Briefing Book 2026: Children’s Eligibility for CHIP, MCHIP, Medicaid, and HCBS, Including Information on Premium Requirements for CHIP – KLRD

The History of Medicaid

In the United States, Medicaid is a partnership between the federal government and the states with shared authority and financing, created by Congress in 1965 through Title XIX of the Social Security Act. The program was designed to finance health care services for low-income children, their parents, the elderly, and people with disabilities. Medicaid has become the nation’s largest source of funding to provide health services to low-income people.

State participation in Medicaid is optional. However, the federal government’s financial share of Medicaid financing creates an incentive for the states. To date, no state has declined to participate. All 50 states, American Samoa, the District of Columbia, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands participate and administer their own Medicaid plans. Although all states participate, eligibility varies widely because the states can choose to cover additional people and services above and beyond the federal minimum requirements.

Kansas participates in Medicaid, but has not participated in Medicaid expansion under the federal Patient Protection and Affordable Care Act (PPACA).

Health Coverage Programs in Kansas

The Kansas Department of Health and Environment (KDHE) and the Kansas Department for Aging and Disability Services (KDADS) administer the KanCare program. KDHE maintains financial management and contract oversight as the single state Medicaid agency, while KDADS administers the Medicaid waiver programs for disability services, mental health, and substance abuse, and operates the state hospitals and institutions. The State of Kansas offers medical assistance to eligible Kansans primarily through these health care coverage programs.

KanCare under the Medicaid plan (KanCare) . KanCare is the largest program and provides health and dental coverage for people with limited income who meet program eligibility, which may include pregnant women, children up to age 19, adult caretakers of children, persons who have aged out of foster care, persons with disabilities, and elderly.

HCBS . The Home- and Community-Based Services (HCBS) program in Kansas is part of the KanCare system. It provides long-term care and support services to eligible Kansans in their homes or communities rather than in institutional settings like nursing homes or hospitals, with Medicaid covering the cost of those services.

Long-term care and support services can include acts of daily living, such as bathing and dressing. Typically, Medicaid does not pay for these types of services unless they are provided in an institutional setting. With an HCBS waiver, the State is waiving the requirement that care must be provided in an institution and instead paying to provide the same level of care at home or in the community. The HCBS waiver program was authorized under Section 1915(c) of the Social Security Act.

Kansas operates seven approved HCBS waivers: Autism (AU), Brain Injury (BI), Frail Elderly (FE), Intellectually/Developmentally Disabled (IDD), Physical Disability (PD), Serious Emotional Disturbance (SED), and Technology Assisted (TA).

KanCare under the Children’s Health Insurance Program (CHIP) plan . CHIP covers uninsured children up to age 19 who do not qualify for Medicaid. CHIP households who are above 166.0 percent of the federal poverty level (FPL) are required to pay a premium per household which is either $20, $30, or $50 per month. When a family has not paid their monthly premiums for two months, the account is considered delinquent. When a child’s CHIP coverage ends for delinquency, they cannot re-enroll in the program for 90 days unless they qualify for Medicaid or the balance is paid.

CHIP was implemented on January 1, 1999, and state law requires that all CHIP children be in capitated managed care to control costs. State statute currently ties CHIP income limits to the 2008 FPL. [Note: This limit has been addressed through various provisos to bring the income limits in line with the CHIP state plan eligibility threshold.]

M-CHIP . M-CHIP is a category of Medicaid coverage for children between the ages of 6 and 18 who are between 113.0 percent and 133.0 percent of the poverty level standard (PLS). M-CHIP is Medicaid, and CHIP-specific requirements do not apply. However, the funding for these children is still related to CHIP.

MediKan . MediKan is funded entirely by state funds and covers persons who are applying for Social Security disability benefits.

Managed Care Organizations

Kansas contracts with three Managed Care Organizations (MCOs) to coordinate health care for nearly all Medicaid beneficiaries. The MCOs are Healthy Blue (HB), Sunflower State Health Plan (Sunflower), and United Healthcare Community Plan of Kansas (UHC). As of April 2025, the average MCO enrollment for the 2025 calendar year was 429,638 beneficiaries per month. In April 2024, there were 443,151 beneficiaries.

Each Medicaid consumer in the state is enrolled in one of the KanCare health plans, and as of April 2025, UHC had 37 percent of the enrollment, or 160,363 beneficiaries; Sunflower 36 percent, or 156,864 beneficiaries; and HB 26 percent, or 112,411 beneficiaries. Consumers have the option during open enrollment once a year to change to a different KanCare health plan if they wish to do so.

As of April 2025, there were 61,100 beneficiaries in CHIP, 10,386 age 0–4; 50,001 ages 5–18, and 413 age 19 and older.

CHIP Premiums KanCare Update, April 2025

Family Poverty Level for Household Size Under age 1 Ages 1-5 Ages 6-18 <100% FPL Medicaid, No Premium Medicaid, No Premium Medicaid, No Premium <133% FPL Medicaid, No Premium Medicaid, No Premium CHIP, No Premium <150% FPL Medicaid, No Premium CHIP, No Premium CHIP, No Premium 151-166% FPL CHIP, No Premium CHIP, No Premium CHIP, No Premium 167-191% FPL CHIP, $20 Premium per Family CHIP, $20 Premium per Family CHIP, $20 Premium per Family 192-218% FPL CHIP, $30 Premium per Family CHIP, $30 Premium per Family CHIP, $30 Premium per Family 219-255% FPL CHIP, $50 Premium per Family CHIP, $50 Premium per Family CHIP, $50 Premium per Family

Data from KDHE KanCare Update April 2025 slide 16

Eligibility for Health Coverage Programs

General Rules

These general rules apply to all medical programs.

Kansas Residency . Participants must live in Kansas.

Citizenship and Immigrant Status . Participants must be a U.S. citizen or immigrant with a certain status. Some immigrants must wait five years before they can get coverage.

Household . All persons living in a home are required to be included in the application process for a household. The eligibility worker will decide who must be included in a household for a person’s medical assistance plan. It should be noted that different household members may be in different medical programs based upon the household members’ qualifications.

Other Health Insurance . If a participant has other health insurance, it is a primary coverage and should be billed before KanCare.

Coverage Date . Medical assistance usually starts with the month of application. However, sometimes a participant can receive coverage for the three months before the month the participant applied if it is requested.

Reviews . Currently, medical assistance applications are reviewed each year. Participants are required to keep KDHE advised of changes in address and coverage could end if KDHE does not have a current address for the participant.

Income Rules

The Affordable Care Act established a new methodology for determining income eligibility for Medicaid, which is based on Modified Adjusted Gross Income (MAGI).

MAGI is the basis for determining Medicaid income eligibility for most children, pregnant women, parents, and adults. The MAGI-based methodology considers taxable income and tax filing relationships to determine financial eligibility for Medicaid. MAGI replaced the former process for calculating Medicaid eligibility, which was based on the methodologies of the Aid to Families with Dependent Children program that ended in 1996. The MAGI-based methodology does not allow for income disregards that vary by state or by eligibility group and does not allow for an asset or resource test.

Some individuals are exempt from the MAGI-based income counting rules, including those whose eligibility is based on blindness, disability, or age (65 and older).

Federal Poverty Level (FPL) Dollars Per Year

Family size 2024 income numbers 2025 income numbers For individuals $15,060 $15,650 For a family of 2 $20,440 $21,150 For a family of 3 $25,820 $26,650 For a family of 4 $31,200 $32,150 For a family of 5 $36,580 $37,650 For a family of 6 $41,960 $43,150 For a family of 7 $47,340 $48,650 For a family of 8 $52,720 $54,150 For a family of 9+ Add $5,380 for each extra person Add $5,500 for each extra person

Kansas Income Rules . KDHE states each medical program has different income rules. A household’s income must be less than the maximum income level for the program that the participant applies. Both earned income and unearned income may be counted to determine eligibility. Earned income is the money the applicant or other members in the household receive from paid employment. Unearned income is the money the applicant or other members of the household receive from Social Security, child support, unemployment, U.S. Department of Veterans Affairs, pensions, and other income sources. The approval process will use gross income and subtract deductions, such as qualifying pre-tax, federal deductions, to calculate the household income for the application.

Resources and Assets . Examples of resources are bank accounts, cars, property, and stocks that are owned by a person or someone in the household. Most plans for the elderly and persons with disabilities have a limit on the amount of resources a person may have. Plans for families and children do not have a limit.

By Elizabeth Cohn and Amanda Prosser . See Health and Social Services for more.