including the caretaker requirements in 2110), cooperation 2020, citizenship and alienage 2040, and residence 2050 must be met.
2402 Age - The child must be under the age of 19. Coverage may be provided through the end of the month of the individual's 19th birthday unless she is a pregnant woman. See 2300 for pregnant woman standards.
2403 State Psychiatric Hospitals - CHIP coverage continues throughout the month of entrance and the following month, regardless of the anticipated length of stay. CHIP coverage terminates at the end of this period and any continuing eligibility is determined under the Medicaid program. No patient liability is determined during this period; however, any premium obligation continues.