2610 General Program Information

Both Medicaid and MediKan benefits are provided to help cover the cost of health care for an individual. Medicaid is a federally regulated and state administered program which is jointly funded by the federal and state government. It covers the majority of the state's medical recipients including children, pregnant women, and the aged and disabled. MediKan is a totally state regulated and funded program and covers disabled individuals who do not qualify for Medicaid. Separate state-funded programs are also operated for TB eligibles and residents of an IMD (see section 8112.4 ) between 21 and 64 years old. Eligibility policy for the AIDS Drug Assistance Program is the responsibility of Kansas Department of Health and Environment – Division of Health Care Finance (KDHE-DHCF).

Both the Medicaid and MediKan programs provide payments for comprehensive medical care and services furnished either through managed care entities or by enrolled providers. Payments are limited based on the scope of their practice, as defined by state law, and within the scope of services covered through the specific program. Specific services for which payment can be made and the proper payment rate (including capitation rates for managed care) are established by the Kansas Department of Health and Environment – Division of Health Care Finance (KDHE-DHCF) and are reviewed and adjusted periodically. Information on covered services can normally be obtained from the provider. Each provider is given a policy and procedure manual providing instructions related to coverage and processing claims; additional information can be obtained by the provider from the fiscal agent or KDHE-DHCF. Establishing eligibility/ineligibility of applicants/recipients based on the policies established within the limitations set forth by the Code of Federal Regulations and the Kansas Administrative Regulations is the responsibility of the KanCare Clearinghouse. Licensed or certified medical practitioners determine the necessity of specified medical services, subject to review and approval by KDHE-DHCF. Payments (either capitated payments or direct service payments) are made directly to the provider (vendor) of medical services rendered to individuals certified as eligible. A contracted fiscal agent is used to process medical claims.

Both medical programs are funded by the Kansas State Legislature through KDHE-DHCF, Title XIX of the Social Security Act authorizes federal financial participation (FFP) in medical payments for Medicaid covered individuals as well as specifies basic eligibility and service requirements. ethodologies of the SSI program affect the Medicaid eligibility in the aged and disabled categories. Financial eligibility rules are the same as those used in Medicaid program for non-disabled children. The MediKan program is authorized through state legislation as well as the Kansas Administrative Regulations.