Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 11/22/2024
02440
2441 Premium Delinquency - Payment of CHIP premiums is a requirement for CHIP eligibility with the exception of pregnant CHIP minors, see 02510. Failure to pay premiums at review results in the establishment of a three-month penalty period where CHIP coverage cannot be received. The penalty period is considered to be ‘Served’ on the first day of the month following the end of the premium penalty. Once a penalty has been served, that same amount and time periods cannot be used again to terminate or deny CHIP coverage.
An account meets the definition of delinquent when there are two invoices that have not been paid and not previously used in a penalty. These invoices do not have to be consecutive and may occur from two different eligibility periods. An account remains delinquent until the payment is made for the delinquent amount, the penalty is served, or the penalty is shortened. The Premium Billing and Collection (PB&C) system is responsible for determining when an account is delinquent and transmitting that information to KEES so it may be used in the eligibility determination.
A denial or discontinuance for delinquent premiums shall only be applied to individuals who are otherwise eligible for CHIP at the time of their review. For example, if an individual has existing health insurance, they shall be denied or discontinued for that reason. They are not considered otherwise eligible for CHIP, so the delinquency is not relevant to their denial or discontinuance
Penalties are applied at the case level, not the individual level. If there is a request to add a child to a CHIP program where there is a premium delinquency on the case, the child is ineligible for CHIP and a premium penalty would be established. If a penalty is already established and has begun, the child is ineligible for CHIP and will have the same penalty period that has already been established on the case.
2441.01 Penalties and Penalty Statuses - There are four penalty statuses, which will all be updated automatically by KEES depending upon the individual case situation. They are defined below:
- Active - Individuals outside a continuous eligibility period are not eligible for CHIP when there is an active penalty period. When a penalty is first applied to a case it starts in Active status. It will stay in this status until it moves into one of the following statuses. The penalty will be in an active status even prior to the start date of the penalty. The Active status begins from the moment the decision is made to discontinue or deny coverage.
- Negated - A penalty is cancelled before it actually begins. This occurs when the delinquent premiums are paid before the penalty start date.
- Shortened - A penalty is shortened if the consumer pays their delinquent premiums or becomes Medicaid eligible sometime DURING the penalty period.
- Served - A penalty is considered served once the penalty period has ended and no other status changes have occurred.